reforms in the bill. dennis cortise said the reid bill took baby steps toward revamping the fee for service. the dean of the harvard medical school said the bills being considered in congress would accelerate national health care spending.i wish there were morel reforms in the bill. i applaud some of the efforts that senator baucus included in rewarding providers who provide higher quality. i believe those are the type of things that we should do to improve the medicare program. the savings from the actual reforms are a few pennys compared to the arbitrary payment cuts included in in bill. according to the congressional budget office, all of the savings from the various policies to link medicare payments to quality and encourage better coordination of care in the reid bill provide less than $20 billion in total

savings. in contrast the reid bill includes $220 billion in arbitrary payment cuts to health care providers including hospitals, nursing homes, home health agencies an hospice providers -- and hospice providers. we made a point of making it known how much those are and it is going to take away services people expect. the reid bill includes an additional $120 billion in cuts to medicare advantage plans. medicare advantage is -- we talk about wanting to provide catastrophic care for everybody. that was one of the goals. well, medicare people do not have catastrophic care. they can buy catastrophic care through medicare advantage. but we're talking about making some substantial cuts to that that are either going to decrease benefits or in some cases make the whole service go away. those are not reforms. they represent the best efforts of folks in washington to guess how much it toolly costs real doctors and nurses to provide

health care services to medicare beneficiaries. we are not experts in the health care field. but we are going to guess at how much extra revenue they're getting. and i want to emphasis the word revenue. as and a accountant there is a difference between profit an revenue. we're going to cut substantially into the revenues which is going to eliminate profits which is the point at which people say: why am i doing this? why am i doing this? so doctors and nurses are going to -- people that are looking at being doctors and nurses are going to say, why would i want to do that? well, there's going to be a huge demand because the baby boomers are coming up and they're going to need services. so cuts like the ones to doctors and nurses an home health and all of -- and home health are an excellent example of how government price controls don't work. medicare does not negotiate payment rates with providers like private insurers do. medicare uses price controls to

set payment rates. now, when i first went into the shoe business, nixon suggested that we should have price controls. that the cost of goods was going out of sight. and at that time you could -- you could buy a man's dress shoe for $10. and they put in price controls. but, like this, they couldn't put the price controls in immediately because it takes a while to pass the bill. what did everybody that was manufacturing shoes do? they raised our prices, which forced us at the retail end to have to raise our prices too. by the time that went into effect, that $10 shoe was $20. so price controls don't work. i've experienced it. and it was dramatic and it was terrible for the customer. and we're talking about customers here again. medicare uses price controls to set payment rates. experts in washington then look at various reported costs, revenues, and profits of health care providers and then decide how much we should pay health care providers.

i often said that everyone thinks that they know everything about a business until they actually have to run it. unfortunately, we've been taking over a lot of business here and our expertise is showing. i'm kind of fascinated by the cash for clunkers. that was a little business that we decided to setup on behalf of the government. we said that it would last for four months and it went broke in four days. any of the numbers that anybody around here is considering, ought to take a look at. because as a former small business owner, i want to assure them that it's a lot harder to run a business than it looks. the simplest business out there, if you scratch the surface a little bit, you'll find out those people are making dramatic decisions on a daily basis just to keep in business. which means, hopefully paying themselves, but also paying their employees, because that's not an option. if it was as easy as we think it is around here to do a business,

everybody would be going into business. now the medicare cuts in this bill are based on the efforts of folks in washington to decide how much it costs to run a nursing home in cheyenne or a home health agency in gillette or any of these businesses in much smaller communities than that. based on the past track record of washington, i don't have much confidence in their abilities and i don't think america does. i think that's showing up in the polls. i think that's showing up in the town meetings. in 1997 congress passed the balanced budget act. it contained medicare payment cuts. lots of really smart folks in washington made arguments similar to those we're hearing today about how those cuts would not harm the providers or beneficiaries. that was historic. well, let me show you the historic arrogance of that time. what happened after these cuts went into effect. after two years these cuts have driven four of the largest

nursing homes in the nation into bankruptcy, sun corps, mariner, filed for bankruptcy. between them they operated 1,400 nursing homes that provided care for hundreds of thousands of medicare beneficiaries. similarly the bill also included cuts in payments to medicare and choice plans much after these cuts went into effect one out of four plans pulled out of the program. millions of beneficiaries lost the benefits these plans had provided. the presiding officer: the senator's time has expired. 6. mr. enziexpired. -- the presiding officermr. enzi: y statement be made a part of the record. the presiding officer: the senator from montana. mr. baucus: i ask until 1:15 m be under the provisions ordered.

the presiding officer: without objection. mr. baucus: i yield 25 minutes to the senator from north dakota. mr. conrad: i thank the -- the presiding officer: the senator from north dakota. mr. conrad: i thank the distinguished chair and i thank the presiding officer. madam president, i've come to the floor to respond to some of the things that i've heard over the last several days with respect to the legislation before us. and to try to give in some cases the other side of the story. because i'm increasingly concerned, as i listen to this debate, that people have started to create their own facts that's never useful in a debate. and let me start with an ad that's running -- full-page ad back in my home state of north dakota with the headline, "isn't senator conrad suppose to be a deficit hawk?" and it starts by saying some nice things about me. it says that senator conrad as a

long admiral record as a deficit hawk. for years he advocated for fiscal sanity and smaller deficits and he served north dakota well. you know, i wish they would have just ended the ad there. that would have been a very good ad. but they go on to say that now federal spending is totally out of control, and they give some examples. and they say on top of all of this, congress is considering a new $900 billion health care entitlement, with some estimates saying that it could cost more an $2 trillion. well, the $2 trillion number is a number that somebody concocted. that is not the 10-year cost of this bill. the 10-year cost of this bill is between $800 billion and $900 billion, as the ad says. then they conclude, america can't afford it, north dakota can't afford it. this ad is not paid for by north dakotaians. but they are clear that north dakota can't afford it. "senator conrad, how can you

even consider this? how can you even consider this?" well because i read the bill. this bill does not increase the deficit. this bill reduces the deficit. and that's just not my opinion, as chairman of the budget committee. that is what the congressional budget office, which is nonpartisan, which is the objective score keeper, they're the ones we look to for analysis of legislation before congress. objective analysis. not madeup analysis. and here's their conclusion. this is the congressional budget office estimate of the senate health plan. the legislation that is before us now. it reduces the deficit over the budget period by $130 billion. it doesn't increase the deficit. despite all the speeches that have been given here. it reduces the deficit b by $130 billion.

now, our colleagues get different numbers because they come out here and say, well, if this part of the bill weren't included, it would increase the deficit. but that's not the bill. the bill before us has been analyzed by the congressional budget office and they say the bill before us -- the one we'll be voting on -- reduces the deficit by $130 billion. in the first budget window. in the second budget window, the second 10 years, the congressional budget office says this and i quote -- "bob expects that the bill, if enacted, would reduce federal budget deficits over the ensuing decade, beyond 2019, relative to those projected under current law with a total effect during that decade that is in the broad range of one-quarter of 1% of gross domestic product." what is one-quarter of 1% of

gross domestic product in the second decade? it is $650 billion. now, if you take then in total what the congressional budget office is telling us to 2019, the first 10 years, it reduces the deficit by $130 billion. in the second 10 years, it reduces the deficit by one-quarter of 1% of g.d.p., which is equal to $650 billion. so to my friends who ran the ad in every newspaper in the state wondering why a deficit hawk might support in legislation, it is because this legislation reduces the deficit both in the first 10 years and the second 10 years according to the congressional budget office. madam president, that record should be clear.

now, do we have a problem long term? absolutely we do. because as this chart shows medicare and medicaid combined are going from 2% of g.d.p. back in 1980, to 12.7% of g.d.p. on the current trend line by 2050. and that is an unsustainable course. i think we all understand that. medicare and medicaid are increasing very dramatically as a share of our gross domestic product. and they are a key reason we are seeing the gross federal deficit ex banexpand and expand dramatih we expect the gross medical debt to be -- that is almost as high as it was after world war ii which is the previous record in this country. already we're approaching 100% of g.d.p. with the economic

downturn and with all of the pressures that exist with two wars and a very sharp reduction in revenue in this country. the reality is for those who say we don't have to do anything, medicare is going broke. it is already cash negative. that is, more money is going out for medicare than is coming in under the revenue sources of medicare. and the trustees tell us it will be insolvent by 2017. two years earlier than forecast just last year. so those who say you don't have to do anything, just steady as she goes, status quo is fine, are detatched from any financial reality. but the bill before us has significant medicare savings. provisions that lower cost

growth without harming beneficiaries. let me just give some examples. in the legislation before us we reduced overpayments to private medicare advantage plans. we reform the health care delivery system. and, by the way, this is the provision that most experts say is the single most important component of this legislation and it's gotten almost no attention in this debate. got almost no attention from the media. reforming the delivery system so instead of paying for procedures, we pay for quality outcomes. and we incentivize those integrated systems, like the mayo clinic, cliec th like the t have much lower costs an highest quality outcomes. we're going to provide major incentives for other systems to adopt their good practices.

this is what health reformers say are really the most important parts of the legislation. we also improve payment accuracy, crack down on fraud and waste, which we all know is significant in medicare. perhaps as much as $70 billion a year. and we are going to beef up very substantially the moves to go after those who are committing fraud -- fraud in this system. it also slows the growth in reimbursements to providers, many of whom will benefit from ove30 million newly ensured peo. how is this bill paid for? one of the biggest ways of paying for it is to go to the providers and say, your future increases will not be as large as previously indicated. you're not going to have growth as much as you had previously

thought in your level of reimbursement. and these groups have by and large agreed to that prospect. why? because, number one, they know there are savings to be accrued. number two, they know, with 30 million more people being covered, that they will have a big increase in business, and they will have a sharp reduction in uncompensated care. so that's why the hospitals have agreed to more than $150 billion in savings, and that's why nursing homes and home health care have agreed to significant savings, and why the pharmaceutical industry has as well. let me say, before we're done, i believe that the nursing homes -- what is in the bill will be further modified, so it's not as much a reduction in their increases as was anticipated.

because, you know, if you look across who's put up how much, there's rough agreement from these providers to take these reductions in their increases. they're not cuts in the sense of getting less the next year than they got the year b it's getting less of an increase. interestingly enough, an argument made by republicans when they were advocating reductions and savings out of medicare, far higher, far bigger than anything that's in this bill. this is an amusing point, for those who have listening to this debate. our republican colleagues decrying savings out of medicare which just a year ago they themselves were advocating. they had their president come forward with a proposal with much bigger savings than are in this bill. we'll get to that in a minute. now, here's what some of my colleagues have been saying on

deficit and debt, because the rhetoric coming from our colleagues on the other side has been interesting, and the difference between their rhetoric and their amendments really striking. had but here's what they have said -- but here's what they have said. this is senator mcconnell, the republican leader. "we are heading down a dangerous road. it is long past time for the administration and its allies in congress to face the hard choices that americans have had to face over the past several months. no more spending money we don't have on things we don't need. no more debt." that is leader mcconnell. senator kyl, again a member of the republican leader. " ... we've got to reduce deficit spending to manageable levels and ultimately learn to live within our means, and the sooner the better." and senator mccain, who offered the first republican amendment, "this staggering deficit threatens our children's and grandchildren's future and

simply cannot be sustained ... i call on my colleagues on both sides of the aisle to chart a different course towards real change and fiscal responsibility." well, that's what they have said in their speeches. what have they done with their amendments with respect to debt? well, this is curious. every major amendment they've offered was to increase the debt, to increase deficits. after all the brave speeches about how important it was to be fiscally responsible, what amendments have they offered? well, senator mccain offered the first one to eliminate the medicare savings. that would increase the deficit and increase the debt by $441 billion. so much for the brave speeches.

the hatch amendment was to continue overpayments to medicare advantage plans, increasing the deficit and debt by $120 billion. so much for the brave speeches. and the johanns amendment, to eliminate the home health care savings, would increase the deficit and debt by $42 billion. so, so far our republican colleagues, who have given such strong speeches about the need to reduce deficits and debt, every single major amendment that they have offered have been to increase deficits and debt. and so far the running total is $600 billion that our colleagues on the other side would increase the deficit and debt by if their amendments had been adopted. now, the good thing is there are other people watching, other

people who are listening to the speeches and comparing the speeches to the amendments and comparing the speeches to the policy prescriptions of our colleagues on the other side. here's what the association of retired persons said november 20. "opponents of health care reform won't rest. they're using myths and misinformation to distort the truth and wrongly suggesting that medicare won't be harmed. after a lifetime of hard work, don't seniors deserve better?" and on november 18, the association -- the aamerican association of retired persons said this: "the new senate bill" -- tock talking about the bill before us -- "takes improvements to the medicare program by creating a new annual wellness benefit, providing free preventive benefits, and most notably for aarp members, reducing drug costs for seniors who fall into the dreaded medicare doughnut

hole, a costly gap in prescription drug coverage." the federation of american hospitals on november 20 said, "hospitals always will stand by senior citizens." the american medical association said on that same day, "we're working to put the scare tactics to bed once and for all and inform patients about the benefits of health care reform." and on november 16, the catholic health association of the united states said, "the possibility that hospitals might pull out of medicare is very, very unfounded. catholic hospitals would never give up on medicare patients." and again from the national committee to preserve social security and medicare on november 19, "we are ... very well-aware of the positive impact health care reform can have on the future of the medicare program and its beneficiaries."

now, madam president, one of the things that is most striking to me in listening to our friends on the other side is the they're trying to stair people into thinking that the savings -- to scare people into thinking that the savings in medicare are going to disadvantage medicare beneficiaries. and what's really most remarkable is the last time our friends on the other side offered a budget -- it was offered in the bush administration -- their savings out of medicare in that budget was $481 billion over ten years. far larger than the savings in this bill. and, interestingly enough, i never heard a single republican colleague say one peep about those savings out of medicare. there was no suggestion that it threatened grandma. there was no suggestion that

this was going to ruin medicare. there was no suggestion that these savings out of medicare were going to undermine medicare beneficiaries. and that was their budget. that was their president's budget, to save $481 billion out of medicare. let's compare it to the savings in medicare in this bill. the bush administration, the last budget they offered, had $481 billion in ten-year savings out of medicare. the net reduction in this bill is $380 billion. i would just ask my colleagues on the side opposite, what is a bigger number, $481 billion bigger or is $380 billion bigger? because they didn't say one word in opposition to medicare savings from the previous administration, their administration, when it was $481 billion. but know tha now that this admin

has savings of $380 on a net basis, all of a sudden the sky is falling and it is the end of the world. i'd say the see abovencc meter is on tilt when i listen to these speeches from the side opposite. and medicare advantage plans -- i have heard so many speeches here about medicare advantage. medicare advantage was originally put in place to save money for medicare. in fact, it was capped at 97% of traditional fee-for-service medicare. what's happened? is it saving money? no. on average, it's costing 114% of traditional fee-for-service medicare. in fact, there are plans in medicare advantage that are costincosting 150% of traditionl fee-for-service medicare. we have a runaway train.

we have a program in medicare advantage -- at least some elements of it, to be fair, because some of them are working fine -- some elements of it are a runaway deficit train, costing 150% of traditional fee-for-service medicare. this is the hard reality is medicare advantage is contributing to medicare's fiscal problem. this is the medpac report from march of 2009. "in 2009, payments to [medicare advantage] plans continue to exceed what medicare would spend for similar beneficiaries in traditional [fee-for-service]. medicare payments per enrollee are projected to be 114% of comparable fee-for-service spending for 2009 ... this added cost contributes to the worsening long-range financial sustainability of the medicare program."

in plain english, it's contributing to medicare heading for insolvency, and this bill does something about it. it moves medicare advantage to a more sound and sustainable course. by the, interestingly enough, -- by the way, interestingly enough, estimates by the congressional budget office, are that there will be more people in medicare advantage after this bill passes, after this bill passes. there will still be more people in medicare advantage than have been in the past. so medicare advantage will go forward, but the abuses will be run out of the system. the overpayments will be reduced, and that will help extend the solvency of medicare. question: does this bill that is before us extend the solvency of medicare or does it reduce the years of

solvency of medicare? what is the right answer? the correct answer is that this legislation extends the solvency of medicare by at least four years and perhaps five. we know -- the house bill has been scored -- it extends medicare solvency, according to c.b.o., by five years. the bill that came out of the finance committee extended the solvency of medicare by at least four years. and most estimates are that the bill before us does somewhat better. back on the question of medicare advantage, taxpayers pay 50% more for beneficiaries enrolled in medicare advantage plans in some areas. i asked c.b.o. last year, is medicare advantage saving money, which was its original

intention? they came back and said, not only is it not saving money, it is, on average, costing 14% more, or 114% of traditional fee-for-service medicare, and in some places, the medicare advantage pricing benchmarks currently range from 1% to over 150% of local per capita spending in the fee-for-service traditional medicare sector. madam president, facts are stubborn things. the fact is, this bill reduces the deficit by $130 billion over the first ten years, by as much as $650 billion over the second ten years. those are facts according to c.b.o., not facts made up by colleagues here on the floor for one purpose or another. madam president, this bill extends the solvency of medicare by at least four years and

perhaps as long as five years. that is not all that needs to be done, but it's a beginning. and those who want to oppose it and vote against it will have to explain why they don't want to extend the solvency of medicare, why they don't want to achieve savings, why they don't want to go after the fraud and abuse that exists in the system. madam president, let me just say with respect to the gregg amendment, i've got enormous respect for senator gregg. but his amendment is designed to kill this bill. let's just be clear. that's the purpose of this amendment. if you want to kill this bill, if you want to kill a bill that reduces the deficit, if you want to kill a bill that will reduce premiums for a significant majority of the bill, if you want to kill a bill, then you ought to vote for the gregg

amendment. if you want this bill to advance that delivers on the promises made to the american people about what must be done to solve medicare, to not solve it but to extend its solvency, if you want to have legislation that begins the critically important process of reform, then reject the gregg amendment. i thank the chair and yield the floor. mr. enzi: madam president? the presiding officer: the senator from wyoming. mr. enzi: i want wasn't going to take any part of this 30 minutes, but i can't help it. i would allocate myself 5 minutes. i keep running into this comment that the republicans were willing to cut $481 billion from medicare. would somebody show me where we cut $481 billion from medicare? we didn't do it, and this bill won't cut $464 billion. seniors are not going to let you do that.

we didn't even propose it. the president proposed that. and we knew that it was not going to happen. you can't cut medicare without having the seniors all upset because they understand that their program is going broke. going broke. and that's why we've had this series of amendments, and we've tried to come up with one that would actually solve the problem. we've been emphasizing the problem. the gregg amendment takes care of the problem. and that's why we brought up the gregg amendment, and that's why we should pass the gregg amendment rather than relying on cuts that could devastate the medicare program, we can find a stable and reliable funding source that we could use to pay for health care reform. the gregg amendment says that savings from any medicare cuts should be reserved for the medicare program. that's saying that if these things are all possible that we're talking about as being possible as being cost savers. if they really work, put it into

medicare. if you really want to extend medicare, don't just say you're going to extend medicare and overlook a few things. i've got this little chart that i haven't had a chance to use yet. it was just reiterated again here that this bill is deficit-neutral. yes, according to c.b.o., this bill is deficit-neutral. if you assume -- if you assume -- that medicare physicians payments will be cut 20% in 2011 and that they'll be cut 40% over the next ten years. we hold the physicians hostage every year, one year at a time, to get something out of them. and then we keep the cuts from happening. these cuts aren't going to happen, but if they did happen it would not be deficit-neutral. and the bill makes no provision for paying this 20% that's going to be cut in 2011 or the 40% over the next ten years. there's no provision in there. that part is going to be false

as having a deficit-neutral bill. a massive new tax will be imposed on employers health benefits hitting 31% of the american family plans by 2019. if that happens -- if that does not happen -- and i think people are going to notice the tax in a whole bunch of different ways -- then this assumption is wrong and it isn't deficit-neutral. also, it relies on us cutting $464 million from the medicare -- that's their own actuary said this level of cuts would bankrupt hospitals, home health care and all the rest. i see i have a typo there. it's supposed to be $464 billion, not million. i'm still having a little bit of trouble adjust to go that. it's such a big number. that would fund the state of wyoming for 320 years. it's a big number, and we're talking about cutting it. if we don't cut this, if we don't use this to pay for the other new entitlements, this is

not deficit-neutral. and c.b.o. says that. everybody's entitled to their own opinions, but the facts are there. the facts say if -- if, if -- and we're not going to do those ifs. i won't dwell on that point even though i'm a little upsefplt and i would -- a senator: would the senator yield for just a quick question. the presiding officer: the senator from new hampshire. mr. gregg: the senator from idaho wants to speak. if i could ask the ranking member of the "help" committee a quick question? i heard the senator from montana, the senator from north dakota say that the amendment that i have pending would make it impossible for them, under this bill, to create a new entitlement programs because the medicare money which is going to be caken from medicare and used to create these new entitlement programs would not be available. my amendment says they can't do that. it says medicare cannot be used

to create new entitlements which benefit seniors. it doesn't say those entitlement programs can't be created if they want to pay for them some other way. what they're saying is they don't have the idea, the courage, or the will to pay for them other than by stealing from medicare. isn't that what they're saying? mr. enzi: the senator from new hampshire is absolutely correct, and i'm glad you came down to make that point on the amendment that we're going to be voting on later this afternoon, because it's critical. if you want to save medicare, this amendment will save medicare. and otherwise -- it does not prohibit the other programs from happening. they can do the other entitlements, they just have to make sure they're paid for because that's one of the promises they made. to say they're going to take the $464 billion from medicare and put it into these other entitlements, that's not fair. mr. gregg: i thank the courtesy of the senator from idaho. mr. enzi: the chair yields ten minutes to the senator from

idaho. the presiding officer: the senator from idaho. mr. crapo: thank you very much, madam president. i'm here today to talk in support of the gregg amendment. i rise in support of my colleague from new hampshire's amendment because it would prohibit using medicare cuts in the democratic health care bill to pay for new government spending. it's interesting as you listen to the debate -- in fact, i was interested to hear my colleague from minnesota say the republican amendments would increase the deficit. they would only increase the deficit if you assume all the spending in the bill that is also opposed by the republicans. one of the key parts of the debate that i think needs to be emphasized here is among all the other things that this bill does, when you have the first full ten years of real implementation of the bill, it's a $2.5 trillion increase in federal spending paid for with hundreds of billions of dollars, in fact trillions of dollars of new taxes and cuts in medicare. and the purpose of -- excuse me,

let's go to this chart right here. the purpose of the gregg amendment is to require that when we do achieve savings in medicare, that instead of being used to transfer into a new government entitlement program making medicare less solvent, we instead use those savings for medicare itself. in the first ten years of the bill we'll see cuts in medicare by $465 billion, every dollar of which will simply be transferred over to a massive new federal entitlement program. if you actually take the first ten full years of the implementation of the bill and recall that there's some budget gimmicks being played here in order to say it's not generating a deficit. it's not really implemented fully until four years into the bill. if you take the first ten years of implementation, the cuts to medicare are not $465 billion but $1 trillion.

and $3 trillion over a longer period of time, as we evaluate the bill, moving out into the future. in the medicare hospital insurance trust fund, annual outlays already exceed the annual income. so the fund is drawing down on its hold togz pay for full -- holdings to pay for full benefits. but not for long. by the year 2017 the h.i. trust fund will be insolvent and no longer taoeubl pay for -- able to pay for full benefits for seniors. these cuts make it worse. it provides the major provisions in the underlying bill including the subsidies and medicaid expansion cannot go into effect unless the officer of the management and the center for medicaid services certify all the projected spending in the bill is offset with savings, but that savings shall exclude any savings to medicare or social security. in other words, we require that medicare savings be used for

medicare and social security savings be used for social security. this will ensure that the savings generated from the medicare cuts in the bill do not go toward the savings of -- creation of a brand-new entitlement program at the expense of our seniors. then the secretary of the treasury and secretary of h.h.s. are prohibited from kpwhreuplting new spending or revenue-reduction provisions in the bill. republicans have opposed the reid bill's harmful cuts to medicare through three votes. should those cuts remain, the gregg amendment makes sure that medicare savings go to making the program more solvent. congress should not raid medicare, a program that has raised -- that has $38 trillion in unfunded liabilities, and use it as a piggyback to pay for the new programs. the government already has $70 trillion in unfunded obligations over the next 75 years, and we

should not add to it with these dangerous provisions. this $70 trillion in unfunded obligation represents a burden of $600,000 per american family. the reid bill carries an estimated cost of $2.5 trillion over the first ten years that it's fully implemented. but it's fully loaded also with budget gimmicks. earlier in this debate, we voted 100-0 for the bennett amendment, a rule of construction which stated that nothing in the bill shall result in the construction of guaranteed medicare benefits. in contrast with the bennett amendment, the gregg amendment actually guarantees that there will be for future generations medicare while guarding against the creation of a new unfunded entitlement that this country can't afford. now, madam president, with the remaining time that i have, i'd like to respond a little bit to some of the arguments that my colleague from north dakota just made. we've had three votes already to

try to take these medicare cuts out of the bill. all of those votes have failed. and the senator from north dakota indicated that those votes would have reduced the deficit, would have caused a huge deficit problem. that's true if you assume that $2.5 trillion of spending in the bill will continue. but those who claim that there is a reduction in the deficit in this bill can do so only if they assume three things. one, if they assume the budget gimmicks are implemented. and by that i mean they haven't included the s.g.r. payments for physicians, a $245 billion cost over the next ten years. just not there, not in the bill, because it can't be accounted for. secondly, they delayed the cost implementation portions of the bill by four years now so that they have ten years of revenue and four years of spending, so that they can claim that it balances. and even then they cannot claim that this bill helps the deficit unless they assume the hundreds

of billions of dollars of new taxes and the hundreds of billions of dollars of cuts in medicare. if any one of those items were taken out, the medicare cuts, the tax increases or the budget gimmicks, this bill is shown to be what it is. a huge, huge, expansion of the federal government that is going to necessitate increased tax burdens and reductions in spending as well as budget gimmicks to hide what can't be hidden in order to claim that it does not generate a deficit. i think most americans understand that those kinds of gimmicks are the kinds that we see all the time in congress when we're trying to make it look like we aren't engaging in debt spending and increasing the national debt. the bottom line here is that it's, that there is a significant amount of reform that can be achieved, that can

reduce the cost of health care, that can reduce the cost of health insurance premiums, that we could agree to on a bipartisan basis. if we were not stuck in this debate on the insistence that we create a massive new intrusion of the federal government into control and operation of the health care economy and development of again another massive new federal entitlement program at the expense of some of the current entitlement programs. i haven't even talked about what's being done in medicaid yet. i'm sure that other speakers are going to talk about that. madam president, this bill, as i said, will increase spending and the size of the government by $2.5 trillion. it will cut medicare benefits over that same twofold period by $1 trillion. it will increase taxes by hundreds of billions of dollars, and over that true full ten-year period of implementation, over $1 trillion.

it will force the neediest of our uninsured in this country not into opportunity to gain insurance coverage but into another failing program, a failing federal entitlement program: medicaid. it will drive a massive unfunded mandate on to our states who are trying to figure out how they're going to deal with their fiscal problems. it will cause the cost of health insurance to go up for 30% of all americans immediately and for the 70% who are in the large groups to get their insurance from large companies, they'll basically see no significant savings and ultimately more taxes. so the bottom line is we aren't going to see an increase in the ability to control or handle the cost of health care. we are going to see an increase in government, an increase in government controls, an increase in taxes, and a reduction in the stability of our medicare programs. that's not the way we should

approach reform. the gregg amendment simply says let's create a lockbox, if you will, for medicare. the same kind of lockbox that we need for social security to keep the congress from continuing to raid social security. and let's put it into place to assure that all of these great statements that we hear on the floor about how we want to protect and preserve medicare are enforced. it simply creates by power of law -- by force of law the necessary mechanism to help all of us be sure what we're talking about here on the floor actually happens. namely, that we protect medicare from being raided for the establishment of yet, again, another massive federal entitlement program. with that, madam president, i yield back my time. mr. enzi: madam president? the presiding officer: the senator from wyoming. mr. enzi: might i inquire as to

the time arrangement? the presiding officer: the minority has 5 1/2 minutes. the majority has 7 1/2 minutes. mr. baucus: before we continue, madam president, if i might to extend the time for debate only until 2:00 p.m. with limitations of the previous order remaining in effect. the presiding officer: without objection. mr. enzi: madam president? the presiding officer: the senator from wyoming. mr. enzi: i usually don't say much at these debates. but today i'm going to make that an exception, and i'd allocate the rest of my time to me. because there have been a lot of comments made here and they need

to be clarified. i do want to pass a bill that decreases health insurance premiums. i've traveled thousands of miles across the state of wyoming, and every time i talk to somebody about health care, they ask me to do something to lower their health care costs -- to lower their health care costs. that's what most people in america want. american families can't afford to pay ever increasing health insurance premiums. small businesses can't pay for premiums that increase twice as fast as inflation. earlier this week -- actually it was last week c.b.o. released the impact that the reid bill would have on premiums. c.b.o. said that the premiums for individuals and families purchasing their health insurance will increase by 10% to 13%. that means if the reid bill is enacted, these folks will pay 10% to 13% more -- more for their health insurance. the legislation that it sponsors said it is intended to lower

health care costs when it will actually increase insurance premiums. we shouldn't be surprised by this finding. several well-known actuarial firms have issued the reports that said the same thing. the bill increases health insurance premiums. now what was surprising is that some of my democratic colleagues have argued that the c.b.o. supports health enacting reform. "the new york times" described this as good news on premiums. it defies logic and common sense. the bill attempts to restucture -- restructure the nonemployer insurance market. is anybody surprised that as a result the cost would go up. some of my dngtic colleagues have attempted to cherry pick data and use selective quotes to try to mask what c.b.o. has said. some pointed out that c.b.o. said that the reid bill would lower premiums by 7% to 10% because of changes in the rules governing the insurance market.

now, as the senate's accountant, i take offense at these kinds of reptionz. giving my democratic -- representations. giving my democratic colleagues the benefit of the doubt, i will assume they don't know the difference between gross and net. i'm not going to do a lot of numbers here. i did that in committee, and my staff, who was watching back at the office -- i got to ask all of the accountants at the head of the s.e.c. some important questions, and you could see the people behind the people testifying and they were all asleep. so i want to use this chart instead. c.b.o. did say that the premiums would go down 7% to 10% due to insurance market changes. they said that the premiums would go down another 7% to 10% because healthier people would sign up for insurance. now, what my colleagues forget to mention or don't want to mention is that c.b.o. also said that premiums would go up by 27% to 30% because the bill has so

many mandates and requires most americans to purchase more expensive coverage. yes, the federal government is going to tell you what he need for insurance and then they're going to fine you if you don't get it. maybe this chart helps to explain it. you can see the net impact. here's the 27% increase because of the mandate and requiring to purchase more, more expensive coverage. and this is the decrease that i mentioned, which is in there, but you can't just talk about this decrease and you can't just talk about this decrease. you can talk about the net and the net is a 13% increase in premiums. i urge anyone who questions what i'm saying to read the c.b.o. letter. page four of the letter states that premiums will increase 10% to 13% for americans purchasing coverage on their own. that amounts to $2,100 for families purchasing coverage on their own. that does not meet the

requirement that people in wyoming think they're going to get. the younger they are, the most surprised they're going to be. we get rid of the ratings and those young people will pay considerably more. they're already paying into medicare for seniors without getting any -- any promise that that will last until the time that they become seniors and can take effect of it. unless we pass something like the judd gregg amendment. we have to protect that medicar money to make sure it goes to medicare and only medicare if we're going to make sure that medicare stays solvent. and we've got to make that as a promise to the kids that are paying into that system now. they and their employers, and the amount the employers pay in, is money they could have in their own pocket if the employer didn't have to pay it. they're paying that so that seniors will have the medicare benefits. we want the medicare benefits but we shouldn't at this point take money from medicare, build new entitlements that we're going to expect the same young people to pay an increased amount on. while they pay an increase in

their insurance premiums. and their insurance increase is going to be a lot more than 27%. in wyoming it was estimated that it would be somewhere around $300%. i think they'll notice. i think they'll be upset. if this bill passes, there will be a revolution in this country when people realize what has been thrust on them in this bill. i yield the floor and -- and keep the balance of my time. mr. baucus: i think everybody who is interested in the subject, ought to read the c.b.o. letter. different people make different claims for the c.b.o. letter. i think it's only fair to read the entire letter and refer to the entire letter and not just

bits and pieces and parts of the c.b.o. letter. for example, it has been stated that the c.b.o. -- we're talking about the nongroup market. is that the individual market now. in fact, it's paid -- it's page six of their letter, said that average premiums would be 27% to 30% higher because of greater coverage. that's the statement we just heard. the c.b.o. letter does say that. i think it's also important to say that -- that not -- that -- those people will be getting much higher quality insurance for -- because of all of the insurance market reforms that we are -- we are providing for in this legislation. but even more important c.b.o. goes on to say on that same page in that same letter the majority of these enrollees, about 57%, receive subsidies via the new insurance exchanges and those subsidies on average would cover nearly two-thirds of the total

premium. so it is true that some persons in the so-called nongroup market in the year 2016, would find their premiums would go up without subsidies. and i think that figure nets out to about 7%, but they're getting better insurance. they're getting much better insurance than they currently have. because the insurance will be required -- people buy insurance in the exchange much we're talking about the year 2016. it will be a much better insurance than they now have. but for everybody else, according to the c.b.o. letter, a fair reading of the c.b.o. letter leads one to conclude that premiums will basically go down by a little bit, not a lot, a little bit, or be the same. for example, i heard on the floor the assertion, but no reference, no authority for this assertion, i heard this morning the assertion for employees that work for larger companies, their premiums would go up. the fact is, madam president,

the c.b.o. letter says the opposite. one can make the assertion that premiums go up. it is unfair to the american people to make rhetorical claims if they're not backed up with authority. and the c.b.o. letter is -- it's probably the best authority we have for us to work with. and that letter says flatly that premiums for those persons -- i think it's about five-sixths of americans that their premiums will go down slightly. not up, as asserted, without any authority on the floor here. i think they will go down. but my authority is the congressional budget office. that's what they say. basically 93% of premiums will either go down or be about the same. i mentioned a 3% reduction for the employees, five/sixths of persons who work for big

companies. the so-called small group market -- this is all the year of 2016 premiums will be up by 1% or down by 2%. it really depends on who gets, i guess, the credit. some will, some won't. let's not forget that small business gets a credit under this legislation too. i'm not sure whether the c.b.o. calculated that or not. the fair read something that the small group market, about 13% of americans, they'll either -- it's about -- i'm saying net minus one. because some will go up 1% and some down 2%. so basically, if you compare amples to ample -- apples to apples, what insurance will be in the year 2016, premiums will go down for -- for those in the nongroup market, down by 14% to 20% because of those with better

benefits will find that their premiums might go up by 10% to 13%. adding the tax credits, which one has to do, because that's in the legislation, on a net basis for two-thirds of those folks, their premiums will be lower by a large amount. by large i mean 56% to 59%. who knows what will happen in 2016. c.b.o.'s giving its best shot based on this legislation. that is what they say. that's what the letter says. i have the letter right in front of me. i might also say that c.b.o. says, i don't know if it's in this letter or another letter, that the bill is deficit-neutral and basically over 10 years, i think it is, or 20-year period too, the net effect is not much -- or less government. it's about the same as today. there are wild assertionings, oh, it's extra government. the c.b.o. said that the government's involvement in people's lives will be basically no more or less than today.

and that's partly because there's a lot more choice that people are going to have. they're going to have a lot more choice under the exchanges, and a lot of choice under the exchangeses. and it's -- and i think it's that greater choice that will encourage competition, that greater competition's going to encourage lower prices. at least that's the theory. most of us think the competition tends to lower prices and that's what's this legislation does. unless the senator from wyoming has -- wishes to speak, senator kerry on our side would like to speak for at least 15 minutes. and i recognize that the senator from massachusetts for 15 minutes. the presiding officer: the senator from massachusetts. mr. kerry: i might pick up on this issue of the premiums. first of all, it's astonishing to me how -- how we are continuing here to have a -- a

debate about mythology and not reality. we keep trying to bring it back to reality. friends on the other side of the aisle, for better or worse, seem to be content to continue to try to scare america's seniors and to try to frighten people about this legislation overall. i just was listening to the debate about premiums, whether premiums are going to go up or premiums are going to go down. let me just share with people who are listening, and particularly with seniors, who i hope will not be scared by the false assertions that have been made. let me tell you about the experience in the commonwealth of massachusetts where we passed landmark health care reform three years ago. and since implementing this plan in which we require -- we

require -- every single citizen in the state to buy insurance, and employers are penalized if they don't provide insurance. the fact is that today in massachusetts, the plan is working. the companies like it, and the citizens like it because they have the coverage. in fact, coverage by companies, corporations, has gone up since we put it in place. there are more companies that now participate and find that it works for them than before. but most important, madam president, 432,000 people now have gained quality affordable health care coverage where they didn't have it before. we have the lowest uninsured numbers in the united states of america, and we are proud of that. in massachusetts, 97.3% of our

citizens -- 97, more than we are attempt to go cover under the legislation we are attempting to pass here -- 97.3% of our citizens are covered and have health insurance. equally important, the newly insured have enrolled in all types of private and public coverage. there are 18% are in the state's medicaid program. 40% are in something called commonwealth care, which is administered by the commonwealth, the new subsidized plan. 33% are in employer-based coverage. and 9% are in a nongroup purchase plan. and let me just say to the senate that health reform has improved access in the commonwealth of massachusetts. there are fewer insured

individuals reporting -- who report costs as a barrier to being able to get care. in the last year, most massachusetts residents -- 88% -- had at least one visit to a doctor and 78% had a preventive care visit. a recent state survey found that 92% of individuals reported having a primary care provider in our state. as coverage has increased, the number of insured individuals going to hospitals for free care has declined, so we reduced the number of people who sort of unfairly require everybody else to pay for their coverage when they go to a hospital. the hospital covers them, and it'd paid for unevenly by the people who have coverage and by the corporations that have to make up the difference. that's gone down now. and now the free care has gone down because people have a

program, they have a plan and they can get the care afforded to them. here's what's important. i say this to my friend who's managing republicans right now. the average premiums in the individual market fell dramatically in massachusetts, falling from 8,537 dollars at the end of 2006 to $5,143 in mid2009. in other words, premiums which we've been arguing about here now, premiums in the individual market fell by 40% while the rest of the nation saw a 14% increase. which would you rather have? a program where you spread the risk more fairly, where people have coverage who don't have it today, where you lower the premiums and you provide quality care, or continue the status quo where you get thrown off your insurance by a company that just

wants to take the profit and doesn't care about the fact that you got sick and cuts you off after you paid your premiums and then they find little catchphrase in the clauses of the contract and they tell you, sorry, you're not covered when you're sick. or you can't even get covered because you have a preexisting condition and you walk in and you try to get the coverage. madam president, i think the case is so clear here it's almost unbelievable to me that we're here arguing about this at this point. but even more ridiculous is the following. the very same people who are coming to the floor right now and telling us don't slow the growth of medicare, which is all that we're doing -- we're not cutting any benefits. i hope every senior in america hears this. it's time to end these scare tactics. there is no cut in benefits. every benefit currently under the law will continue to be given to the seniors of this country, and that's an

obligation we have. but listen to what the people who are coming to tell you that there are cuts in your benefits used to say. i say used to say when they had a republican president and they were running the senate. the fact is that in the june 2009 report on long-term budget outlook, we know point black that if we don't cut -- point-blank that if we don't cut, if we don't do something to reduce the rate of growth in medicare, we're going to be by 2080, the federal government is going to spend almost as much as a share of the economy on just its two major health programs as it spent on all of its programs in every branch of government in recent years. the medicare provisions in this bill take the necessary steps to try to reform the delivery system through value-based purchasing initiatives, through

bundled payments -- a bundled payment is when you give a hospital or a delivery provider a sort of global budget, if you will. you give them a big amount of money and you say "this is what we're giving you, and you have to manage with that amount of money," instead of paying them for every single time that somebody comes in to do something. and when you give them that global budget, that so-called bundled budget, it encourages the executives to do what they haven't done today, which is find the ways to deliver the same quality of care but to deliver it more effectively and more efficiently. we provide the creation of an innovation center to test new payments, to have comparativeness effectiveness research. doesn't that make sense? we want to know if what they're doing in wyoming or what they're doing in colorado or some other part of the country makes as much sense as what they're doing in kentucky or in massachusetts or west virginia or somewhere.

and by looking at the comparative effectiveness, we all will learn and become more effective and efficient at delivering services. and we create, thanks to the presiding officer, the distinguished senator from west virginia, we create an independent medicare advisory board which will have a profound impact on forcing the united states congress to make decisions that we have avoided for far too long. now, what have our colleagues who are here today saying don't do this, don't be smart about medicare -- that's effectively what they're saying because that's what we're doing. we're trying to be smart about medicare. we're not cutting any benefits. but they're coming here and telling you you are cutting benefits, even though in june of 1995 -- june 28, senator grassley from iowa came to the floor and said we propose slower growth of medicare. medicare would otherwise be

bankrupt. on june 29, senator jon kyl said we do heed the warning of the medicare board of trustees and limit growth to more sustainable levels to prevent medicare from going bankrupt in 2002. now medicare, we think, is not going to go bankrupt until 2017. and thanks to what's in this bill, we actually extend the life of medicare another four definitely and hopefully five years. but here's what senator kyl said: that preventing medicare from going bankrupt, that's what's necessary to ensure that seniors do not lose their benefits altogether as a result of bankruptcy in seven years. in 1995, senator hatch said -- quote -- "it is important to start the structural reforms which are necessary to make medicare solvent in the long time." that's exactly what we're doing here. that is precisely what we're doing here. and we should have the support

of senator kyl and senator grassley and senator hatch. on october 17 in 1995, senator kyl said -- quote -- "we also know that it is necessary to prevent the medicare program from going broke. the republican budget will slow the growth in medicare because the medicare trustees have warned us that without doing so, the system will go pwroefpblgt i think that it is -- will go broke. i think that it is totally irresponsible for any organization in america to be scaring america's senior citizens. i am quoting senator jon kyl. irresponsible for any organization to be scaring american seniors, and here is the republican party scaring america's seniors. now, mr. president, i want to talk about what this legislation does and doesn't do, because every claim that is being made is simply without foundation. this amendment is basically an

amendment designed to try to gut this bill. and what it does is try to condition any kind of spending that we might spend additionally or any tax reduction in the bill. it conditions it on a certification that they are offset, which we always love to do and we do, but they want to offset it without counting changes in medicare or social security. that's a gimmick. it's a game. it's calculated to prevent us from taking the positive changes we make and using those positive changes in an effective way to do even more that is positive. now let me be very specific about, you know, some of the more that is positive. but i want to first -- let's go through each of the claims made by the other side. first of all, they claim that the medicare payroll taxes are used in this bill to pay for

nonmedicare benefits. they say that we -- that this bill raises the medicare payroll tax so that we pay the non-medicare benefits. well, just not true. it is true that the payroll tax goes up for an individual with an income over $200,000 and for a married couple with income over $250,000. but let's set the record straight. by law -- oh, by law, and nothing in this bill changes that law -- all medicare payroll taxes are used to improve the solvency of the medicare program. this bill does not change that practice, not withstanding anything they try to say. and it certainly doesn't divert medicare payroll taxes to another program. even the c.m.s. actuary has

certified that because of the medicare provisions contained in this bill, the solvency of the medicare part-a hospital insurance trust fund will be improved by five years. so, that -- what they're saying with respect to that is simply not true. they also claim that medicare cuts are used to pay for coverage expansion. this statement actually ignores the benefits that seniors receive from this bill. and i think it also is important to remind people how the medicare financing system works. i just talked about the medicare solvency in the part-a program. the part-a program is paid through payroll tax. the part-b program and the prescription drug program is paid through a combination of

general revenue contributions and enrollee premiums. and they pay, i think, about 25% of the total program cost is paid through the premium, and 75% is paid by the general revenues. part-d financing works exactly the same way. this bill reduces medicare spending by a total of $463 billion. doesn't reduce the benefits, but it reduces those -- the spending over the next ten years. and you know what that does, mr. president? that lowers the out-of-pocket premiums that beneficiaries pay for medicare physicians services and prescription drug coverages. so in effect we -- and this has already been certified by c.b.o. we lower the premiums for seniors. that's the benefit. the opponents claim that the medicare cuts to providers are going to result in decreased

access. well, it's interesting that the very same people who brought us the so-called death panels that never existed are really at it again with respect to access. they want to scare you. they want to say you're not going to get access to a doctor or access to your medical care. and they claim that medicare beneficiaries are going to be harmed by the bill. yet, even as they say that, aren't the people who represent 40 million retired americans say no, no, no, that's not true, our people are protected, the american medical association says no, no, no, that's not true. the folks we want to care about are protected. this bill fully protects guaranteed medicare benefits for seniors. it will keep medicare from going broke in seven years. it extends the life of the medicare trust fund. it reduces prescription drug costs for seniors. it ensures that seniors can keep their own doctors next year by

blocking a 21% pay cut for physicians. it creates new prevention and wellness benefits in medicare. it keeps seniors in their own home and not in nursing homes. the presiding officer: the senator's time has expired. mr. kerry: max, can i get any more time? mr. baucus: i yield an additional five minutes to the senator from massachusetts. the presiding officer: the senator may proceed. mr. kerry: mr. president, i thank the distinguished leader, and i thank the chair. so the opponents of health care reform are simply not telling you that the program is about to be insolvent because private insurance companies and some of the providers are, in fact, using the money to basically get rich off the medicare dollar. we ought to be clear about the impact of these policies. even with the medicare changes that we have made, i hope medicare beneficiaries hear this, even with the medicare

changes in the bill, overall provider payments are still going to go up. they're not cut. they're going up. we're simply slowing the rate of growth. and -- and that is something that everybody on the other side has said that they want to do. wall street analysts have suggested that many providers, including hospitals, are going to be net winners. that's a quote, net winners. under our bill, they estimate hospital profitability will increase with reform because more and more hospital patients will have private insurance that they don't have today, and the hospitals today are out of pocket because they take care of these people but they don't have the insurance. so just as in massachusetts where the premiums went down and where the expenses for free care went down, that's precisely what the impact will be here. so we have a choice here, mr. president. you know, we can do nothing,

which is basically what our colleagues have proposed. you know, status quo means medicare is going to be broke in approximately eight years. it means that seniors are going to pay higher and higher premiums and cost sharing due to wasteful overpayments to providers. it means that each year billions of medicare dollars are going to continue to be wasted, lining the pockets of the private insurance companies who kick people off indiscriminately or tell them they don't have the coverage when they finally get sick and need the coverage, and the status quo means that seniors are going to continue to pay for their prescription drugs. the fact is that this is the time for responsible action. this bill strengthens the medicare program. it reduces premium costs for seniors. it restores medicare's financial integrity. it provides -- it fortifies medicare and it protects medicare benefits for america's seniors. now, let me point to another thing they keep saying.

they keep saying that this bill cuts billions of dollars from medicare -- from the medicare advantage program, hurting the 11 million seniors who are enrolled in those programs today. well, mr. president, i know -- that's exactly what they've said. this bill cuts medicare advantage and hurts those millions of seniors. wrong, not true, scare tactic. same old procedure of trying to distort and provide fear. nothing could be further from the truth. this bill cuts down on over payments, not benefits. what taxpayer in america should knowingly be paying an additional amount for a service more than the service is worth and more than we pay in the regular program? a senator: would the senator yield for a question? mr. kerry: i want to finish the thought. if i can yield on your time at the end, i would be happy to do that. overpayments, it's the overpayments to insurers that

actually threaten medicare's future, and that's what increases the costs for seniors. in 2009, medpac, the independent commission that advises us on the issues affecting medicare, estimates that medicare is going to pay approximately $12 billion more for beneficiaries enrolled in private medicare advantage plans than if they were in the traditional medicare. these are overpayments, according to medpac, and according to folks in the medical profession, and they exist because private insurance under the medicare advantage are overpaid by about 14% on average. now, i might add coincidentally in 2008 when the senator from arizona was the nominee for president, one of his top aides, mr. -- douglas hotels hotels -- douglas holtz-eakin said -- i think it was an article in "usa today" -- "medicare advantage plans should compete on a level

playing field with traditional medicare." the changes in this bill -- this is me speaking now -- the changes in this bill will help to reduce these overpayments and bring us closer to that level playing field that was suggested last year. now, my friends on the other side of the aisle also say that reducing the government subsidies to private medical plans is going to increase the costs for seniors. again, this statement is fiction. the overpayments private insurance companies receive under the current law to deliver medicare benefits have increased the costs for seniors today. so, mr. president, i would ask -- they, in fact, result in a $90 increase to seniors to pay for that difference. so i would ask unanimous consent that the full text be placed in the record in full, and i hope as we go forward here that it is the truth and fact that will prevail here, not the fiction that we keep hearing to scare seniors. the presiding officer: without objection. mr. enzi: mr. president? the presiding officer: the senator from wyoming.

mr. enzi: i would also ask unanimous consent that an article immediately following his speech be placed in the record called "the coming deficit disaster" by douglas holtz-eakin. that goes into a number of these points that i will probably do later but won't do at this moment because i want to relinquish such time as the senator from oklahoma might want. mr. coburn: i thank the senator. the question i was going to ask -- the presiding officer: the senator made a unanimous consent request. it's granted. the senator from oklahoma. mr. coburn: the question i was going to ask, how many medicare advantage patients has he ever paid for? how many medicare patients has he ever cared for? how many times has he been in the trough experiencing the heavy hand of government as we try to care for people on medicare? the answer to that question is zero, because he's not a physician. he relies on the american

medical association, the american medical association that today represents less than 10% of the active practicing doctors in this country. he relies on aarp who has 40 million in membership but is the fifth largest revenue receiver from supplemental policies. that's who he relies on. the fact is he doesn't have the experience of being in the trough, caring for patients. now, let me tell you what's going to happen to medicare advantage patients. the senator would not yield to me. i have no intention of yielding to him. mr. kerry: no, i was ready to yield on your time. mr. coburn: the senator would not yield. i will continue my talk. medicare advantage patients, there's no question i have agreed with the chairman of the finance committee that competitive bidding needs to happen, but there is one little thing that happened on the way to the bank. is that there is going to be a decrease in benefits.

not only a decrease in what we pay for them, but there is going to be a decrease in benefits. and where will that impact be most importantly felt? not in the urban areas. it's not going to be felt in the urban areas. it's going to be felt in rural areas throughout this country. that's where it's going to be felt. it's going to be felt out there where there's a marginal rural hospital that is using the other benefits to help maintain the flow to that hospital. so there's no question that if you're one of the 11 million -- or with the exception of those that got deals cut in this bill -- that for sure the 90,000 oklahomans are going to feel an impact from this cut. now, nobody says medicare advantage is perfect. it's not. it's far from it. but there's another aspect of medicare advantage that really helps those on the lower rungs

of the economic ladder. it is with medicare advantage, they don't have to buy a supplemental policy, because all the things they need are covered. 94% of americans on medicare purchase a supplemental that are not on medicare advantage, purchase a supplemental policy. why do they do that? why do they spend $300 or $400 a month to buy a supplemental policy? because basic medicare that we have proudly said will not be cut doesn't cover the basic needs of a senior and their health care. so consequently, they pay into medicare part-a trust fund their whole life, they buy medicare part-b and then they buy a supplemental policy. it just so happens one of the largest sellers of those policies happens to be somebody that's endorsing this bill. if that's not a conflict of interest, i don't know what is.

i heard the senator talk about massachusetts. i would relate appear article from the "chicago tribune," they have broadened care, and i'm proud of them for doing that, but at what cost? at a 10% increase in cost of premiums for people in the middle. so when we go back to what the president said about what his goals were, there's no question that this bill does not keep those promises. i'd ask unanimous consent now to turn to another area which we have discussed and ask unanimous consent to put into the record an article from the "north county times of the california," dated december 5, 2009, at 9:35 p.m. mr. kerry: reserving the right to object. the presiding officer: it is so ordered. oh, the senator was -- mr. kerry: i reserve the right

to object. i would like to find out if we could have a moment to have a discussion, i ask my colleague. mr. coburn: i will offer you the same courtesy you offered me. when i finish my remarks, on your time, you are more than welcome to refute what i have said. the presiding officer: without objection. mr. coburn: i ask unanimous consent this be entered into the record. the presiding officer: without objection, the senator may proceed. his unanimous consent request is granted, as it was before. mr. coburn: in this bill that we're debating are three terrible things for care but great things for cost. the u.s. preventative task force on prevention services. it's the medicare advisory commission, and the references to the cost comparative effectiveness panel. you know, when the united states task force on preventative services came out with their

determination, as far as costs, i'm talking on breast cancer screening for 40-49-year-olds, as far as costs, they were absolutely right as far as cost-effectiveness. but as far as clinical evans -- effectness, they were absolutely wrong. and what did we do? we accepted a vitter amendment to hold off so that that recommendation, that mandate from that panel won't apply to women in this country under these programs. except the women in california on medi cal -- medical, because you see this week, california embraced u.s. preventative health services task force so that if you're a medicaid patient where we're going to put 15 million more people into, you can't have a mammogram in california if you're under 50.

you can't have it because from a cost standpoint, they're right. from a clinical standpoint, they're wrong. and so what we have done is every time one of these three organizations creates a ruling that the american people rise up and say that's wrong, we're going to come in here and correct it? but throughout this bill, strewn throughout it is multiple references to what these three panels are going to ration -- and i didn't miss that word -- ration the care to the american people in this country. if you're a senior, you have two real reasons to be worried. one is is we are cutting medicare, and if we are not, then vote for the gregg amendment and you'll make sure we don't. it's an insurance policy. but more importantly, within that, we're going to see the

care to seniors rationed, based on what is not in their own best interests or their health's best interests, but is what is in the costs' best interests. there is no question about it. we're going to do that. it we had a comparative panel, but they're already out there. we knew that. when i studied this to take my recertification exams, i have to know what the clinical comparative effectiveness guidelines are or i won't pass it as a practicing physician. but we didn't do that. we said cost is most important and so how are we going to cut? we're going to say where something's cost effective, though not clinically effective, and we're going to cut that care

out. so if you're a senior, especially if you're on medicare advantage, you don't have to just worry about the fact that we're going to decrease the revenue stream that will cause those benefits to not have a supplemental policy. and we're going to decrease some of the things available to you as a medicare advantage patient. but you also have to worry about what the next ruling that's going to come from the u.s. preventive health services task force. you have to -- you have to worry about what's going to come from the medicare advisory commission. because it's going to be looking at costs too. and then you have to worry about what's going to come from the cost comparative effectiveness panel. i could spend eight hours up here talking about tragedies from england and canada on care denied based on things that americans have today that that very panel is going to deny to americans in the future. because they're not cost

effective. that's one of the reasons that our -- our results in terms of cancer treatment is one-third better than anywhere else in the world. it's because we don't have mother nanny bureaucracy saying what you can and can't have. it would be totally different in this bill if we created incentives for lowering the costs, but we don't. we create mandates. we drive down cost of health care in specific areas through these three separate panels. now, there's one thing that's even worse than the two things that i just talked about for our medicare patients. and here's what it is: when you have these three panels, you have just taken away the loyalty of your physician to you.

you have just decided, with these three panels, that the physician has to keep their eye on the government. and they have to do what the government says is in your best health interest rather than what that provider knows is in your best interest. and -- and remember that the medicare sa advisory panel commission, the cost effectiveness panel and the preventive task force panel had never touched you, doesn't know your family history, doesn't know your clinical history, has never done an exam on you, doesn't know the i hado sink si of your -- i had sink si of your health plan, but we're going to apply that to you. we're going to depersonalize health care. and i readily admit for 80% of the people in this country, it's going to be just fine. you're not going to see any untoward result. but i will predict to you, as a

practicing physician for over 25 years, that for that remaining 20%, it's going to be a disaster as far as their personal health is concerned. it will destroy the patient-doctor relationship, number one. it will give us worse outcomes, and it will not save us any money because the consequences of those decisions will create a complication which will require more dollars expended. when we think -- we think that the government can practice medicine and that's what this bill does. this bill sets government up to practice medicine. when we think the government can practice medicine, we might as well hang it up and just be ready that 20% of us are going to get far substandard care to what a medicaid patient sees today. that's what's going to happen. we're going to get sicker. i'll repeat it, the life expectancy of people in this country under this health care bill will decline. will decline. the quality of care will

decline. the innovation of new advancements in health care will decline. because we have chosen the government to decide what everybody will get. it's a disaster. as far as the individual patient is concerned. that's not the motivation of my colleagues on the other side of the aisle. i know that. and i'm not accusing them of that. but what they don't see sitting in washington is what i see in a clinic office practicing medicine. and that medicine is intensely personal. it ought to be about your choice, about what's best for you and your family and your children, not what the government says make the best economic sense to the budget picture in washington any particular year.

and when we lose that quality in american medicine, we're going to lose the best of what we have in america in the name of fixing what's wrong. i agree with my colleagues that the insurance industry has a lot of stink to it, but there's a lot of ways to fix it other than the way we've done it. i agree with my colleagues that my profession is not pure at every turn of the corner. i agree with my colleagues that we can do better. but when we write a bill that is absent of any absolute clinical judgment left to the practice of medicine by those who know the patients best, who have 100% of that patient's best interest at heart, we're going to hurt the

quality of care in this country. and we're going to thurt significantly -- we're going to hurt it significantly. your motivations are good. the answers are wrong on a clinical basis. now to the gregg amendment. the gregg amendment does what you all say you want to do. and i would remind my colleagues that the medicare trustees are highly suspicious of the medicare cuts in this bill. and what they say is is they can claim it, but we highly doubt that it will ever happen because it's never happened before. because there's not political will to decrease the dollars in medicare. and, more importantly, the dollars are going to come out of care instead of out of fraud. for there's only reall really $2 billion say out of at

least $100 a billion a year. at least $100 a billion in year in fraud. only 2% of it per year is coming out. and, you know, that's the problem because this thing was so partisan. we could have had a medicare bill and we could have cut $60 billion or $70 billion in fraud together out of this bill. we can come together on that. and we could -- we could have cut $720 billion out of expenditures out of medicare just based on fraud alone without ever touching medicare advantage, without ever giving sweetheart deals to those in florida, because the senator wanted it, without touching fmap adjustments in other states. we could have done that, but we chose not to do that. and we know -- what do we know? we know there's some ripoffs in

home health care. we know there's significant ripoffs in durable medical equipment. we know there's some ripoffs in hospice. we know there's drug company ripoffs. we could agree to some of those. we actually know in large hospitals that there's some problems there as well. but there's very few problems in our rural hospitals because they're struggling just to keep the doors open. we could have done that. but we chose not to. and so we have this divide and we're going to fix it one way and the biggest pot of hone in medicare -- honey in medicare is fraud. the biggest pot of honey. everybody knows that. but we're not going to fix it. the whole purpose of the gregg amendment is to prevent us -- if, in fact, what my colleagues claim, that these are medicare

cuts that nobody will ever feel any consequence from in spite of my own years of practice and knowing the difference that that isn't true. but let's give you that. why would we not put it all back in medicare? so that we don't steal from our children and our grandchildren. why would we not do that? we've chosen not to do that. we've chosen to mix it and we've chosen to create -- and it's honorable to try to create a system to get more people insured. but, yet, we're going to have 24 million people in this country not insured. out of the 2.5 trillion bill, we're going to have 24 million people in this country not insured when it's all said and done if everything goes as planned. i would also note that with the

gregg amendment, as well as with several of the others, yesterday i introduced into the record the analysis by the state insurance commission in the state of oklahoma. kim holland is of your party, the majority party. but she sees what's getting ready to happen with this bill. and what does she say? what she says is is that insurance premiums are going to significantly rise in oklahoma. what she says is more people will be uninsured than there are today. what she says is the state medicaid fund is going to be tremendously stressed with at least $67 million a year having to go into that again based on the mandates in this bill that we don't have that money to do it. that, in fact, it's not the way to solve the problems that

oklahoma's facing in terms of their health care. she said -- i didn't call her and said, give me something bad to say about this bill. she volunteered this information out of her legitimate concern of the consequences that's going to happen with this bill. now, why would she do that? because she knows one heck of a lot more about insurance than i do and anybody else in this body. she knows it in our state and the other insurance commissioners around here. some, through their association, have endorsed this bill. most when they look at their state, especially the poorer states, especially west virginia, it's going to hurt. now, how are we going to cover what? we're going to shift 15 million people to medicaid. what do we know about medicaid? i've delivered thousands of babies and over half of them have been medicaid. i've cared for thousands of

medicaid children, thousands of medicaid adults, and thousands of medicaid patients. what do we know? medicaid is a substandard program. compared to everybody else, it's substandard. except when you compare it to indian health service. and that's a disaster. so our answer is is to put a mandate on the states that they can't afford and shove another 15 million people into a system that has poorer outcomes, higher compill taition rates, a higher infant mortality rate, latter presentation and a system that has 11 million people for it today that are eligible that haven't signed up. we have a system out there, but they're not signed up. so they're not getting preventive care, they're not interacting with a primary care physician, and that's our answer. move 15 million more americans

into medicaid. keep a discriminatory stamp on their forehead rather than give them an insurance program, put a stamp on their forehead to say that 45% of the doctors can't see you, 65% of the specialists can't see you because your reimbursement rate is so low, they can't afford to have you walk into their office and cover the cost of seeing you. that's what we're going to do. that's not reform to health care. that's banishing people to a substandard system as compared to what the rest of the system is in this country and then feeling good about it. that's not reform. that's discrimination. and it's discrimination because here's what really happens to a medicaid mom and her children is she's got a sick kid and she can't get in. she's got the sick 2-year-old

with a fever, not eating, dehydrated and she can't get in to see a primary care physician, which could keep that child out of the hospital. so what happens? she keeps trying to get in. what does she do? she accesses the emergency room. the most expensive place. and she accesses it late. not early, late. so we have a sicker child with higher costs because we have a system that won't reimburse its costs, and we -- you all actually have talked about the cost shift on that. from medicare and medicaid to the private sector. we would be much better off paying the same rates in medicaid so we don't get that cost shift, so we don't discriminate against people on medicaid for access to care. but we have chosen not to do that because it fits with the numbers. it fits with the washington government-centered management of health care.

i will tell you as a physician we would be better off single-payer rationing and all than what you're doing to so many of these patients in this bill. we would be better off with the government just running it all, ration it and say tough, you get 75 years of age, you can't have your hip fixed. you get cancer, we're not going to give you the latest drugs. we would be better off because now we're going to get the worst of both worlds. we're going to get the rationing through these three panels that i talked about. they're going to tell doctors what they can and cannot do. they're going to practice medicine. the very people who have never touched, never had an encounter, never visited with that patient, don't know anything about it, they're going to make a decision. i would inquiry -- inquire, i think i have five minutes left? the presiding officer: the senator is correct. mr. coburn: what is the request of my chairman?

mr. enzi: senator? a senator: i would just respond -- senator kaufman, you use the balance of the time, and then i will be able to work -- democrats have a few minutes left. mr. coburn: i think i will finish up here in just a second. mr. sessions: you take the balance of the time, and then it will be my opportunity in a few minutes. mr. coburn: every person in this country should be able to have access. i agree. nobody should lose their home. nobody should have to file bankruptcy because of health care. i agree. that premise we agree on. how we get there are two totally different ways. the number one impediment to access is cost.

costs aren't going to go down in this bill. we know that by all the stakes. the health care costs are not going to go down on this bill. they are not going to go down per individual and they are not going to go down in total. so we will not have fixed the big problem with health care which is cost. we will have worked on access through government programs, but we will have not fixed the real problem. what are the real problems? fraud. at least 6% of the cost of health care. tort extortion by the trial bar. at least 6% of the cost of health care when you count defensive medicine. there is 12% you could lower it tomorrow. 12% you could lower the cost of health care tomorrow. if, in fact, we would do -- fix the real things. number three, transparency with insurance companies, and transparency with doctors so you know what the cost is, you know what the outcomes are, you know

what their track record is so that you can truly make a decision about your care. there's no incentive he in there for that. the insentization -- for information and chronic disease. i have said this on the before before -- on the floor before but it bears repeating. the reason we have a primary care shortage of doctors in this cup today is because of medicare. so you have a disruption -- a differential of 300% from the family practice doctor, an obstetrician like me to a super sub specialist, and what do you think the doctors and medical schools are doing? only one in 50 last year went into primary care. only one in 50 went into primary care. so let's say we get everybody

covered. who are they going to see? oh, i know what the answer is. we're going to use physician extenders, so not only are we going to say you're covered, now we're not going to give you the experience, play hair, reasonable, long-term educated balance of having a physician whom she might have had 25 or 30 years of experience,uary going to hand you off to somebody that's a nurse or a p.a. who are good at limited things but don't practice the art of medicine. so i will wind up with this, mr. president. i so want to fix health care. i'm so sick of the way it is, but i'm not near as sick of the way it is as the way it's getting ready to be under this bill. i know my patients are going to get hurt under this bill. my medicaid patients are going to get hurt under this bill. my medicare patients are going to get hurt under this bill.

and those that are in between, whether with insurance with their employer or insurance that they are big on their own or they are paying cash are going to pay more for their health care because of this bill. now, that's what i whreef is -- believe is going to be the outcome of this bill. all you have to do is look at the history, auction to alice rivlin, the first c.b.o. director about the accuracy of c.b.o. in estimating anything when it comes to health care. they've missed it every way. they have only got one wrong by saying it was going to cost more. every other one they said it's going to cost less than what it did. so every patient, every patient in some way or another is going to suffer under this bill. that's what we should be worried about. we shouldn't worry about whether the president wins or we win. the presiding officer: the senator's time has expired. mr. coburn: i thank the president for the accommodation of the time, and i would yield

the floor. a senator: mr. president? the presiding officer: the senator from montana. mr. baucus: how much time is remaining in this hour? the presiding officer: eight and a half minutes. mr. baucus: mr. president, i'd yiek to yield three minutes to the senator from massachusetts. i spoke with senator sessions. he has very kindly -- he was very gracious and agreed that senator shaheen from new hampshire speak next. so five and a half for her. i also ask unanimous consent that we are able to proceed until 3:00 under the usual form -- that is, under the conditions of the last agreement. the presiding officer: without objection, so agreed. mr. baucus: i yield three to the senator from -- also, it is my understanding that the majority leader -- excuse me, the minority leader, the republican leader, may come down at some point after senator shaheen and use his leader time. it's my understanding. oh, it's after senator kerry. whenever he comes, he comes. okay. thank you.

the presiding officer: the senator from massachusetts. mr. kerry: mr. president, thank you very much, and i thank the leader. my friend from oklahoma asked how many patients i had taken care of in terms of medicare. i must say, mr. president, that, you know, that is not the essential ingredient of being able to exercise common sense and make some judgments about this. i can turn to him and say how many buses has he driven but he votes on transportation policy? how many wars has he fought in but he sends people to afghanistan. how many courtrooms has he practiced in and tried a case in but he's willing to limit attorney fees. that's not the measure here. the measure here is what does the policy do? in the normal -- let me just be very clear. the medicare advantage program was put in place, it's a private plan that's run by the insurance companies, and we put them in place and they grew in 2003 and gained the name medicare advantage because they were going to be run more efficiently

and at lower cost. originally, we were repaying about 95% to the repayment, but that has annualed up now to the point where medpac itself, not aarp -- this is not aarp, this is medpac. here's the medpac report. and medpac says that: "medicare advantage plans, 14% -- they pay the medicare advantage plans 14% more than they would spend for similar beneficiaries in the medicare program. that's a subsidy of $3.26 for each dollar of enhanced benefits. so the medicare folks are subsidizing additional payments to a program that is paying more than the other -- than regularly paid, and it goes straight to the insurance company. it doesn't make sense for tax dollars to be spent that way. finally, let me just say he referenced massachusetts. let me read from the massachusetts taxpayers' foundation. it is the most conservative. it is -- it is constantly

protecting the expenditure of tax dollars. everyone in the state looks to it on issues of tax policy and expenditure, and here's what it says about our plan in massachusetts." the cost to taxpayers of achieving near universal coverage has been relatively modest and well within initial projections of how much the state would have to spend to implement reform, in part because many of the newly insured have enrolled in employer-sponsored plans at no public expense." that's what happens. the final comment i would make to him. we're blessed to have five physicians in my immediate family -- my daughter, my son-in-law, her father-in-law, and two nieces. every single one of them would overwhelmingly disagree with the comments made by the senator from oklahoma. they hope we'll pass this legislation, as do millions of other doctors. mrs. shaheen: mr. president? the presiding officer: the senator from new hampshire. mrs. shaheen: in the past several months, my office has

responded to thousands of letters and phone calls about health care. i have traveled all across new hampshire talking to small business owners and to families, business owners and families who are desperate for help. i have talked to health care providers who are frustrated with the current system, and the underlying message is very, very clear. health care reform cannot wait any longer. my colleagues on the other side of the aisle continue to offer amendments that would take this bill off the floor of the senate, arguing that we need to go back to the beginning and start all over, or worse, do nothing at all. but, mr. president, you and i both know we need to act and we need to act as soon as possible. we need to continue to move forward. we need to move forward on behalf of thousands in new hampshire and millions across this country who need health care reform. i've listened to these families, these individuals, and i want to take just a few minutes this

afternoon to share two of their stories. judith petronero from francis town, new hampshire, was diagnosed with breast cancer in 2005 after her doctor found a lump during a routine mammogram. after undergoing multiple surgeries and radiation treatment, i'm very pleased to report that judith is now in her fourth year of being cancer free. however, at a time in her life when she should be celebrating her good health, judith is facing a new challenge: finding affordable health insurance. because, you see, when judith was in treatment, she was fortunate to be covered on her husband's insurance plan. they paid $82 a week for a family plan. unfortunately, her husband lost his job last year, but the family has been able to take advantage of cobra. however, when her cobra option runs out, which is going to be the end of this year, she will

be unable to buy an insurance plan from her current carrier. that's because breast cancer is considered a pre-existing condition until the patient is cancer free for five years under her plan. but the rub is that once she is cancer free for five years and able to qualify for insurance under her current plan, she will face a monthly premium of over over $2,000 for a plan that has a huge deductible. health care for judith will simply be out of reach. now, mr. president, you and i both know cancer doesn't discriminate. this could happen to any of us. i also recently heard from colleen connors, a woman who lives in my hometown of madbury, new hampshire. like so many others, she struggled with our ailing health care system. she was born with a hip condition and she suffered from

several other medical problems including lupus and scoliosis. as a result, she has also been denied coverage because of her pre-existing conditions. and, you know, i heard my colleague from oklahoma talking about the people who he said were being denied care in other health care systems, but let me read what colleen, my neighbor in madbury, says about her situation under our health care system. she writes: "it's very difficult to be in this position as a part-time lecturer at a college, i'm not eligible to buy health insurance through the system. my previous existing condition "-- and she says --" i was born with a serious general cal hip deformity and have had 30 hip procedures to make it possible

for me to walk and function with relative normalcy. has given "-- she names her insurer. i won't report that. -- "all the reasons to deny me the coverage i so badly need. all other venues i have attempted to obtain affordable, sustainable and efficacious coverage have similarly been denied me. i cannot tell you how hurtful this has been. the trickledown economics of my currently uninsured state has had a terrible impact on my daughter also who just earlier today asked me "mom, how long ago is it since your last mammogram? i told her five years i think. to which i don't want to lose too. what's happening to people in new hampshire and throughout this country is devastating to people like colleen and to

judith. but, you know, despite colleen's struggles and the difficulties that life has placed in her path, she's remained optimistic and hopeful that things will get better. and i, too, am optimistic. i'm optimistic that we can pass comprehensive health reform that changes the way the insurance market works so that my neighbor colleen and judith from new hampshire and americans in communities all across this country no longer face this discrimination. the reality is that we can't always control whether or not we get sick, and when we're at our most vulnerable moments, we shouldn't have to worry about whether we're going to be kicked off our insurance or whether our coverage is going to run out. health care reform will offer this peace of mind to millions of americans. mr. president, health care reform will touch the lives of all americans. we have the opportunity to improve our health care system

for everyone in new hampshire and across the country, and we must act now on this opportunity and pass meaningful, comprehensive health care reform. thank you. the presiding officer: the senator from alabama. mr. enzi: the chair yields up to 20 minutes to the senator from alabama. the presiding officer: the senator from alabama. mr. sessions: mr. president, i appreciate the comments that have been made about preexisting illnesses, and i do think that we can do something with this legislation to fix that. you just got to be careful, if you have two people, both making the same salary, they've both worked for 20 years, one individual saved and paid his health care insurance for those 20 years and got sick and is covered by it and another one chose not to, it's really not insurance if -- if a person then

walks in and wants somebody else to pay for it. but we can do that. i think we can work through those difficulties and i would support definitely moving in that direction. and my colleagues earlier mentioned about medicare advantage, that this is a program that some are critical of and they think we can deliver health care better without medical -- the medicare advantage part of the medicare program. i would just say if we can save money on medicare advantage and that would be a good thing, then let's do that if we can and without diminishing care, let's take that money but let's use it for medicare, not starting entirely new entitlement programs. and with regard to the physicians in my hometown of mobile, the medical association

ran a poll of their members and 94% of those opposed medical -- a government option, which is in this bill and a part of this legislation. they oppose the bill in general in large numbers and a similar poll in montgomery, alabama, they did the same thing. but what i'd like to talk about today is the gregg amendment. the purpose of his amendment is to prevent medicare from being raided for new entitlements and to use those medicare savings, any that we can achieve, to save medicare. and i would just note for the record, senator gregg, who -- former chairman of our budget committee, ranking member on the republican -- on the budget committee today, is probably "the" most knowledgeable person in the senate. not probably, i'm pretty certain about the most knowledgeable person in the senate on the

financial instability of medicare. and he has worked hard over the years to try to identify some way to fix it. and he proposed a number of years ago an amendment, an idea that would have saved over five years $10 billion through cost-effectiveness and smart actions within medicare and that $10 billion would have labeled the medicare program to extend its life. because all the actuaries tell us -- and there's no dispute about this, tha this -- that by, medicare will be in default. less money will be coming in than going out of so senator gregg saw that problem coming. he attempted to fix it. he was attacked by my colleagues on the other side for this $10 billion efficiency idea that would have strengthened medica medicare, not spent it on something else but spent it to

strengthen medicare. and he was criticized. not a single member of the democratic party i think voted for it and several republicans didn't. it's a tie vote. the vice president had to break the vote. i'm just saying that the idea now that we're going to find $465 billion in medicare savings without damaging the care and take that money not to strengthen medicare and put it on a self-sustaining basis, as we should be trying to do, but that they can create an entirely new entitlement program is something i cannot support. and actually, i understand my colleagues and their speeches say they don't support it. they say they don't. they voted for the bennett amendment which sort of seemed to say that. but we knew, those of us who read it carefully, that senator

bennet from colorado, his amendment wouldn't do anything. even "the new york times," which supports this bill, says it was a meaningless amendment. so let's talk about where we are. the gregg amendment, unlike the bennet amendment, means what it says. this is a serious vote. it simply says if you take money from medicare, it ought to be used to strengthen medicare, not to create a new program with. and it's pretty clear about it. it has teeth. it means what it says. it's not a joke. it's not a flimflam. it's a serious amendment. so we'll now be i think ascertaining how people in this body actually believe about medicare and whether we ought to be taking money from it. so the amendment says if

non-medicare savings -- which are very few, if you want to know truth -- if the non-medicare savings in this proposal do not offset the new costs of this new bill, the secretary of treasury and the secretary of h.h.s. are prohibited from implementing new spending or revenue reduction provisions in the bill. in reality, there's not going to be any or very few, say, non-medicare savings. that's where the savings are, frankly. the amendment prevents medicare cuts from being used to create new and expanded entitlement programs and to create a massive government growth on the backs of the medicare beneficiaries. and i would just recall for my colleagues that people who pay into medicare have paid into it all their lives and they're now at a point in their life where they're drawing from it, and the

social contract we had with them was that they would pay into this program and when they got to be 65, they would get the benefits of it. they didn't get the benefits of it when they were 30. they didn't get the benefits when they were 40. they didn't get the benefits when they were 50, yet they were paying in all these years. and now when the time comes to benefit from it, we now have a massive plan to raid that program that clearly is "the" most unstable, unactuarially sound program we have in our country. it's heading into default. and when it goes into detaught, it's not going -- and when it goes into default, it's not going to gradually go below the break-even line, it's going to drop below it dramatically. it accelerates. one study from the heritage foundation, i believe, said as much as $80 trillion over the

lifetime of un -- instability in this program. so i don't think anybody disputes the numbers and the problems that medicare faces. now, the bill says that we're going to have a budget-neutral piece of legislation here and that, don't worry, it's not going to add to the debt. and, in fact, we're told by the president that not one dime will be added to the debt. we have members of this body who say that the bill on the floor will create a $130 billion surplus over ten years. well, that would be good if it were true. how do you do that? well, there are a number of things but one of them is you have an $894 billion tax increase so you increase taxe

taxes -- excuse me, $494 billion tax increase and an $848 billion fund achieved from medicare. that's where the $464 billion comes from medicare. but the truth is, that's not an accurate number because the tax increases start immediately and the benefits don't start until 2014, five years down the road, the fifth year. and when you add that up and you take the first ten years of the real implementation of the legislation that's on the floor, it's going to cost $2.5 trillion. that's -- that's a big amount of money. and also, it does not fix the doctors' payments that everybody assumed and thought and we were told would be part of health care reform.

that's not done. why is it not done? because it wouldn't make the budget -- the bill wouldn't balance. they wouldn't be able to tell the american people that it brings in revenue when it doesn't. that's $250 billion to fix an essential payment to our doctors that we will and cannot cut. and we need to put that on a sound financial basis. it should be a part of this reform. but since they couldn't -- they figured they raised enough taxes and they couldn't claim to cut any more from medicare, they took -- they just take and put it out on the side somewhere. we'll do as has been done in the past, unfortunately, pay the doctors their payments by increasing every -- increasing the debt. of penny of the money that goes to make up the shortfall in doctor payments increases the debt and it's going to continue and it should end. so the bill is not balanced in

any fair analysis. it's a shell game. it moves the $250 billion in shortfall in doctors out of the bill. so they say, we don't have a problem, our bill is passed. but there's a $250 billion hole sitting over here. we just moved it -- moved it across the room here. that's not good and sound policy. the gregg amendment prohibits the using of the $465 billion in medicare cuts to pay for the new government spending in this legislation. it would keep the medicare expansions -- medicaid expansions from going into effect without -- without -- by having savings or cuts in medicare or social security. and unlike the bennet amendment, which really had no meaning whatsoever, it has some teeth to

it. so we'll know something significant i think about how people feel about medicare and financial responsibility when this vote comes up. senator bennet it said -- quote -- "with my amendment, the bill strengthens medicare and preserves seniors' benefits." well, i just think that's not an accurate statement once and for all, with this amendment we'll be able to show i think the american seniors who've paid in to their health care -- medicare all their lives that we mean it when we say we don't want to weaken their program. and you would ask, how can you have such a disagreement, sessions? look, you might ask me, they say the money's there, you say it's cutting medicare. they say it's not cutting medicare. $465 billion. i mean, somebody ought to be able to get it straight here.

how can you possibly have this kind of disagreement? i would just say to you, the general fund budget for the state of alabama, we are about 1/50th of the nation's population, 4 million people, is about $2 billion. so how can we lose $465 billion? well, this is what they're saying. they're saying if you listen to much of the comments carefully, they're saying we're not cutting guaranteed benefits to seniors. they're not saying they're not cutting medicare if you listen to most of the people who are careful about what they saism they say we're not -- say. they say we're not cutting guaranteed benefits. we're cutting home health care agency. we're cutting hospice programs. we're cutting hospitals. we're cutting the disproportionate share hospitals for poor people. we're cutting program after program after program. so they're cutting the providers

and telling everybody that we're not cutting medicare. we could have cut providers, why haven't we done it and put medicare on a sound footing? you can't cut providers this much. you cannot do so it will collapse it. doctors are already refusing to take medicare patients and they're worried about that and i think in the future if we go through this -- with this legislation, you'll see far more will quit seeing those patients. well, mr. president, the gregg amendment makes sure that medicare savings go to making the program more solvent and not to offset the creation of an entirely new entitlement program. there are many things we can do in this legislation to improve health care in america.

i know many on our side have offered many things. some of which are in the bill. man of -- many of which are not. we could do a lot of things together that we can agree on that would strengthen and make health care better in this country. but this legislation is unsound. we're raiding medicare. we've got a massive new tax increase. if we were going to raise taxes, let me ask, might perhaps that money be best spent to make medicare solvent instead of creating a new program when we know medicare's going to be insolvent in just a few years? so we're raising taxes. we're creating bogus phantom cuts in medicare and claiming that will make the bill balance. we're adjusting the numbers in the bill so that the benefits don't start until five years to make the first 10 years look like a sound program, make it

look like it will cos cost $484 billion. when the first 10 years cos cost $2.5 trillion. all we're going to do is increase the debt. and that's why the american people know it. they've been out there in tea parties an meetings and rallies -- and meetings and rallies pleading with us to be responsible. to quit throwing away money. quit acting like there can be something for nothing. there can't be something for nothing much somebody's got to provide care if we say care's going to be provided. and they have to be paid. we're creating a mindset here that has resulted in a budget from the president that will double the entire national debt in five years and will triple the national debt in 10 years. the national debt, $5.7 trillion last year, will go

to $11 trillion plus in five years and $17 trillion in 10. it's unacceptable. it's irresponsible. we need to be listening to our constituents and be responding to their commonsense plea that's we act with more responsibility here in this senate. i thank the chair and yield the floor. a senator: mr. president? the presiding officer: the senator from arkansas. mr. pryor: i rise to support my amendment to create an enrollee satisfaction survey through the exchange established in the health reform bill. let me show you, mr. president, how this will work. this right here was taken from the federal employee health benefit plan webpage that is administered by the office of personnel management, o.p.m. basically on the webpage they lay out how the satisfaction --

how the survey works. the first question is: how would you rate your overall experience with your health plan? other questions would be: when you needed care right away, how often did you get care as soon as you thought you needed it? other questions: how often did your personal doctor listen to you, show respect for what you had to say, and spend enough time with you? all of this information is collected and put into a form that people can use when they're making their health care decisions on what plan to choose. one of the real measures of quality of a health care plan is how satisfied people are with that plan. a little bit hard to measure, but we send out these surveys right now to federal employees. they come back. the information is available to the public. people can just click on to this and know when they're about to sign up for a plan how the plan

rates out in satisfaction. this is not a new idea. again, it's been around for a long time. it helps people make good health care decisions. it allows them to compare one company to another. it allows them to look at what the people who have that health care plan right now, how they perceive the performance of that plan and it's just really a win-win for the whole system. so the idea here is to allow -- to -- to make this part of the new law that if you're on the exchange, you would have access to filling out one of these surveys, but also, more importantly, you'd have access to reading the survey to know when you're making your health care choice how -- how your company rates out. let me just give you a few examples. this actually is from the webpage right now under fehbp. the first question was overall

planned satisfaction. the feahp national average is 80%. people are 80% satisfied with that. there is one insurance company that only has 54%. another one has 88.7%. so you can understand the range. again, that's not to say nobody's happy with that one at 54.5%. but it allows the people who are purchasing the health care to make an informed decision before they enter into a contract with the company. one of these is: do you get care quickly? well, the average there is 91.6%. it's not a real big spread there. one company said 88%. a little bit below average. the biggest company i said is

95.1%. if getting care quickly is your most important thing, you may want to go to the one where the people who use that insurance company right now say that you get there the quickest. another issue for a lot of people is claims processing. that's one of the questions on here is how is the company -- how does the company do in processing your claim. in our office we have hundreds of complaints from people around state of arkansas who have had problems with insurance companies processing their claims. here, again, the average here is 92%. that's what the fehbp average is, 92%. there is a company that has a 77% rating as a result of this survey. there again, not saying that people won't choose that company. they may choose it for other reasons. but if the claims processing part of their business is important to them, they may not choose that company or at least they know what they're getting into. the highest in the claims

processing is 96.1%. this is something that exists. this is something that i can't imagine anyone having a problem with, because what it does is put the tools in the hands of the people making decisions on the health care provider that they're going to choose. it puts the tool in their hand before they choose them to know what they're getting into. and the last thing i wanted to say, mr. president, is basically really what this is -- i -- this doesn't cost any money. i don't think it costs any money at all. but if it does, it's a tiny amount. this is a consumer-friendly tool. it simplifies the process for people. it takes the anxiety out for people. it is a commonsense, grassroots way to hold insurance companies accountable. if they don't do well in these customer surveys, chances are they're not going to get a lot of business in the coming years. so it puts a quality control

there, a satisfaction-based quality control there. and i think it's a great tool for keeping people happy. i can guarantee you that the execs when they look at this company that had only 69% respond in a positive way, they're going to talk to their folks and say, look, we've got to get that number up. what's wrong with this company? we have to get those numbers up. this is something that people have talked about. i've heard many people in arkansas and around the country say, they want the same deal as congress has. this isn't all the same thing. it is part of it. when we make our health care choices, we're able to have this knowledge before we make a decision. accountability and performance go hand in hand. this is a great example of how we can do that in a very, very inexpensive way, in a way that's very meaningful to the people who are making the decision.

and this is there at the point of decision. so, mr. president, i would ask that all of my colleagues join in this amendment. we're going to vote on this, we understand now around 4:00. that time may be moving. but i understand it is around 4:00. so, mr. president, with that, i yield the floor. and suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: mr. pryor: mr. president? the presiding officer: the senator from arkansas. pryor: i ask that the quorum call be dispensed with. the presiding officer: without objection. mr. pryor: i ask that the time for the quorum call be divided equally queeequal between two s.

the presiding officer: is there objection? without objection, so ordered. pryor: and i suggest the absence of a quorum. the presiding officer: the clerk will call the roll.

a senator: mr. president? the presiding officer: the senator from wyoming. mr. enzi: i ask that further time under the quorum call be dissuspended with. and i would allocate -- the presiding officer: without objection. mr. enzi: i would allocate the balance of our time to the

senator from tennessee. the presiding officer: the senator from tennessee. a senator: mr. president -- mr. durbin: mr. president, before the senator speaks, i'd like to ask consent to follow the speaker from tennessee. the presiding officer: without objection. mr. corker: i can't imagine anybody better to follow me than the senator from illinois. how much time is left on minority time? the presiding officer: 12 minutes. mr. corker: 12 minutes. okay. and to the senator from illinois, it might not take quite 12 minutes. i'm here to speak regarding the gregg amendment. this health care debate in many ways has been going on the better part of this entire year. and there are obviously differences in this body over philosophical issues and how health care needs to be delivered. one of the things that i hope has come across is that all of us would like to see health care

reform. i campaigned on health care reform. i used to be commissioner of finance for state of tennessee. and in that -- in that particular role, i oversaw the medicaid programs in the state called 10-care and i saw firsthand the tremendous plight that people not having appropriate health care deal with on a daily basis. and so when i ran for the united states senate, i've been here three years now, i ran on the whole notion of health care reform. i put -- i put forth numerous inside during my first congress, all with other bills that i feel would have delivered health care in an appropriate way to citizens across this country. the other part of this debate, though, is not just philosophically how that's done, and obviously we have had a lot of give and take on that, but it's been the issue of paying for something like this. mr. president, early on, i sat down with the chairman of the

finance committee. i have met add news yum with people on both sides of the aisle regarding health insurance and sent to the leader, the majority leader of the senate a letter signed by 36 senators to this effect. we all want to see health care reform. but we also want to ensure that the entitlements that are in place and in particular in this case medicare is on a sound footing, and we want to make sure that those commitments that we have made to seniors and future seniors will remain in place and we want to make sure that our country's fiscal condition is on solid footing. i could go into lots of discussion about how we're perceived around the world as it relates to our financial situation. i could talk about the value of the dollar, but i'm going to talk about just the one issue that the gregg amendment addresses, and that is keeping integrity in the medicare program. now, mr. president, i really

believe that -- that the senator from illinois and myself who is going to speak in just a moment, that you and myself would be much closer in this debate had we -- had we not begun with a fundamental building block of this bill being -- using using $464 billion in medicare savings -- quote -- to leverage an entirely new entitlement. for me that was an absolute nonstarter. i know that for senator enzi from wyoming, an absolute nonstarter. i think that is probably the biggest goal. there are numbers of differences that we have, but the fact that we would raid a program that we all know is insolvent, has has $38.6 trillion of unfunded liabilities, that we know is going to end up creating havoc for our country if we don't deal with it, the fact that we would take savings from that program which is insolvent and use it to

leverage a new entitlement in my state and i think in most states around the country, that just doesn't pass the commonsense test. and i know that people have lined up on both sides, i know that my friends on the left certainly see this probably -- and certainly i'm in no way implying any agenda issue, but just this has become a political issue. the president obviously was over here yesterday advocating that everybody stick together and pass this, but this one amendment that we're getting ready to vote on this afternoon to me defines much of this debate. and that is are we truly as a country going to take take $464 billion in savings from an insolvent program that everyone knows is insolvent and use that to leverage a new entitlement that even when it begins is insolvent also. i mean, if you look at a

ten-year cost versus ten-year revenue, we know that over time this new entitlement that might be created by this bill is also going to have tremendous fiscal implications to our country. i think one of the most offensive pieces of this, though, is the fact that not only are we taking this this $464 billion -- and i realize that, you know, the senator from illinois mentioned yesterday on the floor regarding the fact that some of the things that are in this bill will lengthen the life of medicare. i understand how the math works on that, i do, i understand that. but i think the fact that we would take again savings from a program that is an entitlement that people count on, that seniors count on and that future generations, these young people sitting before us today on the steps, these wonderful people who have come here to help us, are going to ultimately be stuck with paying for -- taking that

money to create a new entitlement. it doesn't make sense. but the offensive part i was going to allude to is not even the issue of dealing with s.d.r., the doc fix. i think all of us know the way this bill is constructed, in a year, this pays for the doc fix for s.d.r. for one year. for those of you who are listening who don't know what that means, it means that physicians who deal with medicare recipients for one year will not receive a 21% cut in reimbursements. but in the next year, the very next year, there's going to be a 23% cut to physicians who serve medicare recipients, and this bill, instead of taking those savings and dealing with that, and over a ten-year period that would cost $250 billion, i might add, instead of dealing with that, we're going to throw that off to the side and use the the $464 billion to create a new entitlement. that -- i just don't know how anybody in this body can talk to

their constituents or talk to any of us with a straight face and say that that is a sensible thing to do. i think all of us know that -- that we have got huge deficits that are being run, and even if although we disagree about much of that, the stimulus and some of the other things that are happening, i think the thing that we agree upon is that our country has some long-term issues that need to be dealt with. and it seems to me that what we would do is show people around the world and certainly show our citizens back home that we have the courage to deal with those entitlements. i'm hoping we're going to have the opportunity to vote on a task force, a commission that will have a binding ability to cause us to be able to deal with medicare and social security in a defined amount of time very soon, but it seems to me that

the first huge step for all of us is to vote for the gregg amendment today. now, i realize that if the gregg amendment were to pass, the construct under which this entire health care reform bill is based would dissipate. i realize that. i realize that this is -- we're creating a health care bill from something that is insolvent, taking money from it to create something that again will be insolvent. and what i would say to my friends on the left is i stand ready to talk about solution toss that. i have proposed solutions to that. i just don't know how anybody in this body can with a straight face say that we are being responsible as it relates to medicare as an entitlement if, in fact, members of this body do

not support the gregg amendment which would keep this rate or keep this savings from being used for a new entitlement and instead would lock it away in a manner to make medicare more solvent for generations to come. so, mr. president, i thank you for the time. i really do believe that it was the initial building blocks, the fundamentals of this bill that have kept us apart. i realize there are some emotional issues that -- that separate members of this body, and my guess is that senator reid, his man jers -- managers' amendment in working with senator durbin and others will figure out a way to resolve those issues. i know there is the issue of the public option, and my guess is that will be figured out in some form or fashion on the other side of the aisle. the issue of -- there is other issues that i know are emotional that divide us. but the fundamental building blocks of this bill are just

flawed. they are flawed. and i think it's very issue plus a couple of others that have kept this body from being able to work together and have made this debate a very, very partisan debate, and i regret that, and i hope that my friends on the other side of the aisle will over the next few days realize that this is not something of common sense. this is not sensible. and i hope that they will reconvene and i hope that we together can focus on something that will stand the test of time instead of kicking the can down the road, snowing full well this is incredibly irresponsible. my guess is that -- and i'd love to hear the senator from illinois maybe dispute this, but my guess is if this bill were to pass in its present form, that within a week or two, the majority will take up the issue

of paying for the doc fix -- or not paying for it but actually passing legislation to basically throw debt on these young men and women sitting in front of us. my guess is that if this bill passes, the majority party will say oh, we've got to deal with the doc fix, we've got to deal with s.g.r. by the way, that's a a $250 billion tab. my guess is the majority party is going to bring legislation forth in the next two or three weeks to deal with that, so that -- or maybe not in the next two or three weeks. i guess since we have a one-year -- within the next year, the majority party will bring something forth to deal with this issue and point back to this moment of disingenuous, disingenuous activity in this -- on this floor. i hope that's not the case. i thank all involved. i know this has been a very vigorous debate, which i hope

will carry on until we get it right, but i'm very disappointed at the fundamental building blocks of this bill that have separated us. i hope this body will stop what we're doing in this regard as it relates to medicare, come together, do something that will stand the test of time. i realize that my time is about up. i don't even cause the president to have to tell me that. i yield the floor. thank you very much. mr. durbin: mr. president? the presiding officer: the senator from illinois. mr. durbin: how much time is remaining on the majority, democratic side? the presiding officer: 19 minutes. mr. durbin: thank you. i'd like to thank the senator from tennessee. although we disagree on this issue, i respect him very much, and i am just hoping -- maybe it's a false hope, but i'm hoping that before the end of the day that he will come join us and make this a truly bipartisan effort. we have tried -- we have reached out to the other side of the aisle for almost one calendar year with lengthy hearings in the "help" committee, in the finance committee, inviting republican senators to come join

us, and there were times when there was kind of a tease that was going on where they would come in and offer amendments and the amendments would be adopted in the "help" committee. i think over 100 republican amendments were adopted, and we felt they're coming our way. we're finally going to have a bipartisan bill, but then the bill was called and not a single republican senator would vote for it. as i stand here today, despite one year of effort, despite three committees in the house going through markup, two committees in the senate, despite the vote on the senate floor, the official tally is this -- only two republicans have voted for health care reform. one congressman from new orleans, louisiana, a republican congressman voted for the house bill. one republican senator, senator snowe of maine, voted for the finance committee bill to be brought from the committee. so we have made a good-faith effort. we will continue to. i salute the senator from wyoming who was on the floor here who is the ranking member

of the "help" committee, and i know that he spent long, arduous allocations of time meeting and trying to find a bipartisan solution without success, but i thank him for trying, and i will say to the senator from tennessee we'd like to have your support, we'd like to have your help in passing this and truly making it bipartisan. that is our goal, and i hope it happens. you questioned the fundamental building blocks of this bill, and i can't, i guess, resist the student to say that i think this is a good bill, and i believe that the effort that went into it by senator dodd of connecticut who has now joined us in the "help" committee, senator baucus of the finance committee has resulted in a bill which does many positive things. this is our bill. 2,074-page bill. it is the democratic health care reform bill. you will see the desks on the other side of the aisle are empty because they don't have a bill. republicans have not produced a

health care reform bill. in one year of speeches and press releases and charts and appearances on television talking about health care reform, they have not produced a comprehensive health care reform bill. i know why. it's hard. it's very difficult to tackle 1/6 of our economy. we did it, and it took a lot of effort, a lot of effort as i mentioned earlier. secondly, there are some in the senate -- not on this side of the aisle but some in the senate who don't believe we need a change. some accept the current system, and i think if they accept it, then they have to answer a few fundamental questions about the building blocks of this amendment. if the republican senators who oppose our bill accept the current system, what do they have to say about the affordability of health care premiums? you know what's happened. health care premiums have risen dramatically. ten years ago, a health insurance plan for a family of four was $6,000, on average.

today, it's $12,000. we project in eight years, it will be $24,000. if we don't stop this, fewer and fewer americans will have health insurance, and what they have may not be any good. so we have in this bill efforts to reduce the increase in costs in health insurance premiums, and don't take my word for it. the congressional budget office, which is the official umpire, has said yes, the vast majority of americans will see their health insurance premiums either go down in cost or not go up as they would have. so we address, number one, the affordability for health care for businesses and families across america. there's no republican bill that does this. secondly, this bill -- provisions in this bill will extend protection of health insurance so that 4% of americans will have the peace of mind of knowing they have health insurance. 30 million more americans

uninsured today will have health insurance. in the lowest income categories, some will qualify for medicaid, the government program for the poor and disabled. and in other instances, some will qualify for the health insurance program, but they will have protection, 30 million more americans. there is no republican bill or amendment that extends coverable of health insurance to 30 million more americans. there's none. there's a third issue too. we have built into this bill -- into the front end of this bill what we call the health care bill of rights, and it's about time somebody stood up for families and individuals across america who have been treated very poorly by health insurance companies. these extremely profitable companies make a lot of money by saying no. saying no to your doctor's recommendation for a surgery. saying no to your doctor's recommendation for the appropriate medication. they have people who just say no. here's what our bill does. our bill says that in america,

you'll have the right to buy insurance if you have a preexisting condition. what it basically means is that the number-one reason that health insurance companies deny coverage today is going to come to an end. we are creating new pools -- risk pools where preexisting conditions cannot exclude you. and i know everyone -- everyone -- is concerned that at that critical moment in time when there is a -- a frightening diagnosis or a terrible accide accident, that you'll turn to your health insurance that you paid into for a lifetime and they will say no, we checked your application. you failed to disclose something about your past medical history, like acne, incidentally. that was one of the things that was used to fail -- or to refuse coverage. so the first thing we do, we make sure that americans have the right to buy insurance that won't excluded for preexisting conditions. we also make sure that you hav have -- be able to keep your insurance if you become sick or

injured. too many times when you get si sick, your insurance fails you. two out of three people filing for bankruptcy in america today file because of medical bills they can't pay. two out of three. and 74% of them have health insurance. they thought they had protecti protection. they paid the premiums. when they needed it, it wasn't there. so the number two element in our health care bill of rights in this bill is you can keep your insurance if you become sick or injured and that your insurance won't face lifetime limits on coverage, that you'll have affordable insurance if you lose or change your job. and that's a large portion of the uninsured people in america. and here's one that parents will appreciate. remember when you first learned when your family policy wouldn't cof your son or daughter -- cover your son or daughter right as they were coming out of college and you thought, oh, no, they're loaded with student debt, they're looking for a job examine now they don't have health insurance. i can't tell you how many times i called my daughter and said,

"jennifer, have you got health insurance?" "oh, yeah, dad, i'm going to get to that real soon." i don't like to hear that. parents don't like to hear that. well, we extend it from age 24 and we say that you can stay on your parents' insurance policy now until your 27th birthday. additional several years of protection, peace of mind while a young person goes about finding a job, starting a career, starting a family. we also provide preventive care without extra cost, and we also begin to eliminate the discrimination in health insurance premiums. health insurance companies -- insurance companies in general and health insurance companies are the only businesses save american baseball that are exempt from antitrust laws, which means they can literally come together, the executives of the insurance companies, and decide how much to charge in premiums for women, elderly, people who are members of a minority group. they can make those distinctions and do it legally.

well, we put an end to it. we say that you have a right to fair insurance premiums without discrimination based on gender, health history, family history, or occupation. there has not been a single republican bill offered that offers this patients' bill of rights to make sure that we have this kind of protection when it comes to health health insurance. it is one of the fundamental building blocks when it comes to health care reform in america. now, the senator from tennessee and others have raised the question about deficits and have asked, isn't this bill for all it seeks to do just going to add more expense to our deficit? and that was a legitimate question asked by president obama when he told us, if you want to do health care reform, don't do it at the expense of adding to our debt as a nation. you know, when we passed the prescription drug bill under medicare when it was a different party in charge in the senate and in the white house, they added $400 billion to the

deficit and didn't blink. $00 billion in added to the debt in america and didn't blink. more subsidies for pharmaceutical companies, which do quite well, and more subsidies for insurance companies, which are very profitable, at the expense of our deficit. now when it comes to the expense of this bill, that same party has returned to its role as the deficit hawks. well, they should look very carefully at this bill because the congressional budget office tell us this legislation will reduce the deficit of the united states by $130 billion over the next ten years and in the following ten years, $650 billion in reduced deficit costs. that's almost a trillion dollars in deficit savings over 20 yea years. there is no bill that's ever been introduced that makes this kind of deficit savings. according to the congressional budget office. and, unfortunately for their argument, there's not a single

bill before us from the republican side of the aisle which would even come close to reducing the deficit in that regard. in fact, all the amendments -- major amendments that have been offered so far on the republican side of the aisle ad add to our deficit. they want to continue the subsidy for private health insurance companies under a program called medicare advantage. the senator from connecticut has said repeatedly, and i hope he'll say again soon, medicare advantage is neither medicare nor an advantage. it's a subsidy from taxpayers to profitable health insurance companies which the republican side of the aisle has labored day after day to protect, a private subsidy to health insurance companies. well, the health insurance companies can't stand this bill because it upsets their apple cart and maybe their profit and loss statement and they can't stand the thought of having medicare advantage policies held to accountability or losing the subsidy they currently have. but we believe that if we're

honest with medicare and its future, we have to do that. now, i want to address one issue that comes up every time my colleagues on the other side of the aisle stand to speak and it's the issue of the future of medicare. they fail to recall that senator corker from tennessee, senator dodd, myself, and the presiding officer all voted in favor of the amendment by senator michael bennet of colorado, and the amendment that he offered, which is the most bipartisan amendment we've had on this otherwise partisan bill, said nothing we do here in this bill will in any way reduce or endanger guaranteed benefits under medicare. number one. number two, any savings that we get from this bill under the medicare program have to go back in to put medicare on sound financial footing and to extend the benefits available to seniors and to reduce the costs to seniors. we all voted for that.

it is now part of the law that we want to pass. so to come to the floor and argue the opposite is to ignore their own votes on the issue. senator been effort colorado has i think really passed a watershed amendment that every senior and the families of seniors should respect as important to their future. so though you may disagree with the fundamental building blocks of this amendment, i think they are sound, i think they are responsible from a fiscal viewpoint, and i think they're responsible when it comes to the future of medicare. mr. dodd: will my colleague yield? mr. durbin: i would be happy to yield and i would be happy to yield the floor if the senator from connecticut -- mr. dodd: no, i like these moments when we engage with each other a little bit. mr. durbin: perilously close to debate in this senate. mr. dodd: you want to be careful when you get close to that. it used to happen. doesn't happen enough these days. but i think a couple points you made can't be reinforced enough in my view. one of the great worries we all have here -- one of those is the

cost issues. i think most of us agree there's a great problem we have out here with the growing problem of cost. sorry about that. the premium costs. and, again, you know, we either love or hate c.b.o., depending on what numbers they come back for us. i've been on both side that have emotion when's dealing with c.b.o., but we've come to recognize and accept the fact, i think collectively here, that we rely on them. they don't olz approve -- this is you want mount olympus, not to say that they're 100% right on every occasion. but having made the analysis -- and i was going over the numbers, and i just wonder first-degree my colleague from illinois -- wondered if my colleague from illinois, i know he's awafer these but i may be -- aware of these but i may be wrong on some of these. if you take the market, there are 32 people in the individual market. they would pay, according it c.b.o., 14% less in premiums for an equivalent plan than under the status quo. in the small group market, there are 25 million people, according to c.b.o., who fall into the

small business market, the small group market. and ones that are eligible for tax credits would pay 8% to 11% less in premiums for an equivalent plan under the status quo. and if you work for a small business examine don't qualify for the tax credits, your premiums would be about 232% t t 2% or 3% less. and finally, in the large group market, where most of the people work, people who work for large group employers, roughly 134 million people, would see lower premiums up to 53%. now, those are remarkable. now, that to me goes to the heart of this. obviously getting down and reducing our budget, the deficit by $130 billion, $650 billion in the second decade, is terribly important. but if i'm sitting out there as a consumer and i want to know one thing more than anything else, how is this going to affect me? am i going to be paying more or less, and as you point out, we're now looking at -- at the

year 2000 in connecticut, that family of four paying between $6,000 and $7,000 for health care premiums. they're now paying over $12,000, same family. and in the next seven years, it will going to $24,000. and some predict within ten years, go up to $35,000. so those are staggering increases. compare that, if you will, with what we're being told, even if these numbers are off a little bit, and they may very well be, one way or the other. but let's assume for the sake of debate that they're actually off by not quite as much. it may almost be flat, the costs, not actually a reduction in premiums. i can't understand why people wouldn't embrace this in a wholehearted fashion is&say this is a great a-- fashion and say this is a great achievement, no one's been able to produce these numbers. am i wrong about these numbers or are those your calculations assist well? mr. durbin: as a matter of fact, i would say to the senator from connecticut through the chair, is quoting a study by the congressional budget office requested by senator bayh of indiana who asked the straight-up question of the congressional budget office: if this is passed and becomes law,

what will happen to the premiums of people across america? and as the senator from connecticut correctly reports, the premiums are either going to stay the same or go down for the vast majority of people. otherwise, they're going up dramatically. there is one other element which i know the senator is aware of. if you happen to be one ofous callous, step particular hearted individuals who could care less about people who are uninsured, believing the poor will always be with us, you want to stop and -- ought to stop and reflect on the fact that many of the poor people with no health insurance receive medical care through charity, compassionate care at hospitals and doctors and their costs are passed along. we estimate that current premiums reflect about a thousand to $1,200 a year that each of us pays in addition to what we need to cover our families, to cover those uninsured who receive the benefits and the treatment that they seek at hospitals. so in addition to reducing the premiums, as the senator from connecticut has said, as more

and more people come into coverage with their own health insurance, there's less of a pull on our benefit packages to subsidize the uninsured. mr. dodd: one other statistic again that jumps off the page at u. and i went back to my staff and said, are you sure these numbers are right. i'm told they're correct. for people who receive tax credits, and many do under our proposal here, the premium savings on average are $56% to 59% lower relative to the current individual market premiums. 56% to at% lower. -- 56% to 59% lower. that's an incredible achievement in a piece of legislation designed to deal with costs. how do you get costs down? and, of course, the added elements of this that, again, c.b.o. doesn't calculate and showing reductions in premiums that also include, like, catastrophic option available to young adults, reinsurance provisions that would reduce premiums even further. none of those calculations were actually calibrated by c.b.o. in arriving at the conclusions. so actually, i think these

numbers turned out to be far better than the ones we just talked about. mr. durbin: i would say to the senator from connecticut that this affordability element is the number-one reason why we need health care reform, and i think the one reason why our critics on the other side of the aisle really come to this debate empty handed. they don't have anything to offer to reduce the costs. we are looking for a comprehensive bill from the republican side. this is ours and it's been on the internet for over two weeks. every word can be read by every person in america. that kind of transparency and disclosure is what we need in the course of this gaivment i'm sorry the other side doesn't offer an alternative but does, unfortunately, amendments, which don't enhance this bill's goals. mr. dodd: if my colleague -- if i could just get a last minute or so on the floor, mr. president, i'd like to -- i want to commend mark pryor, our colleague from arkansas, who has offered one amendment ofs we're going to vote on shortly. this is a very, very worthwhile amendment he's offering. and giving individuals and small businesses better, more

consistent information about insurance plans to be sold in the exchange. all of us in this chamber earchedz federal employee gets one of these. this is a little booklet here. it is a guide to federal benefits. i think i get some 15-20 options this year. i can open up this book to various pages and dplairsive analysis of consumer reactions to the various plans over the last year or so, what they thought of them, how well they've worked. there's nothing like this. we put language in our bill under the "help" committee to try to put this in common language that people can understand, getting away from the small print, telling people exactly what will be the benefits under their plan or the disadvantages, to some degree, and the pryor amendment includes this kind of provision in the bill, strengthens it tremendously. so i want to commend senator pryor of arkansas for including a provision in this bill that will provide greater clarity and greater understanding, the same

kind of clarity that we get under the federal employees' health benefit plan that allows us to make that very simply -- you don't have to have a ph.d. in economics to understand this. if it's only yourself, if it is yourself and your family, what it is like in deacialg the district of columbia, florida, georgia, every state. very simple, very clear understanding of how this works. and one of the complaints all of us get all the time -- this is complicated and no matter how sophisticated you may think you are, trying to sort out what's the best plan for you, and i say this candidly, the insurance industry isn't always necessarily as forthcoming about letting you know what the disadvantages are, as they're marketing their various plans for people. so the pryor amendment i think will go a long way towards providing that kind of clarity and understanding that all americans want. i urge my colleagues to support the pryor amendment when that issue comes up for a vote. and i see the time is 3:00.

may i inquire, is it -- i apologize, i have gone over a little bit over 3:00. so i apologize to my colleagues. mr. durbin: i would like to make a unanimous consent request that the next half-hour between now and 3 thaisht evenly divided, o.a.s. the time has been before and that the the first time recognized on the democratic side in that slobt the senator from washington, senator murray. the presiding officer: without objection. mr. durbin: and the same other conditions will apply as with the previous use of a unanimous consent request. mr. corker: i wonder if the senator from illinois would yield for a question? the presiding officer: would the senator from illinois yield for a question? mr. durbin: relative to the unanimous consent request, or -- mr. corker: no, no. mr. durbin: i have a pending request q. the presidinrequest. the presiding officer: is there objection to the request? without objection, so ordered. mr. durbin: i'd be happy to yield and ask that our tienl evenly divided.

but i want to give the senator from washington a dhans to speak for a few -- a chance to speak for a few moments, too. mr. enzi: i think i could yield some time to the senator from tennessee. mr. corker: i listened to the senator from illinois talking about medicare and i assume based on his comments that there's a chance we may get 100-0 vote on the gregg amendment, which truly ensures that all medicare savings are used to make sure that medicare is more solvent. the bennet amendment, as i think the senator knows, was parodied in "the new york times" over the weekend as talking about it being toothless. it was a cover vote to make people -- to give people the opportunity to be able to say that they voted for something that saved medicare. but actually the gregg amendment really does that. it puts the money away in such a fashion that all savings that are derived from medicare are used to make medicare more solvent.

i am aassuming that since the senator from illinois is so supportive ensuring that that occurs, that he will be supporting this amendment? mr. durbin: if the senator from tennessee is propound ago question, i will be opposing the gregg amendment. i think the bennet amendment achieved what we want to achievement and i think my friend from new hampshire and his amendment goes too far and basically, i think we understand what he's trying to do. he doesn't want to see us create tax credits to help families pay for health insurance premiums. he believes it's an entitlement. i think your side has referred to it as such. i think it's important to help businesses and individuals who are struggling to pay health insurance premiums receive some assistance in doing so. mr. corker: so what the senator from illinois just said is that the answer is no, that they're willing to use medicare savings to create a new entitlement, and they're not willing to do something that absolutely locks away those savings so they can only be used to make medicare more solvent.

i think all of us know that the bennet amendment was a cover vote. nothing around here that has any meaning passes with 14*u7b votes, with 58 democrats, 40 dernlings 40 republicans and two independents. society fact is that the whip from the other side of the aisle, who i respect and is very eloquent, has just said that, yes, we are willing to raid medicare and to take the savings from that, an insolvent program, to create a new entitlement sore a new program, whatever you want to call it -- i don't want to be pejorative -- that is also going to be insolvent the day it starts but, yes, we will take medicare dollars directly, we will not do what senator gregg wants to do, and that is to be responsible, to try to make it solvent. we are going to leverage it for a new entitlement, a new program, whatever you want to call it and i think by virtue of this vote, we'll see who in this body is serious about truly

wanting to save medicare for seniors and young people aren't hocked to the program in the future. disee desyl afuture. mr. enzi: the senator from washington is next. mrs. murray: i come up to the floordz and i know this is a extremely important issue that we're debating, health care. i wanted to talk on a different topic. that is because tomorrow is going to be a very socioand very difficult day in my home state of washington. that's because tomorrow just a week after the single-worst act of violence against law enforcement in washington state history, police officers from across the state and across the nation, including some here from our capitol police force, a lot of our heartbroken washington state residents, the community of lakewood, washington, and the families of last sunday's brutal tac on four police officers are going to gather together to say goodbye.

tomorrow's memorial in my home state of washington of the four officers killed on the morning of november 29 will begin with a procession that leaves from just steps a away from the coffee shp that was the site of that senseless and cowardly atafnlgt it was an tac in which four officers were targeted solely because they were in uniform. solely because they had sworn to protect their community. the procession will then weave its way through that very community, lakewood, washington. it is a community that has been devastated by this tragedy. it's a community where four officers were original members of their police force and were loved and respected by the colleagues -- by their colleagues and the people that they served. aalong the way, that procession route is expected to be lined by thousands of lakewood residents and by all of those who have been so deeply affected by this

tragedy from throughout my state. at the lakewood police department, the procession is going to stop to pick up the families of the fallen officers. those are families who together now include nine children who are left without a parent, families whose grief is very difficult to imagine. that procession will end at a service that is expected to be attended by more than 20,000 law enforcement officers from every corner of my state and from throughout the nation. it's going to be an emotional end to a week that has really rocked my home state. it will also be a farewell for police officers who devoted and ultimately gave their lives to protect others. you know, mr. president, law enforcement is not for everyone. in fact, it takes a very special kind of person to be willing to wake up each day motivated and ready to be on the line in protection of people standing between dangerous criminals in our neighborhood and our people.

but in the case of sergeant mark reniger, officer gregory richards, tina griswald, and ronald owens, it's easy to see where they got their motivation from. when you hear their live stories, it's clear that to a person, these were officers who, above everything else, were dedicated to family. they were officers who knew that the work they did protected those they loved and families just like theirs. in a telling quote this week, a fellow lakewood officer described his fallen colleagues by saying that they were -- quote -- "executed because they were cops but that none of them saw their own lives that way. "convincing stead he said, they saw themselves first and foremost as family men and women. for these four police officers, any reminder of just how critical the duties they performed each day came when they went home each night. mr. president, officer greg

richards leaves behind a wife and three children. he was an eight-year veteran who served in the kent police department before he jointed the lakewood department. in memorials, he has been described as a glass half-full gierks someone who made things better for the people around him. his wife, kelly, has talked this week about his passion for music and his job, and of course his family. officer tina griswald leaves behind a husband and two children. she was a 14-year veteran who served in the police departments in shelton and lacy before she joined the lakewood police force in 2004. t-she stood proudly at four foot 1. as her colleagues said many, many times, she wouldn't back down from anyone. she was a member of the riot response team. she was a hard-charging officer and a mom who loved her job and her family. officer ronald owens leaves behind a daughter. owens followed his father into

law enforcement and was a 12-year veteran to served on the washington state patrol before moving to the lakewood police department. he has been remembered as spending almost all of his off-duty time with his daughter, teandzing all of her school functions and riding bikes together and treating her to nights out whenever he could. sergeant mark reniger leaves behind a wife and three children. he was a veteran who wore the uniform of the yiewt united states before putting on the uniform of the tecuwilla police department. he was an army ranger an was described as having the kind of natural leadership anlts that put other officers at ease in difficult situations. he was a swat team trainer known for his enthusiasm for his job. but he was also remembered this week for the joy that family brought him, whether it was trips to mayorers in games or family vacations to mt. ranier. this was a senseless and brutal

killing. and it specifically targeted the people who sacrifice each day to keep all of us safe. this terrible crime has not only left the families of the victims shattered, but it has shattered our sense of safety and has left an entire community in disbelief. it was also part of a shockingly violent month for my state's law enforcement community that also included a senseless attack on october 31, which killed seattle police officer timothy brenton and left another officer, brit sweeney, injured. these attacks remind us of the incredible risks their law enforcement sphears take each day. even when doing the most routine aspepghts of their jobs, our law enforcement officers put themselves on the line for our safety. already this year more than 100 police officers across this country have given their lives while serving to protect us.

each of these tragedies sheds light on just how big a sacrifice our police officers make in the line of duty. but these most recent attacks in my home state also offer an important reminder that our officers are always in the line of duty, even when they're training other officers or out on routine patrol or simply having coffee. mr. president, there's no doubt that these senseables attacks have left many law enforcement officers across my state and our country feeling targeted. but there's also no doubt that their willingness to put themselves on the line to protect all of us will continue unshaken. that is a testament to the commitment they make to serve and protect us every day, and it should remind all of us that these brave men and women deserve all the support we can provide to keep them safe. mr. president, as my state prepares to say goodbye to these

four heroes, i want to again extend my condolences and the condolences of the entire united states senate to their families. our law enforcement professionals put themselves between us and danger every day. right now, in light of such horrible events, we hold them even closer in our own thoughts and prayers. thank you, mr. president. i yield the floor. a senator: mr. president? the presiding officer: the senator from new hampshire. mr. gregg: how much time is remaining on both sides? the presiding officer: the minority has 13 1/2 minutes. the majority, 1 minute and 8 seconds. mr. gregg: i would yield 11 minutes to the senator from iowa. the presiding officer: the senator from iowa. mr. grassley: the opponents of the gregg amendment claim that the reid bill doesn't technically change the law on guaranteed benefits for

beneficiaries. but they're enduring the fact that while those benefits may be technically guaranteed -- and i want to say technically guaranteed -- if the cuts put health care providers out of business, then those guarantees will be nothing more than useless words in the medicare act. guaranteed benefits are not worth much without health care providers who can treat patients, provide home health services, run hospitals and hospice agencies. these claims are not good enough to ensure seniors who have paid into medicare program for all these years. it's not good enough for protecting access to health care services and the benefits that our seniors have been promised. so, my colleague from new hampshire, in his amendment,

would back up those claims with very real enforceable mechanisms to ensure that medicare savings aren't being used to fund a whole new program at a time when the trust fund is just about broke. the gregg amendment is needed to protect the medicare program. after all, if you knew that the medicare program already had $37 trillion on unfunded obligations, would you be assured without an enforcement mechanism to back up those promises? no guarantee is worth the paper it's written on without an enforcement mechanism to back it up. and that's what the gregg amendment is all about. otherwise, it's just a meaningless guarantee that our friends on the other side of the aisle are talking about. it's not real without an

enforcement mechanism. and let me say for a third time the gregg amendment provides that enforcement mechanism. it makes guarantees real. it then goes much further than just the words that we get from the other side of the aisle to make sure that what seniors have, they will actually get when needed. so, opposition to the gregg amendment shines light on this issue. if the gregg amendment is not approved, it should be clear to everyone, everyone watching that all the guarantees that are made from the other side of the aisle are -- that medicare is protected in the reid bill are worthless. as a result, i hope that everyone will be watching carefully how the other side votes on the gregg amendment.

the gregg amendment is essentially necessary for protecting the medicare program. it is essential for making guarantees real. the way the gregg amendment works to enforce those guarantees is really quite simple, because the gregg amendment would make sure that the medicare program is not used as a piggy bank, a piggy bank to spend for other purposes. it will make sure that the medicare program is not being raided to fund this new program as the other side claims. under this important amendment, the director of the white house office of management and budget and medicare's chief actuary would both be required to add up non-medicare savings in the bill and compare that total to the

total of new spending in revenues in this bill. the gregg amendment works then that if the non-medicare savings don't offset all the new costs, then the treasury secretary and the health and human services secretary would be prohibited from implementing the new spending or revenue provisions in the bill. by doing so, the gregg amendment would ensure that non-medicare savings are in fact paying for the new spending in this bill. and it would ensure at the same time that medicare itself is not being used to pay for new spending in the bill. it's very simple, very straightforward. it brings common sense to this whole argument that's been full of a lot of nonsense before now. the amendment, therefore, would

prevent massive government expansion at the expense of medicare beneficiaries. massive expansion is one thing if it's paid for, but it's quite another thing if you take the money out of a trust fund that's on its way to being broke and use it to set up for a whole brand-new entitlement program to the tune of $464 billion. as opposed to the mere nonbinding sense of the senate resolutions that the other side has offered to pretend to protect medicare, this gregg amendment requires action, action that has to be taken to protect the medicare program. the gregg amendment is the enforcement mechanism for the guarantees the other side says that they're making to protect medicare. slashing medicare payments to

start up another new and in fact unsustainable government entitlement program is not the way to address big and unsustainable budgets. may i ask how much time of the 11 minutes allotted to me i have? the presiding officer: the senator has 4 1/2 minutes of those minutes remaining. mr. grassley: i don't think i'll use the 4 minutes but i'd like to take a little bit of time to discuss the prior amendment, another amendment pending. i've always been a stronger supporting of transparency. in order to have a successful free market, consumers need to have information. so i can't think of any reason besides my strong objection to the underlying 2,074-page bill to oppose the pryor amendment. it's pretty straightforward. it requires that the secretary of health and human services have a rating system for private health plans. that sounds okay to me.

an informed consumer makes better decisions. so i don't object to the pryor amendment, but i do object to the fact that the pryor amendment is really more proof that this bill is not being crafted here out in the open on the senate floor. the associated press has confirmed based on an e-mail circulate bid democratic staff that the ben -- circulated by delaware staff that the bennet amendment last week was -- quote -- "a message amendment." "the new york times" went on to call the bennet amendment quote, unquote meaningless. now we have the pryor amendment that requires a level of transparency that in fact is already required by the bill. because if you look at page 134, the bill already describes a rating system developed by the secretary that consumers can use

to choose the right health insurance plan. so if the underlying bill is already doing this, i can only assume that this amendment by my friend from arkansas is specifically designed to buy time so that the white house and democratic leadership can cut deals and twist arms behind closed doors. that's right, the american people need to know this bill is not really being written on the senate floor. in fact, we have a 2,074-page bill before us that it took until october 2 whether when wet up here that had one leader, the senate leader to put it together. then we had the president up here yesterday speaking to his caucus. so that kind of object sraoe

educates any efforts to -- obviates to get bipartisan support for this bill. and i think it gets further proof that it's not only partisan, but that what this 2,074-page bill is we don't know yet because they're trying to put together some sort of a group that can get 60 votes to get a bill passed. so, do we really know what sort of a christmas present we're giving to the american people with this health reform bill? i don't think so. i yield the floor. the presiding officer: who yields time? mr. gregg: mr. president, what's the time situation? the presiding officer: 3 1/2 minutes for the republicans. 1 minute, 9 for the democrats. mr. gregg: mr. president, i'm not sure when this vote's going to occur. i hope sooner rather than later. first, i want to congratulate the senator from iowa, who has been involved with medicare and the issue of how we manage

medicare now for many years as a member of the finance committee and ranking member of the finance committee because his analysis was absolutely dead on and accurate, as it always is. a breath of fresh air, common sense and plain speak. the senator from iowa was very precise. the senator who used to be the chairman of the finance committee is now ranking. my amendment is simple. it says that the cuts in medicare in this bill, which are substantial -- substantial, $460 billion over the first ten years, $1 trillion over the ten years when it's fully implemented, $3 trillion over 20 years that,'s how much medicare's cut. cuts come out of primarily medicare advantage and provider payments, all which will

translate into lesser quality of care for senior citizens. that those medicare cuts cannot be used for the purposes of financing new programs which have nothing to do with seniors. the new entitlements in this bill are significant. they're expensive, and they benefit a number of people, but they don't benefit seniors. and in fact, they benefit very few people who have even paid into the hospital insurance fund from which the medicare trust fund is funded. and so it's totally inappropriate to take medicare money and use it to fund a brand-new entitlement, a series of new initiatives, the biggest of which is a brand-new entitlement and the expansion of medicaid. and the other side of the aisle, and 100 participate in a vote here which was sponsored on the other side of the aisle, 100-0 which said that wouldn't happen, the medicare money would not be

used for the purposes of funding a new program that had nothing to do with medicare. the bennet amendment. but that was a political vote. that was a political vote. everybody knew that that was a statement. it was called a sense of the senate. it didn't even raise to the standard of being an amendment really. it's something around here that is a unique vehicle, the purpose of which is to make a political statement, not worth much more than the paper it's printed on. this is different. this amendment, as the senator from iowa has pointed out, is real. it has a hard enforcement mechanism which requires that moneys which are saved by cutting senior citizen benefits and by cutting medicare will not be used for the purposes of creating new programs at the federal level. now i've heard from the other side of the aisle, oh, this is an amendment that destroys the bill, destroys the bill because

all these new benefits they plowed in here -- remember there's benefits for a lot of folks in here. there are some amendments for benefits -- there are some benefits for senators whose vote they needed. i heard some on the other side of the aisle say that's going to destroy these programs. no, it's not. i'd ask unanimous consent for an additional minute. the presiding officer: without objection. mr. gregg: and yield an additional minute. the presiding officer: without objection. mr. gregg: so these programs are not going to be terminated by this bill. the programs will still be in the law. they will still go forward. they just have to be paid for through something other than seniors' money, with something other than medicare. so, that representation from the other side of the aisle is a straw dog. what is not a straw dog, however, is that this bill

enforces the language which this congress, this senate has already voted on 100-0 under the bennet amendment. it says medicare money will not be used to fund new programs that are not medicare related. and in the end, that means medicare money will be used, hopefully, to the extent that these cuts go into place, these changes in benefits go into place for seniors to make the medicare system more solvent because it's already headed towards insolvency. with that, i reserve the balance of my time. a senator: mr. president, do i have two minutes? the presiding officer: the senator is correct. the senator from iowa. mr. harkin: mr. president, i listened to my colleague from iowa earlier talking about meaningless amendments and amendments that don't have any teeth or just meaningless an stuff like that. i listen to that. i want to make it very clear, the gregg amendment is not a meaningless amendment. it has a lot of meaning because what it does is it kills health

reform. oh, yeah, this is a meaningful amendment. make no mistake about it. it goes right to heart of what this health reform is all about. making sure that people at the low-income end of the scale have a little bit better coverage. that's people on medicaid. that's section 2001, the tax credits and co-pays in there to help moderate income people and families to afford better coverage for themselves and their families. he guts that too. and, of course, the expansion of the schip program. so, yeah, i say to my friend from iowa, this is a meaningful amendment if you want to kill the bill. if you want to kill it. and i suppose most of my friends from that side of the aisle would like to kill the bill, will probably vote for the gregg amendment. but it completely guts it. completely guts it. why? to help protect the wasteful

subsidies to the insurance companies at the expense of families who struggling to afford insurance and seniors who rely on medicare. this bill lowers premiums for american families, businesses in the country as a whole. congressional budget office just said that this week. it strengthens medicare, it improves the benefits, adds life to the medicare trust fund. and let's be clear. not one dime of the medicare trust fund is used to pay for this reform. and no guaranteed medicare benefits will be cut. now, if anyone can prove otherwise, please come forward. i've heard a lot of rhetoric about it. prove this statement is not true: not one dime of the medicare trust fund is used to pay for reform and no guaranteed medicare benefits will be cut. the presiding officer: the senator's time has expired. mr. harkin: mr. president, i ask

unanimous consent that the senate now proceed to vote in relation to the pryor amendment number 2939. and that upon disposition of that amendment, there be two minutes of debate prior to a vote in relation to the gregg amendment number 2942. that no opened be in order to -- in order to either amendment that the vote in sequence be in 10 minutes in duration. that each of the votes be subject to a 6 60-vote threshold. if the amendment achieves that threshold, that it be agreed to and the motion to reconsider be laid on the table. that if the amendment does not achieve that threshold, then it be withdrawn. that upon disposition of the above amendments, senator nelson of nebraska, be recognized to call up his amendment number 2962. that once the amendment has been reported by number, it be set aside and the republican leader's designee be recognized to call up his motion to commit with instructions.

mr. gregg: mr. president, reserving the right to object. i believe i saw -- i still have 15 seconds on my time. independent of, that i would ask that this amendment -- that this -- unanimous consent request be amended and that we agree to the pryor amendment by unanimous consent. the presiding officer: is there objection? mr. harkin: reserving the right to object. would you repeat what you asked? mr. gregg: i asked that you amendment your unanimous consent and agree to the pryor amendment by unanimous consent. mr. harkin: i -- i will have to object to that. i have no instructions from senator pryor. i believe he wanted a vote on that. so i'd have to object to that. and, mr. president -- the presiding officer: objection is heard for the modification. mr. harkin: i just want to modify my request that the two nuf

the debate prior to vote be divided. the presiding officer: is there objection? mr. gregg: i'd like to object because i'd like to reserve my 15 seconds. the presiding officer: without objection, the senator's time will be reserved. 15 seconds reserved. is there objection to the original request of the senator from iowa? without objection, so ordered. the senator from new hampshire has 15 seconds. mr. gregg: i reserved the 15 seconds because it's easy to respond to the senator from iowa because it only takes 15 seconds. taking money out of the medicare fund to fund other parts of this bill is a mistake and it is not appropriate. the presiding officer: you still have three seconds.

mr. gregg: i thank the senator. i yield my three seconds. i yield to the senator from iowa. a senator: mr. president? the presiding officer: the senator from arkansas. mr. pryor: i would like to speak on my amendment for one minute. the presiding officer: without objection. mr. pryor: mr. president, i would ask my colleagues to look at this amendment very closely. it's a good consumer-oriented amendment that will day low people to make smart decisions on their health insurance. we need more of this type of information to allow the premium payers to make good decisions for themselves, for their families, for their businesses, so i would really ask my colleagues on both sides of the aisle to consider voting for this. and do i ask for the yeas and nays? and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. the question is on amendment

number 2939. the clerk will call the roll. vote:

the presiding officer: are there

any senators wishing to vote or to change their vote? if not, on this vote, the yeas are 98, the nays are 0. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is agreed to. mr. baucus: mr. president, i move to reconsider the vote. the presiding officer: okay. under the previous order, the motion to reconsider and considered made and laid upon the table. mr. baucus: madam president? can we have order, madam president. the presiding officer: yes, may we have order, please. under the previous order, there will be two minutes of debate equally divided prior to a vote on amendment number 2942, offered by the senator from new hampshire, mr. gregg. mr. baucus baucus: madam presid? the presiding officer: the senator from montana. mr. baucus: madam president, the senate's not in order.

the presiding officer: the senator from montana. mr. baucus: madam president, the gregg amendment is a killer amendment. the gregg amendment would kill tax cuts in the bill, it would kill assistance for co-pays, it would kill the medicaid expansion for the lowest-income americans, it would kill the bill's additional funding for the children's health insurance program. the proponents of the gregg amendment advertise it as protecting medicare. that's false advertising. the gregg amendment would kill health care reform. health care reform would extend the life of medicare trust fund by four to five years. health care reform helps extend the life of medicare by making commonsense changes like decreasing hospital readmissions, decreasing hospital acquire acquired infec, paying doctors and hospitals to work together. health care reform will not reduce guaranteed medicare benefits but health care reform would extend the life of the medicare trust fund. so the choice is clear. if you want to vote against tax cuts, against medicaid, against children's health insurance program, then vote for the gregg amendment. if you want to help extend the

life of medicare, then vote against the gregg amendment. the presiding officer: senators please take your conversations outside. the senator from new hampshire.. mr. gregg: madam president, i appreciate, although with a bit of hyperbole, that the senator from montana has made my case. the medicare trust fund and the medicare recipients are going to be cut by almost half a billion dollars in the first ten years and that money is going to be taken to fund initiatives which have nothing to do with senior citizens and will not benefit senior citizens. and in the end, it's going to meet in the -- mean the medicare trust fund is less solvent and less capable of sustaining the benefits that seniors diseive. this is the only amendment that we'll get to vote on, which absolutely guarantees that the medicare funds will not be used to fund a new entitlement or to fund the purchase of votes for the purposes of passing this bill or to fund anything else in this bill that isn't tied to the senior citizens benefits. so you can either vote with the seniors and protect the medicare

funds for them or you can vote to raid the medicare fund and spend it on something else. i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote? seeing none, on this vote, the yeas are 43, the nays are 56. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is withdrawn.

: the presiding officer: the senator from nebraska. mr. nelson: i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

a senator: madam president? the presiding officer: the senator from nebraska. a senator: i ask to call up amendment 2962 -- the presiding officer: the senate is in a quorum call. mr. nelson: i ask that the quorum call be vitiated. the presiding officer: without objection. mr. nelson: i ask to call up amendment 2962 and that the clerk read. the presiding officer: the clerk will report. the clerk: the senator the senam nebraska, mr. nelson, proposes amendment number 2962. beginning on page 16, strike line 15 -- mr. nelson: madam president, i ask that further reading of the amendment be dispensed with. the presiding officer: without objection. mr. nelson: madam president -- mrs. boxer: would my friend yield for a unanimous consent request? would my friend yield for a unanimous consent request? mr. nelson: yes. mrs. boxer: we've been talking -- the presiding officer: the senator from california. mrs. boxer: thank you. madam president, we're trying to get the times locked in so senators who have come over here

get their time. so i would ask unanimous consent that senator nelson speak for ten minutes, boxer for five, mikulski for ten, grassley for ten, cornyn for ten, gillibrand for ten, and then senator mccain, would you like some time? mr. mccain: i object. mrs. boxer: i'm sorry. the presiding officer: objection is heard. mr. nelson: madam president? the presiding officer: the senator from nebraska. mr. nelson: madam president, my cosponsor, senator hatch, will appear some time later and speak in favor of amendment 2962. he's not able to be here at the moment. before thanksgiving break, i voted with a number, and majority actually of my colleagues in favor of beginning this debate.

debate is essential in our democracy. it keeps our country resilient and strong through changing times. before that vote, some argued here on the senate floor that we shouldn't hold this open and full debate. they seemed to suggest that obstruction was better than action. some also argued here on the floor that the november 21 vote was really about abortion. they were wrong. that vote was just whether to begin a debate on an issue that has consumed the american public. now is the time to start debating the issue of abortion as we're addressing many other issues in health care reform. madam president, i'd like to discuss the amendment that i proposed along with a bipartisan group of colleagues who include senators hatch, casey, brownback, thune, coburn, johanns, vitter, and barrasso. the amendment that we offer today mirrors the stupak

language added to the house health care bill. madam president, for more than three decades, taxpayers' money has not been used for elective abortions, and it shouldn't under any new health reform legislation either. some suggest that the stupak language imposes new restrictions on abortion. i disagree. we're seeking to just apply the same standards on abortion to the senate health care bill that already exists for many federal health programs. they include those covering veterans, all federal employees, native americans, and active-duty service members and others. madam president, i note that the senate health care bill, if enacted, would indeed chart new ground that covers abortions. the language in the bill goes around the federal standard disallowing public funding of

abortion. a clear majority of americans, including my constituents in nebraska, support this prohibition against using public money to cover abortion. our amendment formally extends that standard to this health care -- to this health reform bill. the united states supreme court has held that government may regulate abortion and may disallow public funds being used for elective abortions. beginning in 1976 with the hyde amendment, congress has prohibited public funding for elective abortion in all significant health-related bills. exceptions have been preserved for when the life of the mother is endangered or in the case of rape or incest. and except for those exceptions, public funds may not be used for any health care benefits package that covers abortion. some have now cited the federal employees health benefits

program, fehb, as a possible model for health care reform. the fehbp helps pay premiums for many different private health insurance plans. that way federal employees may choose the insurance plan that best suits their budget and personal needs. so it's important to note that none of the benefits packages offered to federal employees provides health insurance coverage for abortion. i repeat: none of the benefits packages offered to federal employees provides coverage for abortion. nor do benefits packages that are offered to individuals in other federal programs such as the children's health insurance program, medicare, medicaid, indian health services, veterans health and military health care programs. madam president, some have argued that the stupak language imposes tougher restrictions than in current law. that's not the case.

our amendment nearly aims to extend the current standard to this new legislation. and on another point under federal law, states are allowed to set their own policies concerning abortion. many states oppose the use of public funds for abortion. many states also have passed laws that regulate abortion by requiring informed consent and waiting periods, requiring parental involvement in cases where minors seek abortions and protecting the rights of health care providers who refuse as a matter of conscience to assist in abortions. and paps most importantly -- perhaps most importantly, there is no federal law nor is there any state law that provides a public health plan include abortion coverage. so, madam president, i believe that the current health care reform we're debating should not be used to open a new avenue for public funding of abortion. we should preserve the current policies prohibiting the use of taxpayer money for abortion that

have existed for more than three decades. a number of polls this year have again shown that the most -- that most americans do not support using taxpayer money for abortion. the senate bill as proposed goes against that majority public opinion. the bill says that the secretary of health and human services may allow elective abortion coverage in the community health insurance option, the public option, if the secretary believes there is sufficient segregation of funds to ensure federal tax credits are not used to purchase that portion of the coverage. the bill would also require that at least one insurance plan covers abortion and one that does not cover abortion be offered on every state insurance exchange. federal regulation -- federal legislation establishing a public option that provides abortion coverage and federal legislation allowing states to opt out of the public option

that provides abortion coverage eases the restrictions established by the hyde amendment. our amendment would prohibit federal funds from being used for elective abortion services in the public option and also prohibit individuals who receive tax credits from purchasing a plan that provides elective abortions. madam president, i've always been pro-life and i have a strong record opposing abortion. as governor of nebraska in the 1990's i signed into law the parental notification law and the ban against partial birth abortion. in the senate i cosponsored and voted for legislation that prohibits taking minors across state lines to avoid parental notification laws and voted for legislation creating a separate offense for harming or killing an unborn child in utero during the commission of specified violent crimes. aside from my personal views, however, i think most americans would prefer that the health care reform we're working on

remain neutral on abortion. public polls suggest so. so does the fact that over the last 30-plus years congress has passed new federal laws that have not provided public funding for abortions. so the question has been settled. most americans, even some who support abortion, do not want taxpayer money to be used for abortions. we should not break with precedent on this bill. and finally, as president obama has said, this is a health care reform bill. it's not an abortion bill. it's time to simply extend the standard disallowing public funding of abortion which has stood the test of time to new proposed federal legislation. i look forward to debating this and other issues in the health reform bill as we work to address solutions to our troubled health care system. today it just costs too much and delivers too little to the people of my state and to most

americans. madam president, i yield the floor. the presiding officer: the senator from texas. mr. cornyn: thank you, madam president. madam president, this last thursday was one of those days in washington where the left hand of government didn't know what the right hand was doing. on one end of pennsylvania avenue, the president was posting a jobs summit. but here on the other end of pennsylvania avenue, we continued debate on a health care bill which will, for reasons i will explain, be a job killer and discourage small and large businesses from hiring new people, even though unemployment exceeds double digits. the november jobs numbers show the economy is still hurting. not only is the unemployment 10%, 11,000 more families have lost a breadwinner. more than 15 million americans remain unemployed and more than

3 million americans have lost their jobs as congress passed the stimulus bill in february which failed of its essential purpose, which was to keep unemployment under 8%. according to an article by mortgage zuckerman of the "u.s. news and world report," 21% of all families have an immediate family member who has lost a job. my family is one of those, where my daughter lost a job. and 33 p-rt -- a -- 33%, a third of u.s. families, have an immediate family member or close friend who has lost a job. but the president during the job summit seemed to be completely unaware of what the policies here in washington, the impact they have on the desire and willingness of job creators actually to reenter the hiring of laid-off american woerbgs. he seemed tk-rbg american workers. he seemed to be oblivious to the role of the private sector in

creating those jobs. but if you look at the states that have been most successful in creating jobs, it's clear that job-friendly policies can actually lead to better results. i don't want to brag, but texas has been one of the best economies we've had even during this tough recession. many economists have been wondering why that is. but it's clear to me that the texas economy has been doing better than other states because of our laboratory of democracy has embraced better policies. things like growing jobs -- that is the private sector over government -- lower taxes, fiscal discipline, right to work legislation, common sense civil justice reform, just to mention a few. but my state isn't the only state that's been successful in embracing these sound job-creating policies. other states have adopted similar policies and they've

seen similar results. that is why it's so frustrating to many of us to see the white house ignoring those results and focus on policies that will kill jobs. for example, cap-and-trade, in texas alone, according to the state comptroller, more than 300,000 jobs would be lost in the state of texas if we embrace the ill-considered and misguided cap-and-trade legislation that has passed the house and that which we will consider later, perhaps next year. card check, eliminating the secret ballot. according to an economist, ann lane ferrar, for every three percentage points gained in union membership through card check and mandatory arbitration the following year's unemployment rate is predicted to increase by one percentage point, and job creation predicted to fall by about 1.5 million jobs. cap-and-trade is a job killer. card check's a job killer. then there's higher taxes.

small businesses, which are america's best job creator, may soon face the highest marginal tax rate in a quarter of a century. and still the white house wants to raise higher taxes on energy producers right here at home as well as companies that sell american products in foreign markets. the biggest job killer of all, of course, is the bill that's presently on the senate floor. this is a $2.5 trillion expansion of government, and it will cost americans jobs in a number of ways. we'll recall the -- the president's pledge on september 12, 2001, he said -- 2008, he said, no family making less than $250,000 will see their taxes increase. not your income taxes, not your payroll taxes, not your capital gains taxes. not any of your taxes.

yesterday the joint tax committee came out with a new score or analysis of what the impact would be of the reid health care bill. and they said that the reid health care bill increases taxes for 25% of taxpayers earning less than $200,000. that's even after the subsidies that are provided for in this bill are applied. without those subsidies it would be about 42% of taxpayers would see an increase in their taxes. so there are nearly a half a trillion dollars in higher taxes in this bill including things like $145 billion in excise taxes. -- on americans who have certain types of health plans. $15.2 billion on all taxpayers with catastrophic medical costs and $14.6 billion tax on

american workers who use f.s.a.'s. there are also taxes that allegedly target only the rich. but you know what? these taxes hit thousands of small businesses. that's right, the very job creators we're trying to encourage to create new jobs and retain new jobs, particularly those who are partnerships or sub chapper s corporations. for example, -- excuse m me $54 billion increase in the medicare payroll tax would be used not to pay for medicare, but to pay for yet a new entitlement spending program. the reid bill also adds $100 billion in new taxes an fees on the health care industry which will, of course, be passed down to consumers, which is one reason why insurance premiums are calculated to go up under this bill, not down.

and the reid bill would create new punitive taxes on businesses that don't offer a washington approved health care plan. and then there's the employer mandate. the employer mandate will kill jobs because the additional cost of insurance will be passed along to workers in the form of lower wages or result in reduced hours or layoffs. harvard professor kate baker said this, she said, "workers who would lose their job are disproportionately likely to be high school dropouts and minority andy fee meal. those uninsured, those with the least education face the highest risk of losing jobs under employer mandates." i mentioned the reid bill would raise premiums for small businesses. under one study those premiums in the group market would rise by 20%. i thought the purpose of health care reform was to lower and make more afford annual healthae

affordable health care, not more expensive. the reid bill makes it worse, not better. the reid bill would increase the cost shifting due to low medicaid reimbursements. cost shifting occurs because medicaid pays a fraction of what private insurance pays, medicare about 08%. in order to make up the difference, those who have private health insurance have to pay an additional cost in terms of cost shifting. 15 million more on medicaid would make this worse, not better. fiftsd, the reid bill would kill jobs by raising state and local taxes because of unfunded mandates. because of the expense of medicaid, not paid for by the government, over 10 years the state of texas alone would see $20 billion more in medicaid spending because of this unfunded mandate. $20 billion. well, we're a big state, but we can't afford $20 billion more in an unfunded mandate because of medicaid expansion under this

bill. well, it shouldn't be any surprise, madam president -- madam president that the reid bill and these other job-killing policies are the reason why the private sector is not hiring. again, according to mort zuckeman said that businesses are holding back on hiring because of matters of increased health care costs, higher taxes, more corporate regulations and disaffecting labor policies. these policies are causing the greatest anxiety among small business owners. firms of 20 or fewer employ a quarter of the american workforce and in the last economic expansion, they accounted for four out of 10 new jobs. well, i hear this from my constituents in texas, people like richard bellvin who employs 75 people, he files a as a sub

chapter s corporation, so he pays taxes according to the highest marginal tax bracket. he's going to be hit by these taxes. do you think it will be easier for him to higher more -- hire more people or make it harder. i think that the answer is self-evident. there is nathan who owns five burger kin restaurants and employs more than 100 people. he said that the mandates included in this bill will make it harder, not easier to keep the employees that he has. he believes the employer mandate would cost him thousands of dollars per restaurant, effectively eliminating much of his profits and make it exceedingly difficult to operate and improve his business in this economy. and i've heard the same story from the chamber of commerce in lubbock, texas, that employs -- that represents more than 2,100 businesses and employs more than

57,000 workers. it is not just the lubbock chamber, it is the greater austin chamber, the rosenberg richmond area chamber, the liberty-dayton area chamber, the tyler area chamber, the brian college station chamber, the northwest-houston chamber, odesa chamber, the west i-10 chamber, the crowley area chamber, the marble falls chamber, mccallen area chamber and the washington county chamber. well, you get the idea, madam president. these are job-killing policies and this bill is perhaps the biggest of them all. of course a few enterprises will get bigger under the reid bill, namely the internal revenue service. according to the nonpartisan congressional budget office, the i.r.s. will need a budget nearly twice its size to enforce the

reid bill. the i.r.s. will need more agents and bureaucrats to collect the new taxes and enforce all of the new mandates and apply all of the additional red tape. madam president, i think we should be about facilitating the creation of new jobs, not killing jobs through ill-considered policies like this bill. i yield the floor. mrs. boxer: madam president? the presiding officer: senate from california. mrs. boxer: madam president, it's an honor to be here in the senate, a time when we're working on one of the major issues of our time. we know that generations of leaders in both parties have tried toll solve health care crisis, and they've done it bit by bit. we read history, we know that leaders struggle with social

security, the democrats were in the forefront, the republicans fought us every step of the way. and, frankly, roosevelt took the lead on that. and we had john kennedy and lyndon johnson take the lead on comaimplemedicare. the republicans fought us every inch of the way on that. we had some cooperation from certain senators and certain members of congress. but overall it was very difficult. and this fight is very difficult. to make sure that we turn things around. we live in a society where if we don't step into the chair, we are told by -- reid chair, we are told by nonpartisan surveys -- if senator grassley wouldn't mind. it's hard for me to concentrate. we are told if we do nothing, and this is important, premiums for our average families in california will be 41% of income. 41% of income. in states like pennsylvania will be 50% of income.

well, we know what that means. people will not have health insurance. so we could pull the covers over our head and say it's too hard, too it's -- it's too tough. we could turn our bankruptcies are related to health care crisis. we could turn our back that infant mortality in our nation, 29 out of 40 nations, that's where we come out. something is wrong when so many people don't have access to insurance, and even when they do, when they need it most, it's gone. how proud am i to be here at this time? very proud. how grateful am i to the people of my state for sending me back three times to i could stand here and be a voice for them, i can't tell you, madam president, how proud i am. and when we started this health care debate, we knew it was important to the people we represent and we knew it was%

important to the economy of this -- it was important to the economy of this country. senator cornyn has gotten up and said this bill is terrible for the economy. let me tell you, there's $27 billion worth of tax cuts in this bill. let me repeat that. $27 billion of tax cuts for small business. there are billions of dollars of tax breaks for individuals. so for people to stand up and say this isn't good for our economy, i just don't think they understand or get it. if we continue with the status quo, that's when we're in trouble. now, the women of the senate have been very involved. very involved. the democratic women. we have worked together to make sure that this bill meets the needs of all of our families including the women of this country. and senator mikulski, who's on

the floor, took the lead and made sure that we corrected a problem that was in the bill. a problem, which basically was unclear as to who was going to set the benefits. and we wanted to make sure that women can get mammograms after 40 every year, senator mikulski fixed it by making sure that the head of health and human services is going to be the one to decide what is covered. and women's prevention has now gone way up to the top of the list because of senator mikulski and the women who worked with her on this. we're very proud of that. well, there's one thing that was taken care of in the reid bill that we didn't think we'd have an argument about. and that is we thought we had an understanding that we were not going to bring up the issue of abortion, that it wasn't necessary to do it because we weren't doing anything in the bill senator reid -- senator reid doesn't do anything in the

bill that changes the current agreement. and let me say, because i started in the house in the 1980's, i was part of that agreement. i offered the amendment that said, yes, it's true no federal funds could be used unless the life of the woman was at stake for abortion. and through my amendment we added rape and incest. and those are the only three acceptions. no federal funds could be used for abortion except to save the life of the woman or if she's a victim of rape or incest. and that agreement has held for three decades. now, it's fair to say neither side is thrilled with it. but the fact is the agreement is held. and the fact is that senator reid has crafted a bill, which is the underlying bill, that preserves that three decades long agreement. but over on the house side, they passed a radical stupak amendment which strikes at heart

of this delicate -- by preventing women from using their own private funds, madam president, for their legal reproductive health care. now, that's a big shock because women have been able to utilize their own private funds in order to get a legal procedure -- legal procedure and never has anyone, to my knowledge on either side of the aisle, said that she couldn't get access to insurance to cover the whole range of legal reproductive health care if she uses her own funds. this amendment takes us way back. now, here's what's really interesting. the people who bring us this, and mostly it's going to be the men who speak on this, i think -- we'll see if that's right or