yield for a comment? mr. brownback: i'd like to quote bart stupak who carried this amendment, the same sort of amendment you're putting forward only on the house side and the same sort of questions naturally were coming up, saying you're blocking abortion funding of the individual. and i'm quote ron goldman from representative stupak, the cap amendment departed from hyde in several important and troubling ways, by mandating that at least one plan in the health insurance exchange provide abortion coverage. by requiring a minute number $1 monthly charge for all covered individuals that would go toward paying for abortions by allowing individuals receiving federal affordability credits, those are federal dollars, to purchase health insurance plans that cover abortion. in all those ways, the cap amendment, which is in the reid bill, expands and does federal

funding of abortion that we haven't done for 33 years. going on with stupak, hyde currently prohibits direct federal funding of abortion much the stupak amendment, which is also the nelson-hatch amendment, is a continuation of this policy of the hyde amendment. nothing more. nothing less. and i think it's important that we clarify that this is a continuation of what we've been doing for 33 years that the senator from utah, the senator from nebraska is putting forward in this amendment. and i thank my colleague for yielding for that. mr. hatch: i thank my colleague for bringing that forward. the segregation language in here is a very problematic language, and that's what we're trying to resolve. we basically all agreed with the hyde language since 1977, this would, in effect, incorporate the hyde language for the bill. a senator: would the senator yield for a comment? mr. hatch: sure. mr. johanns: if i might just

have a thought on this language. the national right to life group saw through that language immediately. it took them about 20 seconds to figure out what was happening here and i think they referred to it as a bookkeeping gimmick that there would be segregation if the federal money went in the left pocket but you paid for abortions out of your right pocket. and it doesn't make any sense. that segregation isn't going to work. they saw through it. they saw the gimmick it was. let me just say i support your amendment. i applaud you and senator nelson and senator casey for bringing this very important issue forward. i applaud you for keeping this effort that started with the hyde amendment or hyde language, rather. because what we're doing here is saying clearly to the american people, whether directly or

indirectly, your tax dollars are not going to be used to buy abortions. and thank you for your leadership on this issue. i'm happy to be here to support that. a senator: would the senator from utah respond to my question? mr. specter: how can you disagree with the provisions of section 1303, 2a, the bill which is pending which specifies that if a qualified health plan provides for services for abortion -- this is the essence of it -- if a qualified health plan qualifies for services for abortion, the issue of the plan shall not use any amount of the federal funds for abortion. so there is a flatout prohibition for use of federal funds. and under section 1303, 2b, there is a segregation of funds which is identical to medicaid. so however you may want to characterize it, the -- how do

you respond to the flat language of the statute which accomplishes the purpose of the hyde amendment and allows -- allows for payment by collateral funds just as medicaid pays for abortions without federal funds. mr. hatch: i'm not going to ask it in the form of a question. if that's true, then why have the cap language in there? why don't we take the hyde language, which is what we're trying to do. is didn't true. we know under this bill there would be subsidization to help people pay for it. it could go up to $88,000 a year. and that could be indirectly used for abortion. it is a loophole that hyde closes. and if -- if -- if the distinguished senator from pennsylvania believes that the cap language does what hyde meant to begin with and what it's been since 1977, what's

wrong with putting the hyde language in here? what's the problem we see it as literally a loophole through which they can actually get help from the federal government directly and indirectly to pay for abortion. now, let's think about it. there are no mandates in this language that we have for elective abortion coverage. plans and providers are free from any government mandate for abortion. there's no federal funding of elective abortion or plans that include elective abortion, except in the case where the life of the mother is in danger or the pregnancy is caused by rape or incest. the amendment allows individuals to purchase a supplemental policy where a plan that covers elective abortion as long as it is purchased with private dollars. the amendment prohibits the public plan from covering elective abortions, it prevents the federal government from

mandating elective abortion by providers within such plans and are not prevented from selling truly private abortion coverage. even through the exchange. this amendment doesn't prohibit that. bottom line, the effect on abortion funding and mandates is exactly that of the house bill changed by the stupak amendment. look, if -- if the distinguished senator from pennsylvania believes that -- that the cap language is the same as hyde, he's wrong. and if he believes that it does what hyde would do, he's wrong. and why not just put the hyde language in once and for, which has been there since 1977, that's what the stupak language is. the hyde amendment specifically removes abortion from government programs. but the reid bill specifically allows abortion to be offered in two huge new government

programs. the reid bill tries to explain this contradiction by calling for the segregation of federal dollars when federal subsidies are used to purchase health plans. this -- quote -- "segregation" of funds actually violates the hyde amendment which prevents funding of abortion by federal funds and state matching funds within the state plan. simply put today federal and state medicaid dollars are not segregated. and so that's the difference. now, if -- if the distinguished senator from pennsylvania believes that the current language in the reid bill meets the quality of the hyde language, why not put the hyde language in once and for since it has been in law since 1977? it's important to note that today there is no segregation of federal funds in any federal health care program.

for example, the medicaid program receives both federal and state dollars. there is no segregation of either the federal medicaid dollars or state medicaid dollars. with that, i know i have some colleagues who asked to have time to speak. i will yield the floor. mr. vitter: will the senator yield? madam president? mr. specter: the senator from utah has not yet answered the question. the presiding officer: the senator from louisiana. mr. vitter: i strongly support the senator from utah's amendment and along with senator nelson and senator casey. i think that this exchange and colloquy is very helpful. in fact, i think it proves the point and the senator from pennsylvania's participation in it. the only folks defending the language in the reid bill are folks who are strongly and clearly pro-choice an proabortion. -- and proabortion. folks who have a problem with

that say that the underlying language in the reid bill has huge loopholes. and that includes the people who want to support the bill otherwise. as senator brownback mentioned, representative stupak wants to support the underlying bill, supported it in the house, but he was very clear in his efforts on the house floor that that underlanguage, which is now in the reid bill, had huge loopholes, wasn't good enough. needed to be fixed. that's why he came up with the stupak language, and that's essentially exactly what we have in this amendment. similarly the u.s. conference of bishops. they're very supportive of the concepts of the underlying bill. it said clearly that the reid bill is cleell completely unacc,

close quote, on this abortion. and -- quote -- "-- so this colloquy involving the distinguished senator from pennsylvania, that general debate, i think, proves the point clearly. and i, again, compliment the senator from utah, along with senator nelson, senator casey, others. i'm a cosponsor of the amendment. we need to pass this on the bill. this will do away with the loophole. this will be real language to truly prohibit taxpayer funding of abortions. this constitutes exactly the same as that long tradition since 1977 of the hatch amendment. this mirrors the stupak language. so it should be crystal clear. what will this amendment specifically do? it will mean that there are no mandates for elective abortion coverage.

plans an providers are free from -- and providers are free from any government mandate of abortion under this amendment language. it would mean that there is no federal funding of elective abortion or plans that include elective abortion, except in the cases when the life of the mother is in danger or in cases of rape or incest. this means that this amendment would allow individuals to purchase a supplemental policy or a plan that covers elective abortion as long as that separate policy is purchased completely with private dollars. it would prohibit the public plan from covering those elective abortions an prevent the federal government from mandating abortion coverage by any private plan. insurance plans are not prevented from selling truly private abortion coverage, including through the exchange, but taxpayer dollars would have nothing absolutely -- absolutely nothing to do with it. bottom line, the effect on

abortion funding and mandates is exactly the same as the long distinguished tradition of the hyde amendment with this amendment and it would be exactly the same as the stupak language on the house side. now, i also agree with the distinguished senator from utah when he said this should not be of any great controversy. abortion is a deeply divisive issue in this country. but taxpayer dollars being used to pay for abortion is not. there is a broad and a wide and a deep consensus against using any taxpayer dollars to pay for abortion. the senator from utah mentioned polls. that's why the hyde amendment has been longstanding since 1977. that's why it's been voted and supported and passed again and again and again. in congressing with democratic majorities and republican majorities. it is a solid consensus.

it does represent the commonsense of the american people. -- common sense of the american people. i will follow in a similar proud tradition of louisiana senators supporting that consensus. every u.s. senator from louisiana since the hyde amendment was originally adopted has strongly supported this commonsense consensus view. every senator. an everyone, but me, has been democrat. every sitting senator from louisiana has supported that commonsense consensus view, and i surely hope that tradition, as well, continues today. again, i applaud the senator from utah and his leading cosponsor, senator nelson, senator casey on this effort and i encourage all of my colleagues, democrats and republicans, to come together around what the american people consider a real no brainer.

a new consensus. something that clearly reflects the common sense of the american people. is abortion a divisive issue? yes. is using taxpayers to fund abortion a close question? no. there is a clear consensus in america not to use any taxpayers' dollars to fund abortion. it's crystal clear to continue that. we need to pass this amendment and the underlying language in the reid bill is completely unacceptable. with that, i thank you, madam president. i yield the floor. mr. hatch: madam president, i'm appreciative of the distinguished senator from texas, the distinguished senator from louisiana and the distinguished senator from nebraska and, of course, the distinguished senators from kansas and -- and montana -- not montana but south dakota, who are here on the floor and participating in this. i believe we have until 12:27.

so i'm going to relistening wish the floor and leave it up -- relinquish the floor and leave it up to you. a senator: i want to put a fine point on something that was said by the senator from pennsylvania about the use of medicaid funds in the states. there are a number of states that do provide programs that have abortion funding, but i think there is a very clear distinction that needs to be made in medicaid funds which are matching funds, and none of those funds can be used to fund abortions. and you said that in response to his question, but i think that point needs to be made very clear because the senator from pennsylvania was implying that somehow since states had created programs that fund abortions and since medicaid is a federal-state program, that somehow those two are being mixed and that this idea that because we're -- they're calling for -- quote -- segregation, that really doesn't exist in the medicaid program. the medicaid program, those are matching funds. that is a federal-state program,

and the federal dollars that go into the medicaid program, the prohibition that exists on federal funding of abortions applies to medicaid dollars that go to the states. to the degree that states have adopted programs that fund abortions, those are state funds and not medicaid funds which are matching funds. mr. hatch: i'm glad the distinguished senator made that even more clear. last night, a number of democrats got on the floor and i think completely distorted this issue. look, if they -- if they think that the caps language equals the hyde language, why not put the hyde language in? they don't want it in because they want to be able to fund abortion any way they possibly can. and they will not only be able to fund it in a variety of ways with federal dollars if we don't put the -- the hyde language in. so that's what this is about. i would be happy to yield the floor. a senator: i have another point on this as well f you're not

clear about this, then abortion will also be funded. mr. brownback: if there is any sort of this let's kind of be fuzzy about this and not be clear, the commonwealth of massachusetts recently passed its state-mandated insurance, commonwealth care without an explicit exclusion on abortion, and guess what? abortions there were also funded immediately. in fact, according to commonwealth care website, abortion is considered covered as an outpatient medical care. so that's the point about being clear with the hyde type language, which is the nelson-hatch language, is it specifically says no, we're not going to fund this, we're going to continue this 33-year policy. and if we do fund abortion, if we put the caps funding in that does fund abortions, last time the federal government funded abortions was the three-year period after roe but before hyde, annually we were funding about 300,000 abortions a year, federal taxpayer dollars funding of abortion through medicaid. i cannot believe that any of my

colleagues would say yes, i would be willing to buy into that, 300,000, when president obama, president clinton before said we want to make abortion safe, legal, and rare. well, 300,000 a year wouldn't be in that ballpark, and that's the past number that happened when you didn't have hyde language in place at the federal level. mr. hatch: it's just a big excuse. all this yelling and screaming when they say well, it equals the hyde language. it doesn't equal the hyde language. that's the problem. and if they -- if they want to solve the problem, why not use the hyde language that has been accepted by every congress since 1977. and you're right. 300,000 abortions between 1973- 1977 because we didn't have the hyde language, we got tired of it, tired of the taxpayers -- why should -- paying for it. why should taxpayers who are pro-life, for religious reasons or otherwise, have to pay for

abortions, elective abortions by those who are not? they shouldn't have to. and to be honest with you, the language in the current bill is ambiguous, it would allow that, and anybody who is arguing that this is the same as the hyde language just hasn't read the caps language. and we want to change it so that we go with hyde. it doesn't affect the right to an abortion at all except that we're not going to have taxpayers paying for it. mr. thune: to the senator's point if he would yield on that point. that's what the stupak and other members of the house of representatives saw, that this created tremendous ambiguity, and they sought to tighten it up and reinstate what has been long-standing policy with regard to federal funds and their use to finance abortions since 1977 and the hyde language. and so the stupak amendment to the house bill, as you recall, passed with 240 votes. there was a sizable decisive majority of members in the house

of representatives who saw through what the -- the am ambiguity that exists with regard to the house bill and now the senate bill. but this is intentionally ambiguous for the reason you just mentioned. all this simply does is clarify once and for all what has been standard policy here at the federal level going back to 1977. and as was stated earlier, i believe represents the consensus view in america, both republicans and democrats i think believe that this is ground that we all can stand on, irrespective of where people come down on this issue, that the idea that somehow federal funds ought to -- taxpayer funds ought to finance abortions is something that most americans disagree with, and that's why i think there has been such broad bipartisan support going back to 177 for this particular policy and why it should be extended into the future. and as you said, the senator from utah said 61%. i've seen polls that suggest it's much higher than that. it certainly would be much

higher than that in my state of south dakota. but i commend the senator for seeing his way to offer an amendment that clarifies and removes all this ambiguity and what to me is clearly intentional ambiguity with regard to this issue and the underlying bill. mr. hatch: i ask unanimous consent that senator cornyn be added as a cosponsor of the nelson-hatch-casey amendment. a senator: how much time is left on our side? the presiding officer: four minutes, 48 seconds. mr. johanns: i have been on the floor a number of times now debating this issue a while back on the motion to proceed and since this amendment has come out. the senator from utah, i don't believe i have seen a more concise, clear explanation of the history of the hyde language than i just saw over the last

half an hour of debate here on the senate floor. you laid it out perfectly. you laid out how we have over a long period of time stayed with that hyde language. that was the agreement that had been reached. now, our colleague from texas said this is a foot in the door, and i agree with her. if this reid bill passes with the current language on abortion, it's not only a foot in the door, in my estimation it kicks down the door. it kicks down the door and sets up structure for funding, federal funding of abortions, and that's what we're going to end up with. now, a couple of weeks ago, i came to the floor when we were debating the motion to proceed and i said at that time -- i said, you know, to me, this is the pro-life vote, because if this bill goes to the floor, we now need 60 votes to get an

amendment passed. i said i don't count the 60. i kind of issued a challenge. i said gosh, if there is any member who does have a list of 60 members who will vote for this amendment, i'm willing to take a look at that and change my view of the world. well, that hasn't happened. in fact, there are many predictions being made that sadly and unfortunately this amendment won't get the 60 votes needed. well, let me put this in context. for pro-life senators, this is the vote, but it doesn't stop here. in my estimation, you're pro-life on every vote. you don't get a pass on this vote or that vote or the next vote or whatever the vote is. you're pro-life all the way through. and even if this amendment doesn't pass, i wanted to make the case that then this bill should not go forward because it literally will create a system, a structure, a way to finance

abortions. and i don't believe that that's what this country wants. many senators -- the senator from south dakota, the senator from kansas have very, very clearly made the case. the people in the united states do not want their tax dollars to go to buying abortions. and so my hope is that 60 will step up on this amendment. i'm sure going to support it. i'll speak everywhere i can in support of it. i just am so appreciative that senator nelson and senator hatch and senator casey brought this forward, and i'm glad to be a cosponsor. and it is my hope, it is my hope that this amendment will pass, but then it is my conviction that we need to stand strong throughout this debate and make sure that this language doesn't end up in the final bill. i yield the floor. the presiding officer: the senator from kansas.

mr. brownback: i think the -- the catholic bitches put it probably as concisely as anybody. they put it in this term -- they said in every major program where federal funds combine with nonfederal funds to support or purchase health coverage, congress has consistently sought to ensure that the entire package of benefits excludes elective abortions. that's what we've done. that's what we have done for 33 years until this moment. until the caps language that's the base in the reid bill, and now we would flip that on its head and we would say you can combine federal funds with nonfederal funds to pay for elective abortions. that was the policy prior to hyde in 1977. that funded then 300,000 abortions roughly a year at that point in time. there is no way in this country that that's the policy that the american people support. they don't. they would be divided about abortion. they are not divided about

federal funding for elective abortions. no division about that at all. very consistent policy until we've seen the reid bill in this particular piece of legislation. and we have been quite consistent about that, so it would be my hope that my colleagues would say well, okay, i may be pro-choice but i have consistently supported hyde because i think that's -- we shouldn't be funding elective abortions, and i would hope that they would vote for the nelson-hatch amendment because of that very feature on this. it isn't about abortion. it's about the funding. it's about the funding of elective abortions, and that we wouldn't go that direction. i yield the floor. the presiding officer: the senator's time has expired. mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: how many minutes do i have remaining? the presiding officer: three minutes and 17 seconds. mr. baucus: great. thank you. madam president, first, i have five unanimous consent requests for committees to meet during today's session of the senate. they have the approval from the majority and minority leaders.

i ask consent that these requests be agreed to, that these requests be printed in the record. the presiding officer: without objection. mr. baucus: mr. president, with respect to the last debate, let's just be clear that the underlying bill keeps the three decades-old agreement that has been implemented -- that has implemented the hyde amendment to separate federal funds from private funds when it comes to reproductive health care. the nelson-hatch amendment is unnecessary. it is discriminatory against women. and women are the only group, let's remind ourselves, of people who are told how to use their own private money, and that is not fair. madam president, another matter. i'm referring now to the mccain amendment. let me just explain a little bit about medicare advantage and how it works. essentially, the medicare advantage program is insurance

companies. they are insurance companies that have their own officers, directors. they have their own marketing plans. they have their own administrative costs. they were concerned about the rate of return on investment, clearly, and their stockholders. these are plain and simple, garden variety, ordinary insurance companies, but in this case they are insurance companies that get revenue from payroll taxes and premiums, but they are basically insurance companies that get paid -- that give benefits to senior citizens. now, these insurance companies have been overpaid. there's not much disagreement that these insurance companies are overpaid. and how are they paid? how are these insurance companies paid? well, believe it or not, these insurance companies, medicare advantage plans, are paid according to amounts that congress sets in statute. that's what their payment rate

is. it's what congress sets in statute. and the problem is that by doing so, these preset rates overstate the actual cost of providing care by 30%. they pay more than it costs to provide care by 30% in many cases. and these overpayments also clearly promote inefficiencies in medicare. also the -- these payments have not been proven to increase the quality of care that seniors receive. in fact, the ?iment that i saw is that about half of medicare advantage plans have -- have care coordination and half don't. half are no better than ordinary fee-for-service plans. because of this broken, irrational payment system, some plans receive more than $200 per enrollee per month and others receive about $36 per enrollee per month. again, the -- the payment rate is set by statute.

as related to fee for service in the area, it's just broken, it doesn't make sense. it causes great dislocations and differences in payment rates. frankly, under this broken system, all beneficiaries are not receiving the same care. i believe all beneficiaries should be able to have access to the best care, not just those that have to live in states with high payment rates. madam president, i ask to continue for an additional five minutes. the presiding officer: without objection. mr. baucus: madam president, t the -- it's -- i've said that these medicare advantage plans are overpaid. nobody disagrees with that. they are overpaid. the senator from oklahoma, senator coburn, i asked him a few days ago if he thought they were overpaid. he said yeah, they are, they're overpaid. medpac advisory board tells us, says yeah, they're overpaid. here's also a statement made b by -- a few days ago by tom

skully, the formeer administratr for medicare and medicaid services -- quote -- "i think congress should take some of it away. there's huge overfunding." and i've got lots of other citations, some from wall street analysts, others from -- others in the industry saying clearly the medicare advantage plans are overpaid. and, frankly, we are in congress -- due to the statutory provision we have in law have caused this overpayment. so i think clearly we should -- we should fix it. in addition, something that's pretty alarming, madam president. according to a study i saw, about only 14 cents on the dollar of extra payments to medicare advantage plans goes to beneficiaries. only 14 cents, which means 86% -- 86 cents on the dollar go to the company, not to the beneficiaries, not to enrollees but to the companies. the companies, meaning the officers, the directors, administrative costs, marketing costs, rate of return you have

to push up. it's to the company. like any other garden variety company. and i think, therefore, it behooves us to find a better way to -- to -- to pay medicare advantage companies so that th the -- it's efficient, there's no waste and payments go primarily to -- to the enrollees, to the beneficiaries. so how do we do that? this legislation moves away from the current arcane system which sets statutory amounts in effect. rather, we say, okay, why not have these companies bid, let them compete based on costs in certain -- in their regions? one region of the country is a bit different than another region of the country. we're going to say okay, what's fair here, so get rid of the waste and overpayments, is to provide that medicare advantage plans can compete in their area based on cost. and the -- and the plan will be paid the average bids that

are -- that are based on competition in the area. i think, we think, authors of this bill think that's a far better way of paying for medicare advantage. and will that reduce payments to beneficiaries? certainly, no. all guaranteed benefits are guaranteed in this legislation. in fact, i'm going to check up on another statistic i've heard somewhere, that under this legislation that we increase enrollees. increase not decrease, but increase enrollees. i've got to track that down because i want to make sure that i'm accurate with that statement. but it's -- i'll just conclude, madam president, because i want to talk more about this later. there may be a separate amendment on this subject offered by some on our side. but by ask large, it's wrong to continue a -- but by and large, it's wrong to continue a system that dramatically overpays and where 86% of the overpayment goes to the company, only 14 cents goes to the beneficiaries. we have to come up with a fair

way of paying medicare advantage and i think a fair way is to have the competitively bid based on cost in their areas. that way they're going to get reimbursed at a -- at a level that's -- that's relevant to their area, it's also relative to the costs that they incur when they run their plans. i'll have more to say about that later. i yield the floor. the presiding officer: under the previous order, the senate

>> there appears off the floor to be a plan in the works allow younger people to buy into medicare exchange for dropping the government-run insurance plan, the public option. what can you tell us about details that are emerging? >> this is very interesting set of discussions going on between five centrist democrats and five more liberal democratic senators where the liberals appear to drop their insistence having a government-run option if they have a medicare expansion. this is intriguing. they're hoping to offer medicare to folks 55 and over who lack employer provided coverage. medicare is open to people 65 and over and disabled. so it would be an expansion of a very cherished, established entitlement program on top of expansion in medicaid already envisioned in the bill. >> who are the senators

involved in the negotiations. >> i will have to recite those. i have a cheat sheet here. you have some of the centrists already engaged in floor debate. >> right. >> ben nelson of nebraska. blanche lincoln of arkansas. mary landrieu of louisiana. folks like that. liberal side, sherrod brown of ohio. jay rockefeller of west virginia, tom harkin of iowa. some folks are proxies of the leadership like charles schumer ew york, who is the number three senate democrat and mark pryor of arkansas. i probably missed a few. >> this idea that is percolating, if this idea of dropping the public option for going the medicare route, would this affect support of that underlying bill? could it possibly attract republican support as well? >> i think this is more a case of democratic coalition management at this point, getting centrists to a very suspicious of big government involvement in the health insurance market and liberals getting them more or less on the same page. i doubt it would bring anymore republican support. i guess votes of two moderates from maine,

olympia snowe and susan collins are still in play. >> what about senator reid? he apparently given the group a deadline of today to reach an agreement. >> he wants this today, because he has to rush it over to the congressional budget office for scoring, because how will you sell anyone on pretty dramatic change in the bill without getting some numbers? medicare expansion this could be very costly. when you talk about insuring folks 55 and overwho don't have coverage now, that is a pretty tough cohort. a lot of private insurers don't want to necessarily tough them. when they, people in that age cohort get medicare coverage, rather, 65 and over get medicare coverage, sometimes part-b premiums that cover doctors visits can be over 300 a month. so it depends how they would structure this depends how they would subsidize if they even want to subsidize the purchase of medicare for these folks. so the numbers are critically important to whether people are going to buy into this idea. >> now on the senate floor itself abortion has been the

main topic again today. what is expected to happen in relation to the amendment proposed by senators nelson and hatch? >> in all likelihood it will be rejected. this is a language that largely mimics language in the house-passed health bill, the one the house passed in early november that basically would restrict elective abortion coverage through a public option. and it would make it difficult for people who receive subsidies in a retooled health system to acquiree elective abortion coverage. essentially, there are enough abortion rights supporters in the senate to probably beat this back. the problem for the democratic leadership is, senator nelson has said if it doesn't get adopted into the broader health bill, he is going to withold his support for that health bill. that puts onus on harry reid to come up with a quick compromise or start looking for republicans to replace nelson. >> for folks watching the debate will we see a vote on that abortion amendment today? >> in all likelihood. there is a series of

amendments. we're getting into some interesting issues. there is one coming up on drug importation a perrone kneel topic in the health care debate, whether consumers can import from other countries. prescription drugs sold in the u.s. are sold for less in those countries like canada. >> as we wrap up here, give us an idea of some of the next significant amendments we might see in the senate debate. >> well, as we said the drug importation by senator dorgan, among others of north dakota is an important one. there's also a series of cost containment measures that a group of freshmen democrats in the senate have been pressing. ways to kind of make this a more fiscally responsible bill. changes to the health system, changes in payment methods through the government's big programs that would make this not just an expansion of coverage but even more an exercise in fiscal responsibility. when you consider that those were two goals that president obama laid out when he began this exercise early this year, they're

trying to sink that up and sync, as junior members to influence out commodity of the debate. >> congressional quarterly's managing editor. thanks for the update. >> thank you. >> a reminder find out more information about the senate health care proposal at c-span's health care hub. read the bill, information about amendment, previous days video as well, briefing it is al at cspan.org/health care. program reminder, commander of u.s. forces in afghanistan, stanley mcchrystal on capitol hill testifying before the house armed services committee explaining the president's new policy on afghanistan. this afternoon he will be before the senate armed services committee coming up at 1:30 eastern. that will be live on c-span3.

>> president obama this morning laid out a four-point plan for creating jobs that would be funded in part by money left over from the troubled asset relief program or tarp. the plan includes tax relief for small businesses infrastructure spending, energy efficiency incentives and expansion of safety net programs such as unemployment benefits. from this morning at the brookings institution in washington, it is just over half an hour.

>> ladies and gentlemen, to introduce the president of the united states, please welcome brookings institution president, strobe talbot. [applause] >> that could be habit-forming. i don't get that very often. welcome to all of you. president obama honors all of us who are gathered here today. he honors us with his presence. over the past here he has honored brookings by bringing many of our colleagues on to his team, at the white house, at the state department, at treasury, defense, energy, commerce, and a key embassies around the world. we do not regard those departures as a loss.

we regard them rather, as a donation to the public good. government service is a lon long-standing brookings tradition. 35 years ago, the founding director of the congressional budget office, was a brookings scholar. she still is. alice rivlin, right there, in green. the current director of the cbo, doug elmendorf, also came from brookings. so did his immediate predecessor, peter orszag, who is here with us today in his capacity as the director of omb. i single them out because their contributions, both as scholars, and as public servants, are pertinent to what the president will be speaking about shortly. but i could just as easily cite our experts who have worked here, and in government, on education and health care, infrastructure,

and innovation, smart growth, and smart power, climate change, and non-proliferation, war and peace. those subjects of course are all on the president's agenda today and every day. but no matter what else he's dealing with, he is always, always, thinking about the troubles that beset the american economy, and what it will take to fix them. for us, as for him, that is what he might call, an all hands on deck challenge. week before last scholars from four of our research programs joined leaders of the business community for a two-day brainstorming session. it benefited from the participation of our former colleague, larry summers as well as karen mills and valerie jarrett, who are also with us this morning. those discussions resonated

with ones that followed at the white house jobs summit. and with the president's recent visit to hard-hit communities in pennsylvania. so he's been out there listening to americans, who are suffering from unemployment, and we've been listening to him as he grapples with the search for remedies. we thank him for coming to brookings today, with his message, with his respect, for good ideas as the basis of good policis. with his high standard of civility in public discourse and of course, with his leadership. ladies and gentlemen, it's my pleasure to introduce the president of the united states. [applause] >> thank you. thank you. thank you so much. thank you, everybody. please, everybody have seat.

thank you so much, strobe, for your extraordinary leadership here at brookings and thanks to all of you in attendance. almost exactly one year ago on a frigid winter's day i met with my new economic team at the headquarters of my presidential transition offices in chicago, and over the course of four hours my advisers presented analysis where the economy at that time stood accompanied by a chilling set of charts and graphs predicting where we might end up. it was an unforgetable series of presentations. christine roemer, who is here today, tapped to head the council of economic advisors, as well as larry summers, who i have chosen to head the national economic council, described an imminent downturn comparable in its severity to almost nothing since the 1930s. tim geithner, my incoming

treasury secretary, reported that the financial system, shaken by the subprime crisis, had halted almost all lending, which in turn threatened to pull the broader economy in a downward spiral. peter orszag, my incoming budget director, closed out the proceedings with entirely dismal report on the fiscal health of the country, with growing deficits and debts stretching to the horizon. now having concluded that it was too late for me to request a recount, i tasked my team with mapping out a plan to tackle the crisis on all fronts. it wasn't long after that meeting, as we shaped this economic plan we began to see some of these forecasts materialize. over the previous year it was obvious that folks were facing hard times. as i traveled across the country during the long campaign, i would meet men and women bearing the brunt of not only a deeping recession but also years, even decades of growing

strains on middle class families. but now the country was experiencing something far worse, our gross domestic product, the sum total of all that our economy produces, fell at the fastest rate in a quarter century. five trillion dollars of americans's household wealth evaporated in just 12 weeks as stocks, pensions and home values plummeted. we were losing an average of 700,000 jobs each month, equivalent to the population of the state of vermont. that was true in december, january, february, march. the fear among economists across the political spectrum that was that we were rapidly plummeting towards a second great depression. so in the weeks and months that followed we undertook a series of difficult steps to prevent that out come and we were forced to take those steps, largely without the help of an opposition party,

which unfortunately, after having presided over the decision-making that had led to the crisis, decided to hand it over to others to solve. we acted to get lending flowing again, so businesses could get loans to buy equipment and ordinary americans could get financing to buy homes and cars, to go to college and to start or run businesses. we enacted measures to stem the tide of foreclosures in our housing market, helping responsible homeowners stay in their homes and helping to stop the broader decline in home value which was eating away at what tends to be a family's largest asset. to achieve this and prevent economic collapse, we were forced to extend assistance to some of the very banks and financial institutions whose actions helped precipitate the turmoil. we also took steps to prevent the rapid dissolution of the american auto industry which faced a crisis partly of its own making to prevent the loss

of hundreds of thousands of jobs during an already fragile, shaky time. these were not decisions that were popular, or satisfying. these were decisions that were necessary. now even as we work to addressed the crisis in our banking sector, in our housing market and in our auto industry, we also began attacking our economic crisis on a broader front. less than one month after taking office, we enacted the most sweeping economic recovery package in history, the american recovery and reinvestment act. the recovery act was divided into three parts. one-third went for tax relief for small businesses, and 95% of working families. the other third was, for emergency relief, to help folks who have borne the brunt of this recession. we extended or increased unemployment benefits for more than 17 million americans. made health insurance 65% cheaper for families relying

on cobra, and for state and local governments facing historic budget short falls as demand for services went up and revenues went down, we provided assistance that has saved the jobs of hundreds of thousands of teachers and public school workers, firefighters and police officers. the last third of the recovery act is for investments to put americans to work doing the work that america needs done. doubling our capacity in renewable energy like wind and solar, computerizing medical records to save money and lives, providing the largest boost to medical research in history. renovating classrooms and school laboratories, and upgrading roads and railways as part of the largest investment in infrastructure since the creation of the interstate highway system half a century ago. even as the recovery act has created jobs and spurred growth, we have not let up in our efforts to take every responsible action to get the economy growing and

america working. this fall i signed into law more than $30 billion in tax cuts for struggling businesses, extended an effective tax credit for home high buyers and provided additional unemployment insurance for one million americans. the treasury is continuing to adapt our financial stability plan, helping to facilitate the flow of small credit to small businesses and families. in addition, we're working to break down barriers and open overseas markets. so our companies can better cop compete globally, creating jobs in america but exporting our products around the world. now partly as a result of these and other steps, we are in a very different place today than we were one year ago. we may forget but we're in a very different place. we can safely say that we are no longer facing the potential collapse of our financial system, and we have avoided the depression many feared. our economy is growing for

the first time in a year. in the swing from contraction to expansion, since the beginning of the year, is the largest in nearly three decades. finally we're no longer seeing the severe deterioration in the job market that we once were. in fact we learned on friday that the unemployment rate fell slightly last month. this is welcome news, and news made possible in part by the up to 1.6 million jobs that the recovery act has already created, and saved according to the congressional budget office. but i'm here today because our work is far from done. for even though we've reduced the, deluge of job losses to a relative trickle, we are not yet creating jobs at a pace to help all those families who have been swept up in the flood. there are more than seven million fewer americans with jobs today than when this recession began.

that's a staggering figure, and one that reflects not only the depths of the hole from which we must assend but a continuing human tragedy. it was mentioned that i was in allentown, pennsylvania this past weekend and went to a jobs center where people were engaged in job search and, it ran the spectrum. blacks, whites, hispanics, young people who are just starting their careers, individuals 50, 60 years old looking for a job. they were putting a brave face on it, confident that eventually things would work out but, you could also see the sense of anxiety. the fear that perhaps this time it was different. sometimes it is hard to break out of the bubble here in washington and remind ourselves behind these statistics are people's lives, their capacity to do

right by their families. it speaks to an urgent need, to accelerate job growth in the short term, while laying a new foundation for lasting economic growth. so my economic team has been considering a full range of additional ideas to help accelerate the pace of private sector hiring. we held a jobs forum at the white house that brought together small business owners, ceos, union members, economists, folks from non-profits, and state and local officials to talk about job creation. and i've asked people to lead forums in their own communities to send the results to me. so we're hearing as many voices as possible as we refine our proposals. we've already heard a number of good ideas and i know we'll learn of many more. so today i want to outline some of the broader steps that i believe should be at the heart of our effort to accelerate job growth. those areas that will generate the greatest number

of jobs while generating the greatest value for our economy. first, we're proposing a series of steps to help small businesses grow and hire new staff. over the past 15 years small businesses have created roughly 65% of all new jobs in america. these are companies formed around kitchen tables and family meetings. formed when an entrepreneur takes a chance on a dream. formed when a worker decides it is time she became her own boss. these are also companies that drive innovation, producing 13 times more patents per employee than large companies. it is worth remembering every once in a while, a small business becomes a big business, and changes the world. that's why it is so important that we help small businesses struggling to stay open. or struggling to open in the first place during these difficult times. building on the tax cuts in

the recovery act, we're proposing a complete elimination of capital-gains taxes on small business investment, along with an extension of write-offs to encourage small businesses to expand in the coming year. and i believe it is worthwhile to create a tax incentive to encourage small businesses add and keep employees and i will work with congress to pass one. now these steps will help but we also have to address the continuing struggle of small businesses to get loans that they need to start up and grow. to that end we're proposing to waive fees and increase guaranties for sba-backed loans. i'm asking my treasury secretary to continue mobilizing the remaining tarp funds to facilitate lending to small businesses. second, we're proposing a boost in investment in the nation's infrastructure beyond what was included in the recovery act. to continue modernizing our

transportation and communications networks. these are needed public works that engage private sector companies, spurring hiring all across the country. already more than 10,000 of these projects have been funded through the recovery act and by design, recovery act work on roads, bridges, water systems, superfund sites, broadband networks and clean energy projects will all be ramping up in the months ahead. it was planned this way for two reasons. so the impact would be felt over a two-year period, and more importantly, because we wanted to do this right. the potential for abuse in a program of this magnitude, while operating at such a fast pace was enormous. so i asked vice president biden and others to make sure, to the extent humanly possible, that the investments were sound, the projects worthy, and the execution efficient. what this means is, that we're going to see even more

work and workers on recovery projects in the next six months than we saw in the last six months. even so, there are many more worthy projects than there were dollars to fund them. i recognize that by their nature, these projects often take time and will therefore create jobs over time. but the need for jobs will also last beyond next year, and the benefits of these investments will last years beyond that. so adding to this initiative to rebuild america's infrastructure is the right thing to do. third, i'm calling on congress to consider a new program to provide incentives for consumers who retrofit their homes to become more energy efficient, which we know creates jobs, saves money for families and reduces the pollution that threatens our environment. and i'm proposing that we expand select recovery act initiatives to promote

energy efficiency and clean energy jobs which have proven to be particularly popular and effective. it is a positive sign that many of these programs drew some applicants for funding that a lot of strong proposals, proposals that will leverage private capital and create jobs quickly, did not make thecut . .

>> job creation will ultimately depend on the real job creators, businesses across america. we were encouraged today to hear from the business round table that their surveys showed greater confidence and greater potential investment coming out of the business community. government can help lay the groundwork on which the private sector can better generate jobs, growth and innovation. after all, small business tax relief is not a substitute for ingenuity and us have now by our entrepreneurs, but it can help those with good ideas to grow and expand. promoting energy efficiency and energy manufacturing don't automatically lower carbon emissions, but these steps provide a framework in which companies can compete to innovate. and while modernizing the physical and virtual networks that connect us, we'll create private sector jobs, they'll do so while making it possible for companies to more easily and

effectively move their products across this country, around the world, and that will create more jobs. and given the challenges of accelerating the pace of hiring in the private sector, these targeted initiatives are right, and they are needed. but with a fiscal crisis to match our economic crisis, we also must be prudent about how we fund it. so to help support these efforts, we are going to wind down the troubled asset relief program or t.a.r.p., the fund created to stabilize the financial system to banks would lend again. i don't think i have to tell you there has rarely been a less loved or more necessary emergency program than t.a.r.p. which, as galling as the assistance to banks may have been, indices piewt my helped prevent a collapse of the entire financial system. launched hastily, understandably but hastily, under the last administration, the t.a.r.p.

program was fought, and we have worked hard to correct those flaws and manage it properly. and to date t.a.r.p. has served its original purpose and at much low or cost than we expected. in fact, because of our stewardship of this program and the t.a.r.p. is expected to cost at least $200 billion less that be what was anticipated just this past summer. and the assistance to banks once thought to cost taxpayers untold billions be is on track to actually reap billions in profits for the tax-paying public. so this gives us a chance to pay down the deficit faster than we thought possible, and to shift funds that would have gone to help the banks on wall street to help create jobs on main street. small business, infrastructure, clean energy. these are areas in which we can put americans to work while putting our nation on a sturdier

economic footing. and that foundation for sustained economic growth, that must be our continued focus and our ultimate goal. i've said this before, even before this particular crisis much of our growth for a decade or more had been fueled by unsustainable consumer debt and reckless financial speculation. while we ignored the fundamental challenges that hold the key to our economic prosperity. we cannot simply go back to the way things used to be. we can't go back to an economy that yielded cycle after cycle of speculative booms and painful busts. we can't continue to accept an education system in which our students trail their peers in other countries and a health care system in which exploding costs put our businesses at a competitive disadvantage. emerging industries of the 21st century. and that's why even as we strive

to meet the crisis of the moment we have insisted on laying a new foundation for the future. because an educated work force is essential to a 21st century global economy, we've launched a competitive race to the top fund through the recovery act to reform our schools and raise achievement, especially in math and science. and we have made college more affordable, proposed a historic set of reforms and investments in community college and set a goal of once again leading the world in producing college graduates by the year 2020. because even the best trained worker in the world can't compete if our businesses are saddled with rapidly increasing health care costs. we are fighting to do what we have discussed in this country for generations, finally reforming our nation's broken health insurance system and relieving this unsustainable burden. because our economic future

depends on a financial system that encourages sound investments, honest dealings and long-term growth, we've proposed the most ambitious financial reforms since the great depression. we'll set and enforce clear rules of the road, close loopholes and oversight, charge a new agency with protecting consumers and address the dangerous systemic risks that brought us to the brink of disaster. these reforms are moving through congress, we're working to keep these reforms strong, and i am looking forward to signing them into law. and because our economic future depends on our leadership in the industries of the future, we are investing in basic applied research and working to create the incentives to build a new clean energy economy. for we know the nation that leads in clean energy will be the nation that leads the world. i want america to be that nation. i want america's prosperity to be powered by what we invent and

pioneer, not just what we borrow and what we consume. and i know that we can and will be that nation if we're willing to do what it takes to get there. now, there are those who claim we have to choose between paying down our deficits on the one hand and investing in job creation and economic growth on the other. this is a false choice. insuring that economic growth and job creation are strong and sustained is critical to insuring that we are increasing revenues and decreasing spending on things like unemployment insurance so that our deficits will start coming down. at the same time, instilling confidence in our commitment to being fiscally prudent gives the private sector the confidence to make long-term investments in our people and in america. so one of the central goals of this administration is restoring fiscal responsibility.

even as we have had to spend our way out of this recession in the near term, we've begun to make the hard choices necessary to get our country on a more stable fiscal footing in the long run. so let me just be clear here, despite what some have claimed. the cost of the recovery act is only a very small part of our current budget imbalance. in reality, the deficit had been building dramatically over the previous eight years. we have a structural gap between the money going out and the money coming in. folks passed tax cuts without paying for any of it. even as health care costs kept rising year after year. as a result, the deficit had reached $1.3 trillion when we walked into the white house. and i know these budget-busting tax cuts and spending programs were approved by many of the same people who are now waxing political about fiscal

responsibility. while opposing our efforts to reduce deficits by getting health care costs under control. it's a sight to see. the fact is we have refused to go along with business as usual. we are taking responsibility for every dollar we spend. we've done what some said was impossible, preventing wasteful spending on outdated defense systems that even the pentagon said it didn't want. i'm still committed to halving the deficit we inherited by the end of my first term, cutting it in half. and i made clear from day one that i would not sign a health insurance reform bill if it raised the deficit by one dime. and neither the house nor the senate bill does. we've begun not only changing policies in washington, we've also begun to change the culture in washington.

in the end, the economic crisis of the past year was not just the result of weaknesses in our economy, it was also the result of weaknesses in our political system. because for decades too many in washington put off the hard decisions. for decades we've watched as efforts to solve tough problems have fallen prey to the bitterness of partisanship to prosaic concerns of politics to ever-quickening news cycles, to endless campaigns focused on scoring points instead of meeting our common challenges. we've seen the consequences of this failure of responsibility. the american people have paid a heavy price. and the question we'll have to answer now is if we're going to learn from our past or if even in the aftermath of disaster we're going to repeat those same mistakes. as the alarm bells fade, the din of washington rises, the forces of the status quo martial their

resources we can be sure that answering this question will be a fight to the finish. but i have every hope and expectation that we can rise to this moment. that we can transcend the failures of the past. that we can once again take responsibility for our future. now, every night i read letters and e-mails sent to me from people across america. ordinary folks. people who share their hopes and their hardships, their faith in this country, their frustration with what's happened in this economy. i hear from small business owners worried about making payroll, keeping their doors open, i hear from mothers and fathers, sons and daughters who have seen one or two or more family members out of work. the toughest letters are in children's handwriting, kids write to me.

my dad just lost a job. my grandma's sick, she can't afford health insurance. kids who can't just be kids because they're worried about moms having their hours cut or dad losing their job or a family without health insurance. now, these folks aren't looking for a handout, they're not looking for a bailout. just like those people i visited in allentown. all they're looking for is a chance to make their own way. to work, to succeed using their talents and skills. and they're looking for folks in washington to have a seriousness of purpose that matches the reality of their struggle. everywhere i've gone, every stop i've made there are people like

this, men and women who have faced misfortune, but who stand ready to build a better future. students ready to learn, workers eager to work, science terrorists on the bripg of discovery -- scientists on the brink of discovery, entrepreneurs seeking a chance to open small businesses. everywhere i go there are one-shuttered factories just waiting to get back to life. there is a nation ready to meet the challenges of this new age and to lead the world this this new century. as we look back on the progress of the past year and look forward to the work ahead, i have every confidence that we will do exact lu that -- exactly that. these have been a tough two years, and there will, no doubt, be difficult months ahead. but the storms of the past are receding, the skies are brightening, and the horizon is beckoning once more. thank you very much.

[applause] ♪ [applause] ♪ [applause] ♪

♪ >> for changes in the medicare advantage provisions. the bill exempts some states from benefit cuts in the bill, the mccain motion would extend

protection to all medicaid advantage apartments. here's what republicans said about the proposal this morning, it's about half an hour. >> madam president, i ask unanimous consent to engage in colloquy with my colleagues. >> without objection. >> and i'd like to just have a note, you know, i talk a lot about c-span, i'm a great admirer of c-span and how the president, at least when he was running also believed in c-span because he said c-span would be in on the negotiations. there was posted by politico last night at 5:48 p.m. a title, no c-span here. the reporter said, right now a group of moderate senators is meeting behind closed doors to try to hash out a compromise on the public option. reporters waiting for the meeting to break were just moved out of the corridor nearest the meeting and shouted around the corner. c span, this is not. well, the beat goes on. could i just remind my

colleagues of the amendment that we are discussing here is drafted to prevent drastic medicare advantage cuts from impacting all seniors in the medicare advantage. i want -- this amendment says simply, let's give seniors who are members of medicare, who enrolled in medicare advantage the same deal that senator nelson was able to get for the state of florida. at least most of the seniors wh enrolled in medicare advantage program. there are 11 million american seniors who are enrolled in medicare advantage program. this amendment would allow all 11 million to have the same benefits, and there would be no carve outs -- carveouts for various groups of seniors just because of the influence of a member of this body. i just want to quote, again, "the new york times," my favorite source of information. quote, senator tries to allay

fears on health overhaul. mr. nelson, a democrat, has a big problem, the bill taken up by the committee would cut medicare payments for insurance companies for more than ten million americans including one million in florida. the program known as medicare advantage is popular, etc., etc., it would be intolerable to ask senior citizens to give up substantial health benefits they're enjoying under medicare, said mr. nelson, who has been deluged with calls and complaints from constituents. i am offering an amendment to shield seniors from those benefit cuts. i am offering an amendment to shield all senior citizens, the 11 million of them that are under medicare advantage as the senator from florida said, to shield seniors from benefit cuts. that's what this amendment is all about. we should not carve out for some seniors what other seniors are

not entitled to. that's not america, that's not the way we should treat all of our citizens, and i hope that my colleagues will understand that there was, that this is simply in the name of fairness that this amendment is proposed. and i would ask the senator from tennessee and the senator from texas and large numbers of enrollees in the medicare advantage program, also, how this would be unfair as well. >> well, i thank the senator from arizona for his amendment, and i thank the senator from florida for his amendment. because medicare advantage is very important to tennesseans. we have 243,000 tennesseans who have opted for medicare advantage, about one-fourth of all americans who are on medicare have chosen medicare advantage because it provides the option for increased dental

care, for vision care, for hearing coverage, for reduced hospital deductibles, many benefits. it's especially helpful to low income and minority americans, it's especially helpful to people in rural areas. and what the republicans have been arguing all week is that contrary to what our friends on the other side are saving -- saying, this bill cuts those medicare advantage benefits, and the directer of the congressional budget office says that fully half, fully half the benefits on medicare advantage for these 11 million americans will be cut. well, our democratic friend says, no, that's not true, that's not true. we're going to cut a trillion dollars out of medicare over a fully implemented ten years, but nobody's going to be affected by it. well, the senator from florida, apparently, doesn't believe that, and he says we have 900,000 floridian who don't want their medicare advantage cut, and we don't trust, he is saying

in effect, we don't trust this democratic bill to protect these seniors, medicare advantage. so i would ask the senator from texas if the people from florida and the senator from florida don't trust the democratic bill to protect medicare advantage, why should 240,000 tennesseans trust the democratic bill to protect medicare advantage. >> >> well, i agree that what's good enough for the seniors in florida ought to be good enough for all seniors. and in my state, the state of texas, we have 532,000 seniors on medicare advantage, and they like it for the reasons that the senator from tennessee mentioned, and they don't want us cutting those benefits. but i would ask, ask the senator from arizona and tennessee, i seem to recall we had amendments earlier which would have protected everybody from cuts in their medicare benefits, and now we have a targeted effort

negotiabilitied behind closed doors to protect states like florida and pennsylvania and others. and i wonder whether this, the nelson amendment to protect the seniors in florida, would even be necessary if our colleagues across the aisled aisle had agrt no medicare benefits should be cut. >> well, as the senator from texas points out, just a few days ago we by 100-0 vote passed an amendment proposed by the senator from colorado, senator bennett, that says, quote, protecting guaranteed medicare benefits. protecting and improving guaranteed medicare benefits. nothing in the provision of or amendments made by this act shall result in a reduction of guaranteed benefits under title 18 of the social security act. is there any member on the other side that can guarantee seniors in his or her state in medicare advantage that they will not lose a single benefit that they

have today? not the guaranteed benefit that the other side goes to great pains to talk about. i think those who are enrolled in the medicare advantage system believe since they receive those benefits that they are guaranteed benefits as well. and i'd ask my -- we have our two physicians here on the floor who have both had the opportunity of dealing directly with the medicare advantage program. if you have a patient come in, you say, by the way, you're having your medicare advantage program cut but don't worry, we are protecting your guaranteed medicare benefits, do you think they understand that language? >> well, i'd respond to the senator from arizona with the following components, first of all, they won't understand that language. but more importantly, if you look at the law, there's medicare a, medicare b, medicare c, medicare d. they're all law. they're all law. and what is guaranteed under the law today is that if you want

medicare advantage, you can have it. and what's going to change is we're going to take away that guarantee. we're going to, we're going to modify medicare part c which is medicare advantage. so we have this confusing state to say we're not taking away any of your guaranteed benefits, but in fact under the current law today medicare advantage is guaranteed to anybody who wants to sign up for it. so it's due due policous at best. let me just speak to my experience is what is good about medicare advantage? we hear it's a money pot to pay for a new program for other people, here's what's good about it. we get coordinated care for poor medicare folks. medicare advantage coordinates the care, and when you coordinate care, what you do is

you decrease the number of tests, you prevent hospitalizations, you get better outcomes, and consequently you have healthier seniors. so when it's really looked at, medicare advantage really doesn't cost more. it actually saves medicare money. on an individual basis. because if you forgo the test interests -- interests of around hospital where you really start incurring costs, what you've done is save the medicare trust fund, but you've also given better care. second point i would make is many of the people on medicare advantage cannot afford to buy medicare supplemental policy. 94% of the people in this country on medicare who are not medicare advantage are buying a supplemental policy. why is that? because the basic underlying benefit package of medicare is not adequate. and so here we have this group of people who get benefited

by -- because they chose a guaranteed benefit of medicare part c, and all of a sudden we're saying timeout you don't get that anymore. >> [inaudible] so for hundreds of people who enroll in medicare advantage are low income people and a lot of them are rural residents? >> a lot of rural. i don't know the income levels, but i know there's a propensity that you actually get a savings because you don't have to buy a supplemental policy if you're in medicare advantage. >> i would add to that it's not -- following along with my colleague from oklahoma, there is the coordinated care that's one of the advantages of medicare advantage. there's also the preventive component of this, and if we talk about ways to help people keep their health care costs down, it has to do with coordinating care and preventing illness. so things we can do -- >> and we just heard we want to put a new preventive package by the freshman from the other side, yet we want to take the preventive package out of medicare advantage. interesting mix of amendments, isn't it?

>> because we want to keep our seniors healthy, that's one way they can stay out of the hospital, out of the nursing home, stay active. but yet this cuts medicare advantage, and the democrats have voted to do just that, cut all this money out of this program that seniors like, 11 million american seniors who depend upon medicare for their health care choose this because there is an advantage to them. we, as my colleague from oklahoma, the other physician in the senate has talked as i have extensively about patient-centered health care. not insurance-centered, not government-centered, medicare advantage helps keep it patient-centered. so when i see about the deals that are being cut behind closed doors, they're cutting out people from all across the country, and it seems there's a sweetheart deal just to help the seniors on medicare advantage in florida to try to encourage one member of the senate to vote a certain way. but what about texas, louisiana, tennessee, oklahoma, a lot of seniors have great concerns, and

i would hope they would call up and say, hey, this is wrong. why is it that there's a sweetheart deal, you know, just for one selected senator and one selected state when we want to have that statement advantage? and why are the democrats voting to eliminate to cut all of this medicare money? >> let me ask my colleagues a question, maybe starting with the senator from arizona, a related issue which is medicare advantage is a private sector alternative or choice to medicare which is a government-run program. and i'm detecting throughout all of this bill sort of a bias against the private sector and wanting to eliminate choices that aren't government-run plans. am i reading too much into this, or do any of my colleagues see a similar propensity in this bill? >> well, if i could respond to the senator from texas, i think he's exactly right.

there's a lot of very appealing talk that we hear from the advocates of the so-called health reform bill. but when we get right down to it and we examine it closely, we find, basically, a big increase in government-run programs. and what does this mean for low income americans and what does it mean for seniors who depend upon our biggest government-run programs, that's medicare and medicaid? the risk that they may not have access to the doctor they want. the senator from wyoming mentioned that the mayo clinic -- wide ri cited as an example of controlling costs -- is beginning to say we can't take patients from the government-run programs. in some cases because, because we're not reimbursed properly for them. so what's going to happen, you know, behind all of this happy talk we're hearing about health care is that we're going to find more and more low income

patients dumped into a program called medicaid where half the doctors won't see a new medicaid patient, like giving someone a bus ticket to a bus line that runs half the time, and medicare is going to increasingly find itself in the same shape just as the mayo clinic b and perhaps others will say we can't afford to serve patients from the government-run program. so i think, i think the senator from texas is exactly right. we don't have to, we don't have to persuade the 11 million americans who have chosen medicare advantage as a good program, they like it. in rural areas between 2003-7 more than 600,000 people signed up for it. i think in a way the senator from florida may have a sweetheart deal, but in a way he's done us a favor because we've been trying to say all week that the democrats are cutting medicare. they're saying, trust us, we're

not cutting medicare. the senator from florida is saying, floridians don't trust you. you're cutting their medicare advantage, and i want to have an amendment to protect them, and senator mccain is saying, let's protect all seniors' medicare advantage. >> could i also point out to my colleagues and for the record, again, on september 20, 2003, there was a letter to the conferees of medicare urging them to include a meaningful increase in medicare advantage funding for fiscal years 2004, 2005. a group of 18 senators including senator schumer, lautenberg, clinton, wyden, etc., including senator kerry who now, obviously, wants to reduce the funding for medicare advantage. again, perhaps he was for it before he was against it. but again i would also like to

point out as short a time ago as april 3, 2009, a group of senators, bipartisans including wydem, murray, specter, bennett, klobuchar, others wrote to mr. charles, acting administrator of the centers for medicare and medicaid services, quote, we write to express our concern cans regarding proposed changes to medicare advantage rates for calendar year 2010. the advance notice has raised two important issues that, if implemented, would result in highly problematic premium increases and benefit reductions for medicare advantage enrollees across the country. so, again, as short a time ago as last april there was concern on the other side about cuts in medicare advantage program. >> i wonder, wonder if the senator is aware in alabama there's 181,000 people that are

going to get their medicare advantage cut, in arizona your number you listed, in california 1,606,000 people, seniors are going to have their benefits cut. colorado, 1 # 8,000 -- 1980,000 that are going to have their benefits cut, illinois is 176,000, indiana 148,000. kentucky, 110, massachusetts 200,000, michigan 406,000. that's exactly what michigan needs right now, isn't it? for their seniors to have the their benefits cut. minnesota, 284,000; missouri, 200,000; nevada, 104,000; state of new york, 853,000; ohio, 499 ,000; pennsylvania, maybe, maybe not because they may have gotten the deal, 865,000;

tennessee 823,000 according to my numbers. i'd ask unanimous consent to list what the enrollment is by cms on medicare advantage enrollment as of august 2009 into the record. >> and the point of all this is -- >> without objection. >> and the point of all this is that the senator from florida, a member of the finance committee, felt so strongly that medicare advantage was at risk that he decided to carve out and was able to get a majority on a party line vote of the finance committee to carve out a special status for a group of seniors under medicare advantage in his state. this amendment simply says that everyone, that the senator from oklahoma just made reference to, has that same protection. that's all that this amendment is about. >> senator would yield for a question, if this amendment does

not pass which protects all medicare advantage beneficiaries, all # 1 million of them, 532,000 in my state, and as a result of not only these cuts, but perhaps additional cuts to come in the future to medicare advantage which make it harder and harder to, for medicare beneficiaries to get coverage, i would a ask our colleagues, particularly our doctor colleagues, what's the impact on eliminating medicare advantage and leaving people with medicare fee for service which is the, as i recall, the bennett amendment earlier which is you have to parse the language closely? they talk about guaranteed benefits, but i think the senator from oklahoma makes a good point. right now medicaid, medicare advantage are guaranteed benefits, so we're going to cut those. but what's the consequence of seniors losing medicare advantage and being forced only on a medicare fee-for-service

program? >> limited prevention screening? no coordinated care, loss of access to certain drugs, accessory things like vision and hearing, supplementals. but more importantly what's going to be is poorer health outcomes. that's what it's going to be. or a much smaller checkbook. one or the other. a smaller checkbook because now the government isn't going to pay for it, you are, or poor health outcome. and if your checkbook's limited, the thing that's going to happen is you're going to get the poor health outcome. >> and additionally, the senator from arizona started by talking about this closed door meeting, people hiding behind closed doors secretly trying to come up with things. there was an article in the paper today that the democrats are turning to throw more people on to the medicare rolls and medicaid rolls as their trying

to -- they're trying to come up with some compromise, compromising the care of the people of america. they're trying to put more people on to medicaid rolls and the senator from tennessee has said, you know, many physicians don't take those patients because the reimbursement is so poor, and it's giving people -- it's putting more people into a boat that's already sinking. so they want to put more people on medicaid and more on medicare, but at the same time they're cutting medicare by $464 billion. this is a program we know is already going broke, and yet they want to now put people age 55-64, add those to the medicare rolls which is a program i have great concerns about. so special deals for some, cutting out many others and now adding more people to the medicare rolls, to me this is not sustainable, and yet these are the deals that are being cut less than 100 feet from here off of the floor of the senate when we're out here debating for all

of the american people to see the things that we think are important about health care. you know, jobs are going to be lost in our economy as a result if this bill gets passed. people that have insurance, they're going to end up paying more in premiums if this bill is passed and people who depend on health care are going to see their health care deteriorate as a result of this proposal. but i turn to the senator from arizona who's been a special student of this. >> so seniors, by losing medicare advantage, would then lose certain provisions that medicare advantage provides them, and then they would be forced -- if they can afford it, which they're now paying zero because it's covered under medicare sank -- then they would have to buy medigap policies that would make up for those benefits they lost when they lose medicare advantage. and guess who offers those

medigap insurance policies? our friends at aarp which average $175 a month. so we're telling people who are on medicare advantage today when they lose it, they will be, condition guaranteed if they want to make up for those benefits they're losing, they would be paying $175 minimum for a medigap policy. a lot of american seniors cannot afford that, and that's just a fact. $2,000 a year, they can't afford it. >> i would make one other point is over the next ten years 15 million baby boomers are going to go into medicare. fifteen million. and we're taking $465 billion out of medicare and on a ten-year picture one trillion, so we're going to add 15 million and cut a trillion. what do you think's going to

happen to care for everybody in medicare? what do you think's going to happen? the ultimate is we're going to ration the care for seniors in this country. if this bill comes through. life expectancies will -- >> [inaudible] >> there's 35 minutes remaining. >> how many? >> 35 minutes. >> in other words five minutes -- >> five minutes remaining for you. >> dr. barrasso, have you treated people under medicare advantage? >> well, i have. people in wyoming know that there's an advantage to being in this program, and that's why they sign up. that's why citizens all around the country have signed up for medicare advantage, because they realize there's value in prevention, and there's value in coordinated care. there is value in having eye care, dental care, hearing care. there is, there are advantages to want to stay healthy, to keep down the cost of their care. >> so if you were making the

case that even though it may cast more, the fact that you have a weller and fitter group of senior citizens, you in the long run reduce health care costs because they take advantage of the kind of care that over time would keep them from going to the hospital earlier or having to see the doctor more often? >> well, that's one of the reasons that medicare advantage was brought forth. and i know a lot of senators from rural states supported it because it would allow people in small communities to have this advantage, to be in a program like that. it would encourage doctors to go into communities to try to keep those people well, work with prevention, and the 11 million people who are on medicare advantage in this country, they know they're on medicare advantage. they have chosen b it. it is the fast thest-growing component because people realize the advantages of being on medicare advantage. if they want to stay independent, they want to stay healthy, they want to stay fit, they sign up for medicare

advantage. i would think people all across the country who are listening to this debate would want to say, hey, why didn't i know about this program? seniors talk about this at senior centers. i go to senior centers and have town meetings there and visit with folks, hear their concerns, they're converting over and joining, signing up for medicare advantage because they know there are advantages to it. and for this senate and the democrats to say, no, i want to slash over $100 billion from medicare advantage, i think the people of america understand that this is at a great loss to them and at peril to their own health as they lose the coordinated care and the preventive nature of the care. >> i'd ask the senator from tennessee, do you know of any expert on health care that believes you can make these kinds of cuts in medicare advantage and still preserve the same benefits the enrollees have today? >> the answer to the senator from arizona is, no. i do not know of one, and i know of one senator at least who does not believe it, and he is the

senator from florida. and it's interesting that, you know, all week we've been going back and forth, we've been saying to the democrats, you're cutting health care benefits. and they've been saying, oh, no, we're not. well, i'm sure the people at home are going to say, who's right about this? well, the senator from florida has said i'm not willing to say to the people of florida that your benefits aren't going to be cut if you're on medicare advantage, so i want an amendment to protect you. and so does the senator from texas, and so does the senator from oklahoma, and so does the senator from louisiana, and so does the senator from wyoming and from tennessee. and so the senator from arizona is saying we believe you're cutting medicare advantage benefits for 11 million americans. the senator from florida has, doesn't trust your bill, we don't either, we want an amendment that protects 11 million seniors. >> i would ask our senators just

to expand just in the brief time we have. it seems like all of the discussion about health care reform has been about accountable care organizations, coordinating care particularly in the latter part of life when avoiding chronic diseases and the like. when i was at kelsey clinic in houston, texas, they told me it is medicare advantage which allows them to be able to coordinate care to hold down costs to keep people healthier longer, yet the irony, to me it seems, that by cutting medicare advantage benefits is we are going backward rather than forward when it comes to that kind of coordinated, less expensive care. would you concur with that? >> well, i would concur that this is actually taking a step backward, and that's why the senator from florida has demanded that they make accommodations for the people of florida. people of wyoming want those same accommodations as arizona and texas because the people of america, 11 million americans who have chosen the medicare advantage program because it does help coordinate care, it

goes with preventer care -- preventive care, it keeps it more patient-centered, that is the way for people to stay healthy, live longer lives, keep their independence. i mean, we've seen cuts across the board on medicare whether it's home health, whether it's nursing homes, hospice care, medicare advantage. across the board they're cutting medicare in a way that certainly the seniors of this country do not deserve. they've paid into that program for many years, and they deserve their benefits. >> if i may say one other thing, we've talked a lot about our good friend, the senator from florida, and how he's been so perceptive on noticing his floridians with medicare advantage may lose their medicare benefits, i hope he's as -- >> senator's time has expired. >> i ask an additional 30 seconds. >> i would ask the senator from arizona, i believe there are other medicare benefits that are likely to be cut in this bill. aren't there cuts to has hospices? aren't there cuts to home health

care that we talked about yesterday? so if floridians don't trust the democratic bill to protect their medicare benefits for medicare advantage, why should they trust the democratic bill to protect any of their medicare men be fits? >> [inaudible] point out what dr. coburn said. medicare part c, which is medicare advantage, is part of the law. and to treat it in any ways different because those on the other side don't particularly happen to like it, i think, is an abrogation of the responsibilities we have to the seniors of this country. i thank my colleagues, i yield the floor at this time.

>> before we do that, we're going to bring you a conversation we had with a capitol hill reporter for an update on the action both on and off the floor today. and we are joined from the offices of congress canal quarterly by the managing editor of congress canal quarterly. there appears off the floor to be a plan in the works that would allow young people to buy into medicare in exchange for dropping the public option. what can you tell us about the details that are emerging? >> this is a very interesting set of discussions going on between fife centrist democrats and five more liberal democratic senators in which the liberals appear to be ready to drop their insistence on having a government-run public option if they have a medicare expansion. and this is intriguing. what they're hoping to do is offer medicare to folks 55 and

over who lack employer-provided health insurance coverage. of course, medicare right now is open to people 65 and older and the disabled. so it would be an expansion of, you know, a very cherished established entitlement program on top of an expansion of medicaid already edge vised in this -- envisioned in this bill. >> who were the senators involved? >> i have a cheat sheet here, but we have some of the centrist who you've seen already engaged like ben nelson, blanche lincoln, mary landrieu, folks like that. on the liberal side, sherrod brown of ohio, jay rockefeller of west virginia, tom harkin of iowa. you have some folks who are sort of approximate proxies of the leadership like charles schumer of new york who's the number three senate democrat and mark pryor of arkansas. >> so this idea that's percolating, if dropping the public option for this going the medicare route, would this affect support of that underlying bill?

could it attract republican support as well? >> you know, it think this is more a case of democratic coalition management, getting the centrists who are very suspicious and the liberals getting them more or less on the same page. i doubt it would bring any more republican support. i guess the votes of the two moderates from maine are still in play. >> what about senator reid? he's apparently given this group a deadline of today to reach an agreement? >> yeah. he wants this today because he has to rush this over to the the congressional budget office for scoring because how are you going to sell anyone on a pretty dramatic change in the bill without getting some numbers? medicare expansion, this could be very costly. i mean, when you talk about insuring folks 55 and over who don't have coverage now, that's a pretty tough cohort. a lot of private insurers don't necessarily want to touch them, and when they, people in that age cohot, get medicare coverage, rather the 65 and

older, sometimes the doctors' visits can be over $300 a month. it depends how they would structure this, how they would subsidize if they even want to subsidize the purchase of medicare for these folks. so the numbers are critically important to whether people are going to buy into this idea. >> now on the senate floor itself abortion's been the main topic again today, what's expected to happen in relation o the amendments proposed by senators nelson and hatch? >> well, in all likelihood it will be rejected. this is language that largely mimics language in the house-passed health bill, the one that the house passed in early november that basically would restrict elective abortion coverage through a public option and would make it difficult for people who receive subsidies in a health system to acquire elective abortion coverage. essentially, there are enough abortion rights sportsers in the senate to probably beat this back. the problem for the democratic leadership is senator nelson has

said if it doesn't get adopted, he's going to withhold his support for that health bill, so that puts the onus on harry reid to either come up with a compromise or start looking for republicans to replace nelson. >> for folks watching the debate, will we see a vote on that abortion amendment today? >> in all likelihood. there's a series of amendments. we're getting into some interesting issues, there's also one coming up on drug importation which is a perennial topic in health care debate here, whether consumers can import from other countries. prescription drugs that are sold here in the u.s., but are sold for wills in those -- less in those countries like canada. >> give us us a an idea of the t significant amendment we might see in the senate debate. >> as we said, the dug impor -- drug importation is an important one. there's also a series of cost containment measures that a group of freshman democrats in the senate has been pressing. ways to kind of make b this a

more fiscally responsible bill, changes to the health system, changes in payment methods through the government's big programs that would make this not just an expansion of coverage, but even more of an exercise in fiscal responsibility. when you consider that those were two goals that president obama laid out when he began this exercise early this year, they're trying to sync that up and also just to, you know, as junior members to influence the outcome of the debate. >> congressional quarterly's managing editor, thanks for the update. >> thank you. >> and the senate back at 2:15 eastern for more debate on health care. we expect to hear from senate leaders before that. we'll take you there live when they begin speaking. until then, part of this morning's "washington journal," with nebraska senator, mike johanns. >> host: let's begin with some of the lead stories this morning in the newspapers about this senate health care debate and what's happening behind the scenes anyway. momentum builds for altered

public option is the headline in usa today, and it says that these ten democratic senators and liberals, moderate democrats are working behind the scenes to instead of creating what has been known so far as the public option, rather have expands medicare to allow 55 and older to join that as the so-called public option. what's your reaction to that? >> guest: you know, the problem with that, and i haven't seen any details, but the problem with that is that medicare by everybody's agreement, every analysis is due to be insolvent by 2017. i mean, literally, this program that is a safety net for seniors over 65 years old runs out of money. in fact, pieces of it, for example, the hospital portion now, i think, is literally spending more than is coming in. so all of a sudden we open this program up to a whole new list of beneficiaries so it doesn't serve anybody's purposes well.

it's not good for medicare, it's not good for the people who depend on medicare. you know, we can spend a whole year debating medicare changes to try to fix this program, and it looks to me like what they're doing with that idea is making the problem worse. >> host: there is also a discussion of having a public option based on the federal employee model. your reaction to that, what do you think? >> guest: well, again, how are they going to administer that? i think conceptually this idea that people get insurance just like somebody in congress gets is a popular idea, it's well received out there. the difficulty is how do you administer that, how do you pay for it, all of those things kind of come in here. and i think really what you're seeing is they're just struggling. you know, they don't have enough votes for the public option. senator lieberman, for example, has made it very clear that i don't like the public option. if it's there, i join the

republicans in the filibuster. so they keep trying to figure this out. an additional idea was they were going to the expand medicaid to 150% of the poverty level. well, states are going to go ballistic over that because, of course, states pay a share of that cost, and they're struggling today. special sessions and budgets that aren't balancing, so there's a very, very serious problem there, an expansion of medicaid. and then the other thing is the medication reimbursement rates are deplorable. any doctor's office would go broke on medicare rates. docs just don't take those patients anymore, you're going to have just a crisis in excess. all of these millions of people show up with their medicaid card and say, i'm covered now, you don't have the personnel, the

doctors out there to handle that. and it just, i mean, these ideas i just wonder who they're talking to. they can't be talking to doctors or hospitals. this would be, this would be a very serious problem. >> host: what is the economic status of nebraska right now? >> guest: we've fared better than most states. we have a very solid conservative governor, and he's just been very tight with the dollar, if you will. our state we don't borrow money, our constitution prohibits it. what an unusual idea here in washington, but literally nebraska has no debt, not even for highways or roads. but they just did come out of a special session where they had to cut over 300 million which is a huge number for nebraska just simply because the recession has impacted people. they're not earning as much, therefore, they pay less in taxes, they're not spending as much, less sales tax. so they just came out of a special session. you add more burden, more

federal unfunded mandate to any state, including nebraska, and it would be a crisis. >> host: on the floor today is expected a vote on senator ben nelson's amendment, the abortion language as it's being referred to. the amendment mirrors restrictions in the bill approved by the house last month but is more restrictive than what is in the senate bill now. currently, it would require insurance companies to segregate public and private money and use only the latter to pay for the procedure. you've been vocal on this issue. where do the votes stand as far as how many senators are so-called pro-life and pro-choice senators? >> guest: i said a few weeks ago that i really believe that motion to proceed vote was the pro-life vote. maybe i'll be proven wrong. maybe there are 60 votes out there. i think senator nelson is working hard to get those 60 votes. i hate to be pessimistic on the morning of the vote.

i think we will vote on this today. i can't see how you count to 60 on this amendment. it appears to me it will be defeated. the pro-choice forces in the senate have rallied. the pro-choice forces out in the country, if you will, were thrown under the bus in the house bill. i mean, let's just be honest about it. boy, they're angry, they're fired up, they're not going to let that happen in the senate. it'll be hard to get 60 votes in this -- everything is a 60-vote hurdle, no matter which side offers the amendment. so this will have to get 60 votes, and i just don't count 60. >> host: what are you hearing about the timing of this vote this morning? >> guest: you know, sometime today is what i've been be hearing. and that's -- i appreciate a pretty flexible answer to your question. but these things can slip, you know, people start talking about nuances and could you accept this and accept that, and these

things can really take some time. but i'm guessing we will have a vote on this amendment sometime today. >> host: and what about the amendment that you plan to offer or have offered so far? what are they? what are your goals? >> guest: we focused on a number of things. medicare cuts would really be the first effort. there's about $465 billion in medicare cuts. those are very, very serious cuts to states all across the country. they cut reimbursement rates to nursing homes and hospitals and home health care. that was an amendment i offered. it was defeated on saturday, i was sad to see that. home health care b is such a wonderful program, it's so cost efficient. it keeps people in their home which is much cheaper than sending them off to a nursing home or hospital. when these cuts are implemented and if this is a final piece of the bill and that's what the democrats are trying to achieve,

you'll see home health care shut down in many parts of our state. it's just, it's not going to be able to survive these cuts. >> host: wasn't there a similar, though, amendment offered by a democratic senator that passed 100-0, i believe, that protects home health care? >> guest: it doesn't. >> host: okay. >> guest: they argue that it does, and it doesn't. it says that we will protect the guaranteed program. now, let me explain to you quickly how that works. i can say to you, here, look, here's the law. the guaranteed program is still there. and you say, oh, my goodness. it is. you're right, mike. there it is right in black and white. and then i say to you, oh, by the way, we cut $40 billion out of that program. program's still there, guaranteed program is still there. guess what? if you're a beneficiary in rural nebraska or some other part of nebraska, you're out of luck. because there's been such a

dramatic cut to that program that you're not going to get the services. and that's what will happen here. instead of these home health care providers, nurses, whatever going out to some place 50 miles away, they'll just say, look, we can't serve you 50 miles away. we can't serve you 25 miles away. so these programs will consolidate into more urban areas, and if you happen to live in a smaller community or rural area, you could very well be out of luck. >> host: all right. let's get to our phone calls here. ..

>> caller: what to do and who they can shop with and what kind of health care that you get. i hope the analogy holds true. i wanted to say you were able to keep the republicans in line, and demand the rest program for the american people. >> fred raises a very, very val point. here's what i tell you, fred. it's interesting that you ask that question. you are speaking to somebody who used to have responsibility for administrative program when i was secretary of the united states department of agriculture. that's a program that has worked quite well. your analogy is correct. we did not redesign the food distribution for the whole united states. we targeted that population that needed the food supply through

food stamps. and we tried to do everything we could to administer them in a way that made sense, cost efficient, et cetera. that programs continues to improve. and it continues to serve more people. what you're saying here is true. there are tens and tens of millions of people in the united states who look at their health plan and say you know i'm satisfied with with the plan. i wish the premiums wouldn't go up as much and this and that. the president came out and said to them if you like your plan, you're not going to lose it. guess what? there are so many things about this health care initiative that really changes that. he can't keep that promise. you are going to see people out there that will lose their home health care benefit. you are going to see difficulty in serving the population. and so it's just -- it doesn't

make sense. why aren't we taking this a step at the time and focusing on where the problems really are at. >> host: from your home state, sue on the democrats line. good morning. >> caller: good morning, senator. i mean johanns, my question is i've tried for years to turn in two businesses that committed medicaid fraud that was charges thrown and throwns of dollars in -- thousands and thousands of dollars in my name. these businesses are still operational. i haven't seen them being prosecuted. after two years, the office was no longer interested. if i wanted these businesses prosecuted, i would have to hire my own attorney to do that. i'm on disability for epilepsy, i can't do that. when i see people are stealing taxpayers money, i want something done.

i don't want to be given excuses. that's all i've been given. you can go to from city to county to the state. and apparently the senator didn't want to deal with this. because health and human services was involved. and these provider, are charging, sir, for enormous charges for services that are made up. >> here's what i would offer to you, sue. please reach out to my omaha office or really any of your offices. but you live there in omaha. let us take a look at what you claim to be somebody getting away with federal money that they should not be. i take that very, very seriously. we will follow up on that. we will pursue that. we will do everything we can to

get that information in hand to the right officials. i couldn't agree with you more. if we have health care reform or something other than that, we should not have a system where there is so much waste and fraud and abuse. i don't thinking anybody is doubting that there are parts of this medicare system, medicaid system, where there is significant abuse. it needs to be fixed. we're glad to help you, with sue. contact my omaha office. >> host: from mrytle beach, south carolina. >> caller: hello. i have a couple of comments. it just amazes me when it comes to health care there is no question. i apologize, when you comes to war there is no question that the amount. when it comes to care and loving and nurturing to people of the country, all of the sudden

everyone is watching the of budget. and the second comment of course is that it just amazes me that -- and i hope the independents can look past this. because there's no bigger intrusion to the federal government can get into any one's lives. telling a women when she can't and can have a child. that is not the government stand. it's nothing but sexism. terms of your statement on the budget, here's what i would tell you. under the most rosy picture this year, the obama administration will have a deficit of $1 trillion. i'm not talking about the total deficit of this country, i'm talking about how much this budget this year doesn't match with the revenues coming in $1 trillion. as far as the eye can see, the

obama administration projects that their budgets over the next decade will run an annual deficit of $1 trillion. now here's a very important point. somebody has to face the music there. i'm a man who is 59 years old. god willing, i'll be on this earth some more years. but the reality is my productive years are going to be somewhat limited at some point here. what does that mean? it will fall to my children and grandchildren to worry about the debt that i've piled up. i think as americans, we owe them more than that. yes, we want to care for each other. i think we're a caring country. but we need to start paying attention to that deficit. in terms of your statement on abortion, here's what i would offer. i really do believe that government has a role in protecting the most vulnerable. i see that role in this issue of

life. even getting beyond that, the nelson-hatch amend i think is the fact of what the country believes, public funds, taxpayer dollars, should not be used for abortions. and pro-choice, pro-life they seem to agree on that. any analysis i've ever seen of people's attitudes out there, very overwhelmingly, people do not want their tax dollars used clear and directly to finance abortions. >> host: earlier this morning, we asked what should be done with the extra t.a.r.p. money. do you use it to create jobs or pay down the debt? what camp do you fall in? >> pay down the debt. here's why. when that legislation was passed it was very, very controversial. there were probably elections -- votes taken o that legislation.

the past administration, the bush administration, then the obama administration came in and said got to be done though. has to be done. we're going to buy troubled assets. if we don't do that, we're in a crisis. guess what? t.a.r.p. money was used to do all measure of things that was never represented to the voters to be how the money would be used. we bought general motors with t.a.r.p. had i been on this program two and a half years ago -- >> senator mike johanns from this morning. we'll take you live to capitol hill. we'll take you live just outside the u.s. senate. they are waiting to hear from senators. they should be coming to the cameras momentarily. that should be shortly. >> the president brought general motors using t.a.r.p. money with no congressional vote, no

oversight, literally bought general motors, aig, this is not what this money was intended for. and very clearly, i believe when the money is paid back the legislation calls for the money to be put back into the treasury to pay down the debt. that's what we should be done. >> host: back to the phone calls. sherri on the republican line. gled >> caller: good morning. i'm concerned about a health care issue again. i'm a health nurse, we deal with a lot of the older population. unfortunately, home help makes up 4% of health care. yet, we continue to have to take enormous cuts to take care of our aging population. our population that is dependent on government funds such as medicaid, state funds, yet we still could get reduction after reduction.

i want to know our voice would be heard. not only our aging population need care, our care providers want to provide. time and time again home health is hit for cuts. is this something that we actually have a voice as a public and care providers to redirect some of these cuts? >> host: senator johans? >> i wish i had better news for you. on saturday i offered an amendment that was voted on on the senate floor and basically the amendment very clearly take out of the bills the cuts in health care. i agree with it. it's a great program. it's suffers cuts in the past. that amendment was defeated. it was defeated almost on a pure-party line vote, not quite, but close. democrats voted to cut home

health care, republicans voted to keep home health care and protect it from the cuts. now they offered an amendment that really, really was focused. again it said we'll protect the guarantees program. that means nothing. because the cuts will still go forward, even though the program is still there. i think what's going to happen when the cuts impact our states, when they hit our states, you're going to lose home health care agents. they just won't be able to function without this medicare reimbursement at that level. it's heartbreaking to me, because it's good program. i've always believed in the program. it does keep people out of nursing homes. you know, i had instances that i pointed out on the senate floor of the gentleman that came home after a leg amputation. he has home health care. it's much better to have him in the home. somebody coming to take care of that wound than to put him in

the hospital forever. much cheaper to have him in home income you are just looking at the dollars. we had a gentleman in the nebraska that's waiting for a heart transplant. he's at home. that is only possible because the home health care helps his heart failure. it's just story after story. unfortunately, we lost on that vote. those cuts will be made. you will feel the impact in your state, i will in my state, every state will feel the impact. >> host: on the democrat line. >> caller: good morning. you talk about debt and deficit, where were you when there was the tax cut for the top 10% while we had two occupation on the of budget medicare reform bill that was offbudget and we were running up the debt? as far as medicare cuts that are

being discussed have to be waste, fraud, and abuse. and in home health care, there's no less fraud, waste, and abuse than there is in the medicare advantage plan that was privatized and cost us as taxpayers 14% more for basically the same coverage. >> we had hoped to bring you live coverage of the senate leaders. some are coming to the podium now. you can watch that live now at c-span.org. we'll take you live to the u.s. senate pending business includes an abortion coverage and amendment and also a motion by senator mccain for changes in the medicare program. day number nine of health care debate in the senate live here controlling the first 30 minutes and the republicans controlling the second 30 minutes. further that no amendments be in order during in time. the presiding officer: is there

objection? without objection, so ordered. mrs. boxer: mr. president, since this is the 30 minutes of time for our side, i would ask that i be recognized for 10 minutes, senator murray for five, senator lautenberg for five, senator harkin for five, senator cardin for five. we have many members wishing to come and speak and i would urge them to contact us. and i will just take a minute just to get my notes in order and i would note the absence of a quorum and the time should be taken off our time from that. the presiding officer: the clerk will call the roll. quorum call:

mrs. boxer: i ask that the quorum call be dispense dispens. the presiding officer: without objection. mrs. boxer: thank you. mr. president, we are in the middle of a very important debate about whether or not we're going to move forward and make sure that our people in america have health care. that's the -- that's really what it's about. and i'm going to throw out a few numbers that are always on my mind as i talk about this issue. one of them is 14,000. every day 14,000 americans lose their health insurance. it's not because they did anything wrong. a lot of times it's just because they get sick and their insurance company walks away from them or they may reach the limit of their coverage. they didn't realize they had it and they're done for. they could lose their job and

they can't afford to pay the full brunt of their premium. they could get sick and then all of a sudden they are now branded with a p.c., and that's not a personal computer. it's a preexisting condition, and they can't get health care. so we're in trouble in this country with 14,000 americans a day losing their health care. a lot of them working americans. as a matter of fact most of them. sometimes a child, for example, will reach the age where they can no longer be covered through their parents' plan and the child might have had asthma. when they go to the doctor, they beg the doctor not to say they have asthma. i have doctors writing to me saying parents are begging them, please, don't write down that my child has asthma.

say she has bronchitis. because when she goes off my medical plan, she's going to be branded with a preexisting condition. so 14,000 americans a day. remember that number. then, mr. president, 66%. that's a big percent. 66% of all bankruptcies are due to a health care crisis. bankruptcies. people are going bankrupt. not because they didn't manage their money well or they didn't work hard and save. but because they're hit with a health care crisis and either they have no insurance or the insurance refused them. the stories that come across my desk, like yours, are very heartbreaking. so people are going bankrupt. they lose their dignity. they lose everything because of a health care crisis. and yesterday i brought up a couple of numbe numbers, 39 out0

industrialized nations. we're not doing very well. and it's no wonder. more than 50% of the women in this nation, mr. president, are not seeking health care when they should. they're putting it off or they're never getting it and no wonder we don't do well with infant mortality. and why don't women do this? because they either don't have insurance or they don't have good enough insurance or they can't afford the co-pay or they're fearful. they're fearful that maybe if they go this time, the insurance company will say no more. 24 out of 30. that's where we rate. 34 out of 30 -- 24 out of 30 industrialized that's where we rate on life expectancy. my colleagues are shocked by

that, they're shocked at the infant mortality and the lie ex peck transyism i heard my colleagues try to rationalize this. it's because our population is diverse. this is the richest, most powerful nation on earth. there's no reason that we have to be 24 out of 30 in terms of our life expectancy. especially when you know that so much of our problem deals with about five diseases. diseases like diabetes that can be prevented an certainly treated. and the last number i'll talk about 45%. the average family in america by 2016, if we do nothing will be paying 45% of their income on premiums. now this is disastrous. 2016 is around the corn are by my calculations. and that means more and more of

us will not be able to afford insurance. and we're going to show up at hospital emergency rooms, cost a lot, the outcomes are bad, and america will really continue this downward spiral in relation to our health care system. so why do i take time to talk about this? it's because we need to keep our eye on the big picture. and the big picture is not a pretty picture for our people right now. the status quo is not neutral. it's cruel. and every one of us could wake up in the morning, having loss a job and having no health care. it -- what we're doing is going to help every american. and i think one of the -- the best things we do in the underlying bill is to make sure that health care premiums are affordable for everyone. that's the key. we do it in a number of ways.

well, in the middle of all of this we have an amendment that would roll back the clock on women's rights. and i'm here to say, as i said last night, i'm so happy to see other colleagues joining, that it is unacceptable to single out one group of people, namely the women of this country, and tell them that they can't use their own private money to buy an insurance policy that covers the range of reproductive health care. why are women being singled out here? it's so unfair. we've had a fir firewall in plae for 30 years. it said this: no federal funds can be used for abortion, but private funds can be used as long as abortion is legal, and it is.

roe v. wade made it legal in the early stages of a pregnancy. women have that right. what this amendment does is says, there's one group of women here we're going to treat differently. we're going to take 1 procedure that only applies to them and say they can't buy health insurance for that toadure. only if it's a -- procedure. only if it's a separate rider, which everyone knows is unaffordable, impractical and will not work. i don't see any amendment here saying to men that if they want to have a procedure that relates to their reproductive health, they can't use their own private money to buy coverage for it. no, it's not in there. we don't tell men that if they want to make sure their can buy insurance coverage through their pharmaceutical plan for viagra

that they can't do it. no, we don't do that and i wouldn't support that. it would be wrong. well, it's wrong to single out women and to say to women of this country, they can't use their own private funds to purchase insurance that covers the whole range of reproductive health care. now you have to look behind at this amendment to really understand how pernicious it really is. because the whole point of it is, and i -- five male colleagues on the other side of the aisle were on the floor for, i don't know, at least an hour pawckintalking about this amend. and each and every one of them want to make abortion illegal. there's no question about it. they want to take away a woman's right to choose, even in the earliest stages of a pregnancy. even if it impacts her health,

her ability to remain fertile, her ability to avoid a very serious health issue, such as, a heart problem or a stroke. they don't want to have an exception for women's health. no questions that what they want. the presiding officer: the senator's 10 minutes is up. mrs. boxer: i ask unanimous consent for an additional 30 seconds and then i'll turn to senator lautenberg. the presiding officer: without objection. mrs. boxer: so to sum up my part here, the amendment offered by nelson, hatch, vitter,et al, brownback, it hurts women. it singles out one legal procedure and says, you know what? you can't use your own private funds to buy insurance, so in case you need to use it for that legal procedure, you can't.

i will yield the floor and note that senator lautenberg is here for five minutes. i'm sorry, it was senator murray for five -- the presiding officer: the senator from washington. mrs. boxer: sorry. mrs. murray: thank you, madam president. mr. president, and thank you, madam chairman, for your debate on this and for outlining the serious concerns we have. and i rise today not only in strong opposition to the nelson amendment, but in strong support of women's health care choices, which this amendment would eliminate. mr. president, we can't allow a bill that does so much for women and for families and our our businesses and for the future strength of this nation to get bogged down in idealogical politics. because in every single sense of the word, health insurance reform is about choices. giving options to those who don't have them, options for better care or better quality

and insurance that is within reach. this bill was never supposed to be about taking away choices and we cannot allow it to become that. mr. president, this bill already does so much for millions of women across america. already so far the senate has passed senator mikulski's amendment to make sure that all women have access to quality preventive health care services and that screenings that are so critical to keeping women's healthy -- women healthy are available. the bill -- this underlying bill will help women by ending discrimination based on gender rating or gender bias preexisting conditions on covering maternity care on covering preventive care and screenings including mammograms an baby care, expanding coverage, even if an employer doesn't cover it and cover those who are in an abusive relationship, if they leave, they and their children could

lose their coverage. now, mr. president, the amendment before us today would undermine those efforts and goes against the spirit and the goal of this underlying bill. mr. president, all americans should be allowed to choose a plan that allows for coverage of any legal health care service no matter their income. and that, by the way, includes women. but if this amendment were to pass, it would be the first time that federal law would restrict what individual private dollars can pay for in the private health insurance marketplace. if this amendment were to pass, it would be the first time that federal law would restrict what individual private dollars can pay for in the private health insurance marketplace. now, the opponents of this bill have taken to the floor day in and day out for months arguing that this bill takes away choice. mr. president, this bill doesn't take away choice, but, boy, this amendment sure does.

this amendment stipulates that any health plan receiving any funds under this legislation cannot cover abortion care even if such coverage is paid for using the private premiums that health plans receive directly from individuals. simply put, what this amendment does is if a health plan wants to offer coverage to individuals who receive affordability credits, no matter how small, that coverage cannot include abortion care. in this way, the amendment doesn't just restrict federal funds. it restricts private funds. and it doesn't just affect those receiving some amount of affordability credit. it also impacts people who are paying the entire cost of coverage but who just happen to purchase the same health plan as those with affordability credits. so the bottom line, mr. president, this amendment would be taking away options and choices for american women.

mr. president, there's no question this amendment goes much farther than current law, no matter what our colleagues on the other side contend. current law restricts public funds from paying for abortion except in cases of rape or incest or where the woman's life is in danger. the existing bill that is before us represents a genuine compromise. it prohibits federal funding of abortion, other than the exceptions i just mentioned, but it also allows women to pay for coverage with their own private funds. it maintains current law. it doesn't roll it back. but this amendment that is now before us would be an unprecedented restriction on women's health choices and coverage. health insurance reform should be a giant step forward for the health and economic stability of all americans. this amendment would be a giant step backwards for women's health and women's rights. you know, women already pay

higher costs for health care. we shouldn't be forced into limited choices as well. so, mr. president, we're standing on the floor today having a debate about a broken health insurance system. it is broken for women who are denied coverage or charged more for pre-existing conditions or pregnancy or c-sections -- mr. president, i ask for an additional 30 seconds. the presiding officer: without objection. mrs. murray: for people -- for women with domestic violence, c-sections that are classified as pre-existing conditions. it's broken when insurance companies charge women of child-bearing age more than men but don't cover maternity care or only offer it for hefty additional premiums. mr. president, the status quo is not working. women and their families need health insurance reform that gives them options, doesn't take them away, so i urge my colleagues stand up for real reform, reject this shortsighted amendment. thank you, mr. president. i yield the floor. the presiding officer: the

senator from california. mrs. boxer: i wanted to amendment the unanimous consent request to give senator lautenberg eight minutes and myself two minutes followed by senator cardin for five. the presiding officer: without objection, so ordered. the senator from new jersey. mr. lautenberg: mr. president, throughout my service in the senate, i have been a strong supporter for health care reform, but we can't allow reform to be used as an excuse to roll back women's rights they have had for almost a half a century. and that's why i strongly oppose the amendment offered by my friend, the senator from nebraska. i think he's wrong. what this amendment does is remove a woman's right to make her own decision as a practical matter. it's to prohibit any of the

health plans on the exchange from covering abortion. and it will ban coverage even for women who don't get a dime in federal subsidies. women's reproductive rights are always being challenged here in the congress, but what about men's reproductive rights? so, mr. president, let's turn the tables here for a moment. what if we were to vote on a viagra amendment, restricting coverage for male reproductive services. the same rules would apply for vargas being proposed for abortion, and of course that means that no health plan on the exchange would cover viagra availability. how popular would that demand be around here? mr. president, i understand that abortion and drugs like viagra present different issues, but

there is a fundamental principle that is the same, restricting access to reproductive health services for one gender. and this amendment is exclusively directed at a woman's right to decide for herself. it doesn't dare to challenge men's personal decisions. mr. president, i have the good fortune of being a father of three daughters and grandfather of six granddaughters, and i am deeply concerned by the precedent that this amendment would set. i don't want pligz making decisions -- i don't want politicians making decisions for my daughters or my granddaughters when he it comes to their health and well-being, but that's exactly what this amendment does. nothing made me happier than when any of my daughters announced their pregnancy and while i watched them grow and prosper in their health and

well-being as they were carrying that child. and i was fully prepared to support a decision that they might make for the best health of that new baby and protecting her health to be able to offer her love and care for a new child as i saw in my years. and i don't -- i don't want to stand here and think that somebody is going to make a decision in this room that affects what my granddaughters or my daughters have to think about. they want to -- if they want to restrict themselves, let them do it, but why do -- can we stand here and permit this to take place when we are trying to make people he healthier and better informed? but this amendment wants to take away that right. right now, the majority of

proper health insurance plans do offer abortion coverage. now, this amendment would force private health insurance companies to abandon those policies, eliminate services, and limit a woman's option. the amendment does not, contrary to statements made -- being made here on this floor, simply preserve the hyde language that has been in place for more than three decades. make no mistake, this amendment goes well beyond the concept of limiting federal funds from paying for abortion. this amendment would make it impossible for a woman who pays for her premiums out of her own pocket to purchase a private health plan that offers her the right to choose what is best for her, for her health, and her family's well-being. we have been working hard for a

long time to eliminate discrimination against women in our current health care system, and right now our health care bill takes a balanced approach to abortion coverage. it preserves existing federal law. women have fought this nation's -- since this nation's founding to have full rights under the law, including suffrage, including many other things, but unfortunately this amendment would force them to take a step backwards, and i don't want to see it happen, and i urge my colleagues please use your judgment, make your own choices about your own families, make your decisions as to what you would recommend to a daughter or a wife, but for god's sake, let the woman choose what's best for her. and i urge my colleagues to vote against it.

with that, i yield the time. the presiding officer: the senator from maryland. mr. cardin: mr. president, thank you very much. i rise in strong opposition to the nelson-hatch amendment. and let me start off by saying that i support a woman's right of choice. it's a constitutionally affirmed right. and i understand how difficult and divisive this issue is. that is why the underlying bill that we have before us carries out the compromise that has already been reached between the pro-choice and pro-life supporters. it represents maintaining the federal prohibition on funds, federal funds for abortion but allows a woman to pay for abortion coverage through use of her own funds. that's the current law and that's what the underlying bill makes sure that we continue. many of us thought that the health care debate is critically important, it's controversial. let's not bring the abortion issue into the bill.

the nelson-hatch amendment would go beyond that. it would restrict a woman's ability to use her own funds for coverage to pay for abortions. it blocks a woman from using their personal funds to purchase insurance plans with abortion coverage. if enacted for the first time in federal law, this amendment would restrict what individual private dollars can pay for in the private insurance marketplace. i might also point out that when you look at those who are supporting this amendment, you can't help but have some concern that this amendment is being offered as a way to derail and defeat the health care reform bill, because most of the people who are going to be supporting that amendment will vote in opposition to the bill. it's quite clear that the senate health reform bill already includes the language banning

the federal funds for abortion services, so the supporters of this bill are not satisfied with the current funding ban. they're trying to use this to move the equation further in an effort to defeat the bill. i also would point out that this is really wrong as it relates to women in america. i am outraged that the suggestion that women who want abortion should be able to purchase a separate rider to cover them. why would we expect this overwhelmingly male senate to expect women to shop for a supplemental plan in anticipation of an unintended pregnancy or a pregnancy with health complications? who plans for that? the whole point of health insurance is to protect against unexpected instances. currently there are five states -- idaho, kentucky, oklahoma, missouri, and north dakota -- that only allow abortion coverage through

riders. guess what? the individual market does not accept this type of a policy, it doesn't exist. abortion riders severely undermine patient privacy. as a woman would be placed in the position of having to tell their employer or their insurer, and in many cases their husband's employer, that they anticipate terminating a pregnancy. also requiring women to spend additional money to have comprehensive health care coverage is discriminatory. we don't do that for services that affect men's reproductive rights. and the last point i would mention is i hear frequently from my friends on the other side of the aisle that the statements that we make -- that is, those who support the bill, underlying bill, that this allows individuals who have their current insurance to be able to maintain their current insurance, builds on what's good in our health care system. well, this amendment takes away rights that people already have. so if you have insurance today as an individual that covers

abortion services, if this amendment were adopted, you're not going to be able to get that. so we are denying people the ability to maintain their own current insurance if this amendment were adopted. it's the wrong amendment. the policy is wrong, but clearly on this bill it's wrong. i just urge my colleagues to accept the compromise that was reached on this bill, the compromise. many of us who would like to see us be more progressive in dealing with this issue, remove some of the discriminatory provisions that are in existing law, we understand that we'll have to wait for another day to do that. let's not confuse the issue of health care reform. let's defeat this amendment that would be discriminatory against -- against women. that's wrong. i urge my colleagues to reject the nelson-hatch amendment. with that, i would yield the floor.

mrs. boxer: mr. president? i would like to thank senators murray, lautenberg, and cardin for participating in our half-hour of debate at this time. our block of time is almost used. but i'd like to close this half-hour by saying one word that i think is a beautiful word, and that word is fairness. fairness is a beautiful word, and it should always be the centerpiece of our work here. we should never single out one group of people for -- as targets. we should treat people the same. and it's been very clearly stated that the nelson-hatch amendment, like the stupak amendment in the house, singles out an area of reproductive health care that only impacts one group, and that's women. and it says to women they can't use their own private funds to buy coverage for the full range of reproductive health procedures. it doesn't say that to a man. it doesn't say to men you can't

use your own funds to cover the costs of a pharmaceutical product that you may want for your reproductive health. it doesn't say that they can't use their own private funds for a surgical procedure that they may choose. that is in the arsenal that they may choose for their own reproductive rights. so we say to the men of this country, look, we're not singling out any procedure or any pharmaceutical product that you may want to use for your reproductive health care. we're saying if a private insurer offers it, you have the right to buy it. we are singling out women. and, again, let me say this as clearly as i can, mr. president. we've had a firewall between the

use of private funds and federal funds. senator reid has keep that in place in the underlying bill. he keeps the status quo of the hyde amendment. the group here who are coming on the floor continually -- mostly men; i think so far all men, there may be some women that speak in their behalf but i haven't heard it -- are basically saying forget the firewall, forget it. women, you can't use your private funds and government will tell you what you can or can't do. you know, i'll tell you something, that's not what uncle sam should do. uncle sam should respect women, we should respect men, and i hope we defeat this amendment. and i yield the floor. the presiding officer: the senator from wyoming. mr. enzi: mr. president, i'd yield ten minutes to the senator -- up to ten minutes to the senator from arizona. the presiding officer: the senator from arizona. mr. kyl: thank you, mr. president. mr. president, america's seniors have made clear that they value the medicare advantage program.

they like their access to private plans, plan choices, the lower cost sharing, and all of the extra benefits not included in traditional medicare, such as vision, dental, hearing, and the wellness programs that help them to stay fit. before the medicare modernization act of 2003, seniors had been decrying their lack of choices. we made sure under the medicare modernization act that seniors would be assured health care choices just as all of us here in the congress enjoy. now that they have access to private coverage and enjoy more benefits and choices, seniors want us to make sure that medicare advantage stays viable. and they're not happy about the proposed cuts in the majority leader's bill. i have received more than 500 phone calls just since november 1 from constituents who oppose the $120 -- excuse me, $120 billion medicare advantage

cuts proposed by the majority bill. they know you can't cut $120 billion from a program without cutting its benefits. and a lot of seniors in arizona are asking, what happened to the president's repeated promise that if you like your insurance, you get to keep what you have? they don't like the idea that under this bill, their benefits would be slashed by 64%, from $135 value per month to $49 value per month, which is exactly what the congressional budget office projects would happen. they don't want the money that they paid in to medicare going to fund a new government entitlement program for nonseniors, and they're not satisfied with the majority's promise to president clinton guaranteed benefits. they want members of congress to be straight about our intentions and not engage in semantics. they want an unequivocal promise they'll be able to keep exactly what they have now, just as the

president promised. now, here is the problem. there's an earmark buried on page 894 of the legislation before us that suggests that senior citizens in florida must have insisted on this exact kind of protection, for their medicare advantage as well. this provision in section 3201-g was specifically drafted at the request of the senior senator from florida to protect the benefits for at least 363,000 medicare advantage beneficiaries in florida. but very few anywhere else. nothing in the bill grants the same protection that is granted to these senior citizens to those in my state or in the other states in which there are a lot of seniors that have the medicare advantage program. that's why i support my colleague's amendment, senator mccain's amendment, to commit this bill to the committee and return it without these -- well,

actually what his bill does is to ensure that all seniors, whatever state they're in, enjoy the same grandfathering status as the senior citizens in florida would have under the nelson proposal. the mccain amendment to commit is straightforward, that, first of all, would help the president keep his commitment that seniors get to keep their insurance if they like it, and it applies to all of america's seniors the same protection granted to floridians, as is. as -- as i said. isn't that what all seniors deserve, the security of knowing that their current benefits are safe? if our democratic colleagues are not willing to extend this protection to every medicare advantage beneficiary, then i can't imagine how they can claim to be in faif of protecting med -- in favor ofcting i have been sharing letters, mr. president, that i've received from arizona constituents describing what the medicare advantage program means to them. and i thought today i'd just share some excerpts from a few

more of these letters. a constituent in surprise, arizona -- hope you like the name of that town, surprise, arizona, just west of phoenix -- says "i truly hope you'll consider keeping the medicare advantage plans for seniors. i find the savings a must on my fixed income. i appreciate the high-quality doctor care on my medisun advantage plan. prescriptions are included in the cost of my plan, providing further savings for me. medicare advantage has made a real difference in my life. please don't let anything happen to this important program." and a constituent from fountain hills writes, "i suffer from a specific type of ametropholic lateral clersz and rely on medicare advantage for all of my medical needs. i'm asking that do you all that is in your power to protect and provide for the continued funding of this program. in arizona, we have over 329,000 people who count on medicare advantage. our lives would be devastated without it."

and a constituent from wick enberg, arizona, says, "please don't let anything happen to my medicare advantage. i like my medicare advantage plan because i can choose my own doctor in my own town and also choose a specialist if i need one. i can also get regular checkupsdon't have trouble getting to see the -- checkups and don't have trouble getting to see the doctor. so i ask that you don't let the government cut my medicare advantage." and a constituent from mesa, arizona,, "i'm a senior citizen. i'm become more and more concerned about president obama's health care plans and i'm writing to tell you that i'm happy with my medicare advantage plan. i request that you do all you cannot to cut my benefits. i have a fairly wide choice of doctorsspecialists who -- doctors and specialists who have always treated me with respect, giving me the time i feel i need and have given me excellent care. i have a fitness benefit which entitle mez to the silver sneakers program at our local ymca, two choices of a dental plan, a vision plan plus many other options to maintain my level of health or try to improve it.

please, i beg you, do whatever you can to maintain our medicare advantage plan. do not cut any of our benefits." so, mr. president, web, mr. pret there are millions of seniors out there who absolutely depend on medicare advantage. many have stories to tell about how this program has improved the quality of their life and their health care -- excuse me, and their -- their health. and so i urge my colleagues to support the mccain amendment to ensure that all of america's seniors, not just those in certain preferred counties, primarily located in the state of florida, are grandfathered in these benefits. again, just to make it very clear. medicare advantage benefits are cut by the $120 billion reduction in medicare under the bill. the senator from florida found a way to grandfather the medicare advantage benefits for most of or many of his constituents. what the mccain amendment does is to apply that same

grandfathering to all seniors in all states so that none of seniors who have medicare advantage today would lose any of the benefits that they enjoy today. it seems to me that what's good for our senior citizens in florida ought to be good for our senior citizens in arizona or any other state in which they reside. so i urge my colleagues to consider and to support the mccain amendment. mr. enzi: mr. president? the presiding officer: the senator from wyoming. mr. enzi: i'd yield up to men minutes to the senator from highway high, senator voinovich. mr. voinovich: thank you, mr. president. i'd like to just comment on senator kyl's, the senator from arizona's remarks about medicaid advantage. i was surprised to hear that the legislation provides for grandfathering in medicare -- medicaid advantage benefits in two states. obviously, individuals that want

to grandfather them are doing it for a reason and that is they're afraid that if they didn't grandfather them, that the people in their respective states would lose them. and if we're going to apply that same type of grandfather to other states, then it should be uniform i think throughout our country. mr. president, i just want to speak about the nelson-hatch amendment. i want to spend a minute discussing the very emotional and divisive issue of abortion. mr. president, i personally believe that all children born and unborn are a precious gift from god and we have a moral responsibility to protect them and it graves me to think that it's been 40 -- there's been 40 million abortions performed in this country since 1973. think of that. 40 million abortions since 1973. probably the worst -- one of the worst records probably anywhere in the world, the united states of america. i am pleased to support the nelson amendment that would apply the long-standing hyde

amendment which currently prohibits federal funding to pay for abortion services except in cases of rape, incest, or to save the life of the mother to the health care reform bill. the issue of abortion is one that results in very strong emotions on both sides. because of the concern that millions of americans have with using federal taxpayer dollars for abortion, congress enacted the hyde amendment. as my colleagues know, the hyde amendment has restricted federal medicaid dollars from paying for abortion since 1977 and has been applied to all federally funded health care programs, including the federal employees health benefits program. think about this. this language has been in place since the ford administration and has survived through the administrations of presidents carter, reagan, george h.w. bush, president clinton, and george w. bush. that is 33 years.

33 years. and all of a sudden my colleagues want to change our policy on federal funding of abortion. mr. president, we shouldn't be making this type of sweeping policy change in this health care legislation. and the nelson amendment is necessary -- is a necessary addition to the bill in order to protect our current policy and the unborn. i understand that not everyone in this country agrees with my position on abortion. and, again, i know that this issue deeply divides americans on ethical, moral, and religious grounds. while i have said that i don't agree with abortion and believe roe v. wade should be overturned, the nelson amendment -- and this is really important -- does not prevent anyone from seeking an abortion, it does not overturn roe v. wade and it does not place any new restrictions on access to abortions. none whatsoever.

it simply assures that taxpayer dollars will not pay for services that cause such deep moral division in our nation. i think it's notable that this amendment is one of the few bipartisan amendments that the senate will consider as part of this debate. i'm pleased that a similar amendment in the house of representatives passed with a convincing margin, and i urge my colleagues to support the nelson-hatch amendment before the senate. let's take this issue out of the debate on this proposed health reform legislation that's -- that's before us, recognizing that millions of americans are concerned that federal dollars are going to be used for something that many of us feel is -- is not right. people can still use their private dollars, they can still do what they've been doing in

the last 33 years. so let's not -- let's pass this amendment and get on with it, and there are other issues i know that have to be reconciled. but i'm urging my colleagues, please, give serious consideration to the hatch-nelson amendment. thank you. mr. enzi: mr. president? the presiding officer: the senator from wyoming. mr. enzi enzi: i'd yield up to n minutes to the senator from idaho, senator crapo. mr. crapo: thank you very much, mr. president. i rise today to discuss the medicare advantage program aga again. it's one that is facing nearly $120 billion in cuts under the democratic health care bill. currently, there are nearly 11 million seniors enrolled in medicare advantage, which is about one out of every four seniors in the united states. in my home of idaho, that's about 60,000 people, or 27% of all medicare beneficiaries in the state.

medicare advantage is an extremely popular program. in fact, it's probably the most popular and fastest growing part of medicare. a 2007 study reported high overall satisfaction with the medicare advantage program. 84% of the respondents said that they were happy with their coverage, and 75% would recommend medicare advantage to their friends or family members. but despite this popularity of this program, the massive cuts in the reid bill will result in most seniors losing benefits or coverage, or both, under medicare advantage. i've shown this chart before, and you can't really see the individual states too well in it from this distance at this size, but you can see the coloring on the united states here in this chart. if you live in a state that is red, deep red, or the pinkish color, which is almost every state in the union, then you are

going to see your benefits cut under medicare advantage. under this bill. now, why am i bringing this up again? we've already had a vote on it. in fact, we've had two votes on it. the majority has insisted on keeping these cuts in the bill. the reason i'm bringing it up again is, as we have combed through this 2,074-page bill, we have found out that there's a provision in the reid bill that would protect medicare advantage benefits for some people in the united states, for just a few in this country. during the finance committee markup, senator bill nelson of florida advocated on behalf of medicare advantage and on the beneficiaries in his home state of florida. scwntsly, during closed-door negotiations, the legislative language was added to protect those beneficiaries. now, this is interesting, because one of the responses to us, as we have tried to stop the imposition of these cuts to medicare, has been that this

bill won't cut any medicare benefits. well, if not, then why does florida need a special exemption for its citizens? if not, why not support the mccain amendment that would give the same protection to all medicare advantage beneficiaries that the bill gives to just a few -- in florida primarily? specifically, section 3201-g of the reid bill buried deep in the bill on age 894, has a $5 billion provision drafted to prevent the drastic cuts in medicare advantage program from impacting those enrollees who reside primarily in three counties in florida: broward, miami-dade, and palm beach. it seems unfair that taxpayers would foot a $5 billion provision that provides protection for only some of the medicare advantage beneficiaries. but it certainly proves that there are cuts to medicare advantage benefits in this bill.

again, benefits that one out of four beneficiaries in america receives. one of the fastest if not the fastest-growing parts of medicare. instead of preferential treatment for some, why not extend these same protections for medicare advantage to all beneficiaries under medicare? i know that the 60 medicare beneficiaries on medicare advantage in idaho, my home state, want and deserve that same level of protection. that's why, mr. president, that i'm here to support the mccain motion to recommit, and that's what his motion to recommit would accomplish. very plain and very simple. the mccain motion would extend this grandfathering provision to all beneficiaries in the medicare advantage program, so that all seniors in this popular and successful program could maintain that same level of benefits that today they envoy under the current law. -- enjoy under the current law. every senior in the medicare

advantage program deserves to keep these critical extra benefits which include things like dental coverage, vision coverage, flu shots and much more. in fact, most people who are not on medicare advantage have to buy supplemental insurance in order to get access to this coverage. those in medicare advantage, which is one of the reasons it's such a popular program, have the opportunity to get it through their medicaid services. and why is medicare advantage so opposed? well, some say it's because of the extra costs, except that the extra cost in medicare advantage is returned to the government or shared with the beneficiary. i think the reason might be because medicare advantage is one part of the medicare program that we have successfully been able to turn over to the private markets for operation, and interestingly when the private sector gets administered in administering this part of the medicare program, the medicare beneficiaries get more benefits and it becomes the most popular

program in medicare. i know that my colleague from pennsylvania, senator case circumstance has filed an amendment to protect the -- senator casey, has filed an amendment to protect the medicare advantage beneficiaries in his state. i would expect strong support for the motion to commit since i think every senator wants to see this kind of protection in their state. in the end, the mccain amendment will protect nearly 11 million seniors today enrolled in the medicare advantage program and help to keep the president's promise when he said, if you like what you have, you can keep it. if this bill is not amended in the twha way that it is being proposed by senator mccain's amendment, 11 million americans are not going to be able to keep what they have in the medicare program, and that's just a start on the impact of what people in america are going to see under this legislation in terms of a reduction of their benefits and the quality of services they have access to.

mr. president, i urge my colleagues to support this amendment, and i yield the floor. mr. enzi: mr. president? the presiding officer: the senator wyoming. mr. enzi: i'd yield myself the balance of the time. mr. president, i rise today to speak in support of the nelson amendment. we've been talking about the mccain amendment which provides fairness for seniors who have medicare advantage so that everybody across the country can have the same thing that florida is getting. but the really critical amendment that i want to talk about is the nelson amendment. this amendment needs to be adopt fundamental we truly want to prevent federal dollars from being used to pay for abortions. i'm asking to you support a democratic amendment. this is not a partisan issue. it is a human issue. even if you are on the other

side, i would hope you could agree that it is not trite force people to pay for a procedure -- it is not right to force people to pay for a procedure that many people find offensive to the core of their morality. when my wife diana gave birth to our first child, amy was three months premature, weighed just thretwo pounds. the doctors couldn't do anything to help this newborn baby. she survived the nievment the next day i took amy to a hospital in casper. an ambulance was available so we went in a thunderbird. it was in a huge blizzard, a blizzard that prevented us from flying amy to denver to a hospital that specialized in that. but we took this car and went to the center of the state to the biggest hospital to get the best care we could find. we ran out of oxygen on the way because the snow took so long. the highway patrol was looking for us, although they were looking for an ambulance. all along the way we were

watching every breath of that child. we arrived at the hospital in casper and put her in the care of doctors. there were several times when diana and i went to the hospital and found her isolated with a shroud around it. the nurses would say, it's not looking again. we had to help her to breathe again. or, have you had your baby baptized? we did have amy baptized a few minutes after birth as she worked to struggle and live. watching an infant fight with every fiber of her being just unquestionably showing the desire to live, even though they're only six months developed, is something that will show you the value of life. amy survived and is now a teacher so gifted that she teaches other teachers. amy's birth changed my whole outlook on life. it reminded me of the miracle of life and the respect we owe that miracle. the reid bill, as it is

currently, does not respect life. but the amendment before us will allow that respect to be given to every american who benefits from the bill. on september 9, president obama told a joint session of congress, "no federal dollars will be used to fund abortions." i agree. no federal dollars should ever be used to pay for abortions. to do so otherwise would compel millions of taxpayers to pay for abortion procedures they oppose on moral or ethical grounds. unfortunately, the reid bill fails to meet that standard set by the president. section 1303 of the bill provides the secretary the authority to mandate and fund abortions. some have questioned exactly how this bill funds abortions. it's quite simple. the bill fund funds abortions th the government-run insurance option and through subsidies to individuals to help pay for the cost of private insurance. both of these options are funded with federal dollars.

under the community health insurance option, also known as the government-run plan, the secretary of health and human services could allow the plan to cover abortions. in addition, the new tax subsidies in the bill could also go to private plans that cover abortion. in both of these cases, federal subsidies would be paid to plans that cover abortion. the reid bill attempts to use budget gimmicks so that its sponsors can argue that federal funds will not pay for abortions. as the accountant in the senate, i'm not fooled by these gimmicks, and neither should anybody else. if the reid bill is passed, federal dollars will be used to pay for abortions. money is fungible. it means that federal dollarsified a health plan could be shifted across accounts. we don't have a good accounting system for that. there's no way to absolutely prevent federal dollars from paying for abortions once they're paid to plans that cover

abortions. that's why federal laws have explicitly prohibited federal funding going to such plans for the last 30 years. that's right. it's already federal law, although it comes in the appropriations bill on an annual basis. federal law currently prohibits fundinfunds going to pay for abs under the program. under the fehb program, the program where we get our health insurance, the one that provides all the health insurance for all federal employees, and the tricare program which is for all our active duty military and their families. current law recognizes that the only way to actually prevent federal funds from being used to pay for abortion is to offer the coverage of abortion in separate insurance plans and collect separate premiums to pay for that plan. this is what states who want to cover abortion for their medicaid populations already do. as i said earlier, medicaid is prohibited from using federal

dollars to pay for abortions. as a result, states set up separate plans and collect nonfederal dollars in separate accounts to pay for those services. if anyone has any doubts about the impact of the reid bill, i'd point them to the comments made by the senior staff at the u.s. conference of catholic bishops. associate director richard doflinger recently described the reid bill as completely unacceptable and said it was the worst health reform bill they had seen so far on life issues. it's probably worth noting that the bishops have been longtime supporters of health reform and covering the uninsured. similarly, national right to life said the reid bill -- quote -- "seeks to cover elective abortions in two big new federal health programs but tries to conceal that unpopular reality with layers of contrived definitions and hollow bookkeeping requirements." there's also been some misinformation out there regarding this amendment, and i'd like too take a minute to

clear up a couple of arguments used against the nelson amendment. first, it does not prohibit individuals from purchasing abortion coverage with their own private dollars. when similar arguments were made during the house debate on the stupak language, politifact concluded that such statements were false. the nelson amendment only prohibits federal funds from subsidizing those funds. some have argued that the nelson amendment could cause individuals to lose the abortion coverage they currently have in their plans. that also isn't correct. section 1251 says clearl says ct nothing in this act shall be contrudconstrued that an indivi- in which such individual was enrolled at the date of the enactment of this afnlgt end

quote. according to the sponsors of this bill, this section protects the ability of persons with existing insurance coverage to keep that same coverage. if section 1251 works like its authors describe it, this bill should make no changes to existing insurance plans that cover abortion and should allow individuals to keep the plans they have. some have also said that this amendment would ban abortion procedures. that, too, is false. the amendment does not ban abortions. it simply prohibits federal dollars from paying for abortions, which is consistent with the current law. many of my democrat colleagues have argued during the debate that the health care we provide under this bill should be as good as the coverage given to the united states senators. if they really believe that, they should all apply -- they should all support applying the same rules regarding abortion coverage that apply to our own health plans. federal employees' plans are prohibited from covering abortion.

all federal employees, not just senators. i will work hard to see that taxpayers are not compelled to fund abortion services. i believe those of us in elected office have a duty to work to safeguard the sanctity i of humn life since the right to life was specifically named in the declaration of independence. by safeguarding our right to life, our government fulfills the most fundamental duty to the american people. when that right is violated, we violate our sacred trust with our nation's citizens and the legacy we leave to future generations. regardless of what some people think, god doesn't make junk. he makes people in a variety of shapes, sizes and abilities and disabilities. there is a purpose even if we can't understand it. i like a sign that's just outside jill het. it says -- outside gillette. it says if it's not a baby, you're not pregnant. i'll vote in support of the

nelson amendment and encourage my colleagues to do so also. do so to protect the life and respect the miracle of life that i witnessed in the birth of my daughter, amy. i thank the president and yield the floor. mrs. boxer: mr. president? the presiding officer: the senator from california. mrs. boxer: i ask unanimous consent the following order: boxer 1 minute, durbin 5. stabenow 5. shaheen 5. dodd 5. menendez 5. baucus 4. the presiding officer: is there objection? without objection, so ordered. mrs. boxer: mr. president, i gave birth to two beautiful children, and i am proud to say i have now four grandchildren, light of my life. light of my life. and i am just here to say as a mother and as a grandmother and as a senator from california, i trust the women of this country.

and i don't want to tell the women of this country and tell nobody else anything like this, that they can't buy insurance with their own private money to cover their whole range of legal reproductive health care. we don't do that to the men. we don't say you can't get any surgery if you might need it for your reproductive health care. we don't say you can't get certain drugs in the pharmaceutical benefit that you may need for your reproductive health care. we don't say that to men, nor should we. imagine if the men in this chamber had to fill out a form and get a rider for viagra and it was public. forget about it. there would be a rage in this chamber. we're saying now treat women fairly. treat women the same way you treat men. let them have access to the full range of legal reproductive health care.

that's all we're saying. vote "no" on this amendment, the nelson-hatch amendment because harry reid takes care of this fire wall between -- the presiding officer: the senator has used her one minute. mrs. boxer: -- between private funds and federal funds. we keep that fire wall. senator durbin, you weren't on the floor. is it okay if you go after stabenow? okay. senator stabenow for five minutes. senator stabenow for five minutes. five minutes, senator. the presiding officer: the senator from michigan is recognized. ms. stabenow: i'm sorry. i had understood from our manager of the amendment that senator durbin would be going first. thank you very much. i first want to thank the senator from california for her passion, advocacy in standing up for all of us, standing up for the women of this country. i want to thank her very much. as she said, she is a mom. i too am a mom.

as hard as it is for me to believe, i also am a grandmother with a wonderful two-year-old, lily, and little grandson, walt, who was born on his daddy's birth tkaeurbgs on my son's birthday, in august. obviously they are the light of my life as well. one of the reasons i feel so passionately about the broader bill on health care reform, mr. president, is this is about extending coverage to babies so they can be born healthy. it's about prenatal care. it's about making sure that in the new insurance exchange that we have basic coverage for maternity care. i was shocked to learn that 60% of the insurance policies that are offered right now in the individual market don't offer maternity care as basic care. we happen to think that's incredibly important. we are 29th in the world in the number of babies -- 29th in the world, below third-world countries in the number of babies that survive their first

year of life. this health care reform bill is about making sure that we have healthy babies, healthy moms. it's about saving lives. it's about moving forward in a way that is positive, expanding coverage, not taking away important coverage for women who, frankly, find themselves in a crisis situation. that's really what we're doing, unfortunately, through the nelson-hatch amendment. i have great respect for both of my colleagues who have offered this, for others who feel deeply about this. i think what we have done in the bill that has come before us on the floor is to respect all sides and to keep in place the long-standing ban on federal funding for abortion services. and no one is objecting to that. no one is trying to change that. but as my friends have said, this is about whether or not we cross that line into private

insurance coverage, whether or not we say to a woman, to a family, "you know, you're going to have to decide now whether or not when you have a child you're going to have a crisis in the third trimester and might need some kind of crisis abortion service. or whether or not you're going to find yourself in a situation where you're going to need abortion services, and you're going to have to publicly indicate that and buy a rider on insurance because you can't use your own money and go out and buy an insurance policy." here's what we know right now. we know that in five states that -- have riders right now, allow abortion coverage through riders. idaho, kentucky, oklahoma, missouri. there's no evidence that there are any riders available in the individual market. even though technically

colleagues will say you can buy additional coverage, it's not offered. it is not available. we are told by the insurance carriers that in fact it probably won't be available. so we all know what this is really about. this is about effectively banning abortion services coverage in the new insurance exchange we're setting up and could in fact have a broader implication of eliminating this coverage for health plans outside the exchanges. so that's really what this is about, which is why it's so important. again, we are agreeing on the elimination or the banning of federal funding for abortions other than extreme crisis circumstances. we have done that in federal law. this is about whether we go on to essentially create a situation where effectively people cannot get that coverage with their own money. the center for american progress noted that because approximately

86% of the people who are going to be offered new opportunities for insurance, small business, individuals in the private market, that because 86% of them will in fact receive some kind of tax credit, a tax cut, that in fact again we are talking about eliminating this option altogether because the majority of people will get some kind of a tax cut during this process. i think there is also some broader implications around tax policy, mr. president. if we're saying that someone can't purchase an insurance policy of that liking if they are getting a tax credit -- the presiding officer: the senator has used five minutes. ms. stabenow: -- if i could have 30 more seconds to complete this sentence? the fact is what about other tax credits. what about other kinds of ways in which people get tax credits or tax cuts today? the implications of this are

extremely broad. i would urge a "no" vote. let us keep federal policy in place that does not allow federal funding for abortion but respect the women of this country. thank you. mr. durbin: mr. president? the presiding officer: the majority whip. mr. durbin: mr. president, i rise in opposition to the hatch-nelson amendment. for 27 years it's been my honor to serve in the house and the senate. for 27 years the issue of abortion has been front and center, one of the most controversial and contentious issues that we have faced. the same is true when i return home to my congressional district in illinois and now with the state of illinois. there are many strong heartfelt positions on this issue that are in conflict, and members of the senate and house meet with the people who have varying address of intensity on this issue all the time. we are not going to resolve this issue today, not with this amendment, not with this bill. but we are going to do several things which i think are important. what we set out to do in health care reform was to honor the

time-honored principles that we have now accepted. and they are these: abortion is a legal procedure since the supreme court case of roe vs. wade. since over 30 years now, we have said that no public funds can be used for an abortion, but to save the life of the mother or in cases of rape or incest. and we've said that no doctor or hospital will be compelled to perform an abortion procedure if it violates their conscience. those are the three basic pillars of our abortion policy in this country. now comes this debate about health care reform. and a question about whether or not, if we offer health insurance policies through an exchange that offer abortion services and the people are paying for the premiums for those policies with a tax credit, whether we are indirectly somehow or another financing and supporting

abortion. i argue we are not. we find on a daily basis many instances where federal funds go to a private entity, even a religious entity with clear guidelines that none of the federal funds can be spent for religious or private purposes. and organizations far and wide across america live within those bound. they keep their books clean and they account for the money received, and no questions are asked when the audits show that they followed these guidelines. this bill before us strictly follows these guidelines as well. no federal funds shall be used for any abortion procedure in an insurance policy that has to be privately funded. now i want to step back and make a slightly different argument too. there are those who have said, in the house and in the senate, that unless the stupak language in the house is adopted, they would seriously consider voting

against health care reform. i would like to argue to them that that is the wrong position to take if you are opposed to abortion, because the health care reform bill before us dramatically expands health care coverage. today there are 17 million women of reproductive age in america who are uninsured. this bill will expand health insurance coverage to the vast majority of them, which means millions more women will have access to affordable birth control and other contraceptive services. this expanded access will reduce unintended pregnancies and reduce the number of abortions. so the family planning aspect of our health care reform will actually net fewer abortions in america. we know this because of the history of this issue. as more women have access to family planning. so those who argue that they either have this amendment or vote against health care reform should reflect on the fact there

will be fewer abortions in america with these health care services. senator mikulski, in the first amendment we adopted here, provided for more preventive services for women across the board. those services, i believe, will result in more counseling, more contraception, fewer unintended pregnancies. that is a reality. every dollar that we spend, federal dollar on family planning saves $3 in medicaid costs. in 1972, we established a special matching rate of 90% for family planning services in medicaid. across the board we know that this money well spent to allow women to decide their own fate, their own reproductive fate means there are fewer unintended pregnancies. i would argue whether your position is for or against abortion, if you believe that there shall be fewer abortions. you want this health care reform bill to pass with or without the stupak amendment. i think that the stupak

amendment goes too far and that i think we've come up with a reasonable alternative that really adheres to the three pillars which i mentioned earlier on abortion policy in america, sets up reasonable accounting on these insurance policies. and that i think this language in the bill is the right way to move to lessen the number of abortions in america and stay consistent with the basic principles that guide us. i yield the floor. mr. dodd: mr. president? the presiding officer: the senator from connecticut is recognized. mr. dodd: i want to commend my colleague from illinois, the democratic whip, for his arguments. he's laid them out, basically he speaks for me when he identifies what would have been the pillars of our views on this issue. i was elected to the house of representatives in 1974, two years after roe vs. wade. and i've been in congress now for 35 years, and we have lived with those guidelines, which while still have not resolved the matter in the minds of many people who have strongly held

views in this matter, but have served us well. and what we have in this bill is a reflection of a continuation of those pillars. having been the acting chair of the health, education, labor, and pensions committee during the markup of this bill -- in fact, senator kennedy, who voted by proxy, as they call it in that process, we insisted upon the adoption of the kennedy amendment, which maintained the notion of conscience in these matters. so we're not forcing individuals to engage in abortion practices if they felt otherwise. we have long held the view in this congress, under democratic and republican leadership, despite the differences, and others have different views on this matter, that clearly public money should not be used. we have done that again with this bill. despite the arguments to the contrary, it has been done in a way respective to how we manage issues like this and other matters for decades.

the senator from illinois made a point about the measures in the bill that deal with wellness an reproductive riessments we minimized the likelihood of there being demand for abortion on the part of many. i appreciate the fact that our leadership has made this matter, the nelson-hatch amendment matter conscience. there is no caucus on this, and never has been in my view. i want to mention another argument, in addition to the eloquent ones made by the senator from illinois. we rank, i think, 29th, 28th or 29th in infant mortality in the united states. it is an incredible statistic. i worked with lamar alexander on premature births, infant screening, a whole host of matters trying to provide resources and help for families that suffer these debilitating

if not fatal problems that infants can suffer from and lose their lives from there's a vast difference from someone going through a problem that causes infant mortality rates. but this legislation takes a major step forward, mr. president, in taking the united states out of the basement when it comes to infant mortality and gets us back to the point where we are in the position we ought to be in reducing the tragedy that occurs with infant more at icy. so while there's a distinction clearly between abortion and infant mortality, the idea that we would abandon our efforts to include the quality of life for opportunities for children who arrive prematurely as many do in our country today, many don't survive the prematurity. women aren't getting the support they need during the pregnancy thus increasing the likelihood of premature births occurring or the screenings that occur immediately so you avoid the terrible problems that can ensure thereafter.

this legislation takes a major step in that direction. while we have don done what is necessary to do and that is protect the longstanding distinction between private and public dollars when it comes to abortion. we have gone further in provide the kind of support for families when it comes to minimizing the likelihood that a child will be lost because they're not getting those support services as well as the repro democrattive issues that are so important so that a family has the ability to survive that pregnancy and have a chance to be born. my colleagues know that i'm a late bloomer. i'm a parent of a 4-year-old and 8-year-old. i always said i was the only candidate that used to get mail from aarp and diaper services, having qualified for medicare being 65 and being the father of infant children. two little girls, mr. president, grace and christina. i want them to have all of the rights of young women in this

country. hopefully i'll be around to be a grandparent weep worked hard to -- we worked hard to make sure that those children had all of the advantages they could to be born healthy and soundism have a great health care -- sound. i have a great health care plan as a federal employee to make sure that happens. i want every american to have the same sense of security when the same blessing occurs with the arrival of a child or grandchild. this bill does that in ways that were not imaginable weeks ago. this amendment should be defeated. this bill ought to be supported and achieve a great success. i yield the floor. a senator: mr. president? the presiding officer: the senator from new hampshire is recognize recognized. mrs. shaheen: mr. president, i rise today to speak in opposition to the nelson-hatch amendment. the patient protection and affordable care act that we before us does so many good things. it gives women access to preventive care. it makes health care more accessible to families across

the country, it changes the way that patients receive the care they need. mr. president, we must not let the issue of reproductive choice overshadow all of the things that this bill gets right. for over three decades the hyde amendment, which prohibits the use of federal funds to pay for abortions, except in cases of rape, incest, or the life of the mother is at risk, has been the law of this land. abortion should play no role in this health care debate. the finance and "help" committee spent countless hours drafting legislation that's part of the language in our health care bill to make sure that it remains neutral on the issue of choice. the patient protection and affordable care act that's currently before us maintains the hyde amendment prohibiting federal funding of abortions. as a result neither the pro-choice nor the pro life agendas are advanced.

this is clearly explained in an analysis done by the nonpartisan congressional research service, and i would like to ask that this analysis be entered into the record. the presiding officer: without objection, so ordered. mrs. shaheen: the health reform legislation before us preserve the hyde language and maintains the status quo in this country. and we should keep it so. this should be a debate about health care. it should be about patients and about ensuring that they have access to quality care at all stages of their lives regardless of what may happen in their lives. it's a mistake to make this debate one about abortion. the amendment that's before us, the nelson-hatch amendment, would restrict any health plan operating in the exchange that accepts affordability credits from offering abortion services. in essence, the amendment before

us would amount to a ban on abortion coverage in the health insurance exchange regardless of where the money comes from. so put another way, a woman who pays for insurance with money out of her own pocket would most likely not be able to get insurance that covers abortion. so make no mistake about it, this amendment is much more than a debate on whether federal funds should be used for abortion, which is already established law. it's established law that is maintained in the patient protection and affordable care act before us. the nelson-hatch amendment is a very far-reaching intrusion into the lives of women and how we would get private insurance. it is unprecedented. and it would mean that millions of women would lose coverage they currently have. it is true that, as we've heard

from those people who support this amendment, that a woman would be able to buy an abortion rider. well, what we heard from senator stabenow and what we -- seef seen from the national law center, that from the five states that do require such a rider, that there is no evidence that such plans exist. and even if they did exist, who would purchase that kind of a rider? no woman expects to need an abortion. this is not something you go into planning ahead of time. finally, this amendment would have affects that reach well into the private insurance market. an independent analysis by the school of public health and health services at george washington university concluded that a similar amendment adopted in the house, was commonly known as the stupak amendment, will have -- quote -- "an industry-wide effect eliminating coverage of medley indicated

abortions over time -- medically indicated abortions over time for all women." that means, mr. president, that any type of abortion for which there is a medication of need would go uncovered. again, i would ask unanimous consent to enter in this report also. the presiding officer: is there objection? without objection, so ordered. mrs. shaheen: when we pass this legislation that will reform our health care system, it should not be done in a way that would lose benefits for women. all women should have access to comprehensive health care, including reproductive health care from the provider of our choice. i urge my colleagues to oppose any amendment that threatens reproductive care women have counted on for over 30 years. thank you. a senator: mr. president? the presiding officer: the senator from new jersey's recognized.

a senator: mr. president, health care reform legislation we're consideration is good for america, women, and families. mr. menendez: it is a health care reform bill. it is not an abortion bill. in fact, not a dime of taxpayer money goes to subsidized abortion coverage in this bill. it is, in fact, abortion neutral. this amendment, however, would change that. it would roll back the clock on a woman's right to choose. it unfairly singles women out and takes away benefits they already have. it singles out our daughters and legislates limits on their reproductive health, their reproductive rights. if we were to do the same to men, if we were to single out men's reproductive health in this legislation, imagine the outkrievment imagine if men were denied access to certain procedures. imagine if they were denied access to the certain prescription drugs. imagine if the majority had to suffer the decision of the

minority. that is exactly what we're being asked to do with our daughters with this amendment, rolling back the hands of time. i personally find that offensive, as do women across this country. the language of this bill has been carefully negotiated to ensure that we preserving a woman's right to choose, but doing so without federal funding. to claim otherwise is hypocritical and misleading much we need not fight all battles that have nothing to do with the real issue at hand that millions of americans don't have health insurance and many are being forced into debt to buy coverage that insurers later deny. but now instead he we are not only reopening long settled debates over this issue, we are actually faced with a proposal that would turn back the clock and deny women access to reproductive health care. it is the wrong debate at the wrong time. over the years we have made extraordinary progress in addressing women's reproductive rights. we have debated this issue in

the senate. we have debated it in our churches, our home, our communities, and in the united states supreme court. that has said a woman's right to choose is the law of the land. let us not turn back the clock. i respect my friend from nebraska's deeply held views and the deeply held views of my friend from utah. i know we'll debate the issue again many times in many forms. they will raise that your voices in protest of a woman's right to choose, as i will raise mine to protect it. this is teether the time nor legislative vehicle for hot button politics to get into the way of health care reform. the language in this bill is clear, it reserves a woman's reproductive rights without any taxpayer funding. yet, we are engaged in a debate where we're basically told that it neutrality is not good enough. that there needs to be an antichoice bill. not a health care reform bill. that neutrality is not

acceptable that only banning abortion is acceptable. mr. president, we're not going to be dragged down that road and the women of this country won't stand for it and certainly this senator will not either. the sponsors claim that the amendment enforces restriction of federal funding of abortion coverage. let's be very clear, there is no taxpayer money going to a woman's reproductive choices, none. to say otherwise is simply wrong. the fact this amendment clearly takes us back in time would leave our daughters with the same hopeless lack of options as their grandmothers faced, than is not where we ought to be. this amendment would make it virtually impossible for insurance plans in the exchange to offer abortion coverage even if a woman were to pay premiums entirely out of her own pocket. it would do so by forbidding any plan that includes abortion coverage from accepting even one

subsidized customer. this amendment is nothing more than a backdoor effort to restrict rights women already have. now, would i like to see it clearly stated in this legislation that a woman should have a right to choose in all aspects of her -- and all suspects of her reproductive health should be available under every plan? yes, i would. am i willing to accept new tralt yeas a reasonable compromise for the sake of passage of a bill that will provide affordable, accessible health care to every american and not spend a dime of taxpayers' money on women's reproductive choices, i will under this plan, a plan choices to provide abortion coverage, only private funds can go toward that care. that is further than i would like to go, but it's neutrality. in this bill in each state exchange there would be at least one plan that covers abortion and one plan that does not. that's neutrality. it's fair. let's accept it and move on. under this legislation women

will keep their fundamental right to reproductive health benefits -- the presiding officer: the senator has spoken for five minutes. mr. menendez: and gain other benefits they deserve. and that's what we should do in terms of preserving the underlying bill. let's vote down this amendment. let's not turn back the clock. mrs. boxer: i ask unanimous consent that in ly -- in lieu of nor baucus' four minutes, that senator casey take that time. the presiding officer: is there objection? without objection, so ordered. the gentleman from pennsylvania is recognized. mr. casey: thank you, mr. president. i rise today in support of the nelson amendment, for two reasons. and i speak for myself, not for other members of the senate, obviously, and i know there is a good bit of disagreement on both sides of the aisle. but i support this amendment for two reasons. one, i want to make sure that we

ensure through this health care legislation the consensus that we have had as part of our public policy for many, many years now, the taxpayer dollars don't pay for abortions, and i believe we can and should and will get this right by the end of this debate. secondly, the second reason i support this is i believe it's important to respect the conscience, bo women and men, across the country who don't want taxpayer dollars to support abortions. if there's one area or maybe one or two areas where both sides can agree, people who are pro-life and pro-choice, we can agree on a couple of basic principles. one is we don't want to take actions to increase the number of abortions in america. i think that's a prevailing view across the divide of the -- of this issue. and secondly, that we also have to do more to help those women who are pregnant, and i don't

believe we're doing enough and we'll talk more about that. but even as we debate this amendment, the third thing i think we can agree on is that no matter what happens on this vote, this debate will continue even in the context of this bill , and i believe we have to pass health care legislation this year, and there are all kinds of consumer protections in this bill that will help men and women, prevention services that are -- have never been part of our health care system before. insurance reforms to protect families. and finally, the kind of security that we're going to get by passing health care legislation for the american people. i believe we can get this issue, this divisive issue correct in this bill. we're not there yet. i believe we can. i also believe we must pass health care legislation this month through the senate and then on from there to get it enacted into law, and i yield the floor. the presiding officer: the senator from california. mrs. boxer: before we turn this over to the republican side, i

ask unanimous consent to place into the record a letter from religious leaders who support maintaining the underlying bill and oppose this amendment. catholics for choice, disciples justice action center, episcopal church, jewish women international, presbyterian church washington office, religious coalition for reproductive choice, union of reformed judaism, united church of christ, general board of church and society, unitarian universalist association of congregations. we're proud to have their support for our position. the presiding officer: is there objection? without objection, so ordered. mr. enzi: mr. president, i assume that added a few additional minutes to our time as well. the presiding officer: the senator from wyoming is recognized. mr. enzi: i yield ten minutes to the gentlewoman from new hampshire, mr. johanns. mr. johanns: mr. president? the presiding officer: the senator from nebraska. mr. johanns: mr. president, let me start my remarks by offering

my words of support and really commendation to senators nelson and hatch for offering this amendment. they -- they have long been champions of the pro-life cause, and i applaud them for putting the time and effort into this amendment to get it right, bringing it to the floor and offering it, and i'm very proud to stand here today, mr. president, as a cosponsor of this legislation. and fundamentally what this legislation is about, really, is it's simply the right thing to do. it ensures that current federal law is upheld. it just at its most basic form says this. it says taxpayer dollars are not going to be used directly or indirectly to finance selective abortions. in fact, this has been the law of our country now dating back for three decades. basically, what this amendment

does is it applies the hyde amendment to the health care reform bill. it bars federal funding for abortion except in the case of rape or incest or to protect the life of the mother. the hyde amendment, as we have heard so many times during this debate, finds its genesis in 1977. the language in the nelson-hatch amendment is virtually identical to the stupak language that was included in the house bill. 240 representatives in the house supported this, and it passed on a vote of 240-194. it just very clearly prohibits federal funding of abortions. it says this. one, the government-run plan cannot cover abortions. that seems very straightforward. number two, americans who

receive a subsidy cannot use it to buy health insurance that covers abortion. three, the federal government cannot mandate abortion coverage by private providers or plans. and then finally, as has been the case for 30 years, private insurance plans may cover abortion and individuals may purchase a plan that covers it, but taxpayer dollars cannot be in the mix to purchase that. compare that to what is in the current senate bill. the government-run plan can cover abortion. americans who receive a subsidy can use it to buy health insurance policy that covers abortion. the federal government can and does mandate abortion coverage by at least one provider or plan. and there's a stipulation in the current bill that requires health and human services secretary to ensure the

segregation of funds, the tax credit of federal dollars can't be used. but the reality is that's like saying here, put those federal dollars in your left pocket. now, when you're purchasing the abortion coverage, make sure that it is your right hand that is reaching into your right pocket. and how do you segregate those funds? it's impossible. what it does is it just simply erases the line between taxpayer dollars and funding of abortions. according to the national right to life -- and i'm quoting here -- "senator reid included in his substitute bill language that some have claimed would preserve the principles of the hyde amendment." such claims are highly misleading. in reality, the reid language explicitly authorizes direct funding of elective abortion by a federal government program." well, i feel very strongly we

must ensure that federal dollars are not used to fund abortion directly or indirectly. health care reform under the reid language has become a vehicle for changing current law of the land regarding abortion coverage. here's what some of my constituents have said to me, and i'm quoting from a gentleman in carney. "it is time to make sure that abortion is explicitly prohibited by any language that is put forward. another nebraskan said to me -- and again i'm quoting -- i know the health care bill is not the only important issue to consider but it is probably the most important concern i have in this bill. abortion should not be in health care." from central nebraska, i heard this -- "i'm taking a minute to send a note to say thank you for standing up for life. life is precious, whether you're

just conceived or over 100 years old." pro-life groups across the board support this amendment. national right to life, catholic bishops, family research council and others. they represent millions of americans. but the reality is americans support this. in a recent cnn survey, we confirmed that six in ten americans favor a ban on the use of federal funds for abortion. a recent "washington post"/abc news poll indicates 65% of adults believe private insurance plans paid for with government assistance should not include coverage of abortion. i was in mccook, nebraska, a while back doing a town hall in august. after everybody had left, a gentleman came up to me. he told me something about this that i'll remember all of the years i'm in the senate.

first he spoke about his faith. and then he said i hope you understand, senator, i cannot under any circumstances agree to anything that would allow my taxpayer dollars either directly or indirectly to fund abortions. he said i cannot go there. he said please do everything you can to stop this from happening. and today i stand with that gentleman in mccook, nebraska, to say that we have to stop this. i applaud my colleague from nebraska. i want to end my comments there. senator nelson has stood up on this issue and recently in an interview, he said this -- "i have said at the end of the day, if it doesn't have stupak language on abortion in it, i won't move -- i won't vote to move it off the floor." i think that's a courageous

statement. i don't mind standing here and saying i'm very, very pleased to associate myself with senator nelson and senator hatch on this important amendment. how much time do i have left? the presiding officer: the senator has two minutes and 45 seconds left. mr. johanns: i will yield my two minutes and 45 seconds to senator hatch when he speaks. thank you, mr. president. i yield the floor. the presiding officer: without objection. the senator from kansas is recognized. mr. brownback: thank you very much, mr. president. i appreciate that very much. it's been a healthy debate. it's been an unusual debate because we haven't debated hyde around here for 20 years, so this is an unusual debate that we're having because we normally debate about abortion, we don't debate about abortion funding because there has been an agreement in this body for 33 years about that, so this is an unusual debate, but i think it's

an important one. i think it's extraneous in many respects to the health care bill itself. abortion is not health care. and so why we are debating the funding of abortion in a health care bill seems odd to me, but it's in the base bill and we need to deal with that. there have been a lot of people coming forward and saying well, okay, which way is this? is it in the bill or not on funding for abortion? and i want to go to an independent fact checker and cite this. this is a pulitzer prize-winning fact checker politifact.com, says this -- "this independent research checker said our opponent's characterization of this amendment was -- quote -- misleading, end of quote, and -- quote -- the people who would truly pay all their premium with their own money and who would not use federal subsidies at all are not barred in any way from obtaining abortion coverage,

even if they obtain their insurance from the federally administered health exchange." that's an independent group, politifact.com, saying that this doesn't limit the ability for somebody on their own to be able to purchase abortion coverage if they want to do that, but in the base bill what we are saying is we don't want to put federal funds in it as the long-standing policy has been here, and as the president himself has said. the president spoke to a joint session of congress, launching the health care debate. he said this. president obama said -- "one more misunderstanding i want to clear up under our plan, no federal dollars will be used to fund abortions and federal conscience laws will remain in place." unfortunately, in the reid bill, this is not true. this is not true in the reid bill. what is in the reid bill is the so-called caps amendment language whichious for the federal funding of abortion.

and i want to -- i wanted to describe -- i think it has been described a great deal of what is here, but what's taking place is the federal subsidization for the insurance program that will have abortion funding in it. that is according to most groups what's taking place in the caps language which is in the base reid bill. now, i say that this is an unusual debate that's taking place because we haven't debated hyde for years around here. i just want to read to you what is our normal status on funding of abortions, and that is that we don't do federal funding of abortions. and just -- just read to you what the normal status is. u.s. conference of catholic bishops who support this base bill but does not support funding of abortion describes it this way -- "in every major federal program where federal funds combine with nonfederal funds to support or purchase

health coverage, congress has consistently sought to ensure that the entire package of benefits excludes elective abortions. for example, the hyde amendment governing medicaid prevents the funding of such abortions, not only using federal funds themselves but also using the state matching funds that combine with the federal funds to subsidize the coverage." a similar amendment excludes elective abortions from all plans offered under the federal employees health benefits program where private premiums are supplemented by a federal subsidy. so there it's prohibited as well. where relevant, such provisions also specify that federal funds may not be used to help pay the administrative expenses of a benefits package that includes abortion. under this policy, those wishing to purchase abortion coverage must do completely separately from the plan that is purchased in whole or in part with federal financial assistance. and here i take a quick aside. that's what we're saying should

be done in this bill but it's not what is done in this bill. going on, "this is the policy that health care reform legislation must follow" -- this is according to the letter from the catholic bishops -- "if it is to comply with the legal status quo on federal funding of abortion coverage. all of the five major health care reform bills approved by committee in the 111th congress violate this policy." this is from a group, the united states conference of catholic bishops, that supports health care reform but not the abortion funding in it. and they say, as well, this same group, that this fails in the reid bill, that there is explicit funding for abortion that's in this bill. now, i -- i want to thank my colleagues particularly on the other side of the aisle, senator nelson, senator casey, presiding officer for being major cosponsors for this amendment. they are ones that look at this and say i don't want this in the

base bill, this shouldn't be in the base bill, doesn't belong in the base bill. the language should be different. but i'd also like to note to individuals that most people across the country don't want this in the base bill. a majority of the country is opposed to the bill overall. they don't think this is the way we should go. they think it's a wrong way. but even people that support the bill itself by and large don't want federal funding for abortion to be in this bill. a pew poll even showed that 46% of the people who support health care reform want to see the radical abortion language removed, the capps language in the reid bill, and all pro-choice republicans and several pro-choice democrats supported the measure in the house that put stupak language in that removed the federal funding from abortion. the american people feel this way because they know that forcing federally funding abortion is fiscally irresponsible and morally

indefensible. now, those are the two central pieces here that we're discussie fiscal responsibility or irresponsibility of this and the moral indefensibility. and i'll simply point out in that, that at a time of hemorrhaging debt, that the federal government being supportive and funding of elective abortions flies in the face of our trying to restrain or bend the cost curve down in this legislation. that's not us being fiscally responsible. i'd note to individuals back when we did -- and i've shown this chart before but i think it's so striking it bears repeating -- back when we did do funding for abortions that we funded about 300,000 a year. now, how is that extra funding going there going to help us be more fiscally responsible? and i think that's why a majority of people in the country, whether pro-life or pro-choice, are saying the

federal government should not be funding this, i don't think that's fiscally responsible at a time of fiscal restraint. and that it's morally indefensible. whether you're pro-choice or pro-life, you're saying fund 3-g00,00ing300,000? we're having 300,000 children that are not going to be here that we're funding that elimination of 300,000? i think under anybody's definition of looking at that, they would say that is morally indefensible, for a federal government that has long debated abortion policy, has not debated abortion funding, that that's morally indefensible for us to do something along that line. there are many issues to debate but thankfully hyde has not been one of them we've been debating until now. and i would say to my colleagu colleagues, you know, the admonition we've had many times, you know, whether you choose

this day, life or death, blessing or curse? why wouldn't we choose the life route on this one? even if you have a close call you're questioning this, why wouldn't we choose the route that says, i'm not going to fund 300,000 abortions, i want abortion to be safe, legal and rare, as some people in this body, but that's not going to be rare at 300,000. why wouldn't we choose the life route that says this is a controversial issue sometime way in the past -- hasn't been recently -- we just don't fund these things. because so many people in america don't want their money used to pay for abortions. and yet in this base reid bill, it's there. i would urge my colleagues to vote in favor of the nelson-hatch-casey bill, that amendment that puts in the hyde language that is the status quo, that there is not taxpayer funding going towards abortion and to reject those who would

put the reid language forward that would take us back decades to an era when we did fund abortion procedures. mr. president, i would reserve the balance of my time and yield that to the senator from utah. mr. hatch: mr. president? the presiding officer: the senator from utah. who yields time? mr. grassley: i would yield such time as is left to the senator from utah. the presiding officer: the senator from utah. mr. hatch: mr. president, i have a longer statement that i was going to deliver this afternoon but after listening to some of my colleagues speak about the nelson-casey-hatch amendment, i want to take my time to refute some of the arguments that they're making about our amendment. it doesn't even sound like they are talking about the same amendment that i filed with senators nelson and casey. our amendment does nothing to -- quote -- "roll back" women's rights. when my colleagues on the other side say that, they are simply mischaracterizing our amendment.

our amendment simply ensures that the hyde language, a provision that has been contained in the h.h.s. appropriations legislation for the last 33 years, will apply to the new health care programs created through this bill. we are applying current law to these programs. that is it. the current hyde amendment ensures that no federal government funds are used to pay for elective abortion or health plans that provide elective abortion. today, states may only offer medicaid abortion coverage if the coverage is paid for using entirely separate state funds, not state medicaid matching funds. they can't do that under current law. this is a long-standing policy based on a principle that the federal government does not want to encourage abortion. for example, the gootmacher study showed that when abortion is not covered in medicaid, roughly 25% of women in the

covered population who would have otherwise had an abortion choose to carry to term. i want to explain to my colleagues why the reid capps language in the reid bill is not the hyde language. first, the hyde amendment prohibits funding of abortion through medicaid and other programs funded through the h.h.s. appropriations bill. however, the public option is not subject to further appropriation and, therefore, is not subject to hyde. directly opposite of the hyde amendment, the reid-capps language explicitly authorizes the newly created public option to pay for elective abortions. the public option will operate under the authority of the secretary of h.h.s. and draw funds from the federal treasury account. regardless of how these funds are collected, these funds from the treasury are federal funds. funding of abortion through this program will represent a clear departure from long-standing policy by authorizing the

federal government to pay for elective abortion for the first time in decades. the nelson-hatch amendment would prohibit funding for abortion under h.r. 3590 except in the cases of rape, incest, or to save the life of the mother, as is the case with the "chip" program and department of defense health care, the nelson-hatch-casey amendment would be permanent law rather than appropriations -- quote -- "rider" subject to annual debate and reapproval. any funding ban subject to annual reapproval will be in jeopardy in the future. if if there are the votes to maintain the hyde amendment -- even if there are the votes to maintain the hyde amendment, procedural tactics and veto threats could be employed, making it impossible to retain an annual ban. secondly, the hyde amendment prohibits funding for -- quote -- "health benefits coverage that includes coverage of abortion. " th-- of abortion."

the requirement includes that the fell government does not provide access to abortion. when the government subsidizes a plan, it is helping to make all of the covered services available. federal premium subsidies authorized and appropriated in h.r. 3590 are not subject to annual appropriations and they are, therefore, not subject to hyde. directly opposite of the hyde amendment, the reid-capps explicitly allows affordability credits to pay for plans that cover abortion by applying an accounting scheme. under the accounting scheme, the government is permitted to subsidize abortion coverage provided that funds used to reimburse for abortions are labeled -- quote -- "private" funds. this is an end run around the hyde restriction on funding for plans that cover abortion. furthermore, under the accounting scheme, premium holders will be forced to pay at least $12 per year as an

abortion surcharge to be used to pay for abortions. nelson-casey-hatch amendment would ensure that no funds under h.r. 3590 will subsidize plans that cover abortion. however, it does nothing to prohibit individuals from purchasing separate abortion coverage or from purchasing plans that com cover abortion without a federal subsidy. another issue that i want to raise is the impact the nelson-hatch-casey amendment would have on coverage of elective abortions by private health plans. i just heard some of my colleagues say that our amendment would prohibit women from purchasing health plans with abortion coverage even if they spend their own money. i understand that there is a politifax story with the headline -- quote -- "lowey says stupak amendment restricts abortion coverage even for those who pay for their own plan."

that is simply not true. i don't know what got into the person writing it but it isn't true. our amendment would not prohibit the ability of women to obtain elective abortions as long as their use their -- they use their own money to purchase these policies and not the money of the taxpayers of america, directly or indirect. again, our opponents will argue that it does but if they take the time to read our amendment, they will note on page 3, line 6, that it ensures that there is an option to purchase separate supplemental coverage or a plan with coverage for elective abortions. in fact, let me read it to my colleagues so we're all clear on what the language actually saysment and i'm going to read it because i am really tired of hearing some of the misrepresentations that have been made on the floor by, i'm sure, well-meaning people who are very poorly informed on this bill. it's easy for me to see why

they're poorly informed on this bill when i look at this itty-bitty bill. i mean, my gosh, who could -- no matter how bright you are, who could know everything in this itty-bitty bill here, that i'm going to break the desk if i drop it on there. [laughter] my gosh. i'm sorry, i scared the distinguished senator from iowa with this -- with this itty-bitty bill. i should have dropped it a little bit softer. i apologize, senator. okay, now, let me tell you what it actually says. two, "option to purchase separate supplemental coverage or plan. nothing in this subsection shall be construed as prohibiting any nonfederal entity, including an individual or a state or local government, from purchasing separate supplemental coverage for abortions for which funding is prohibited under this subsection or a plan that includes such abortions so long as, a, such coverage or plan is

paid for entirely using only funds not authorized or appropriated by this act, and; b, such coverage or plan is not purchased using, i, individual premium plan payments required for a qualified health plan offered through the exchange towards which a credit is applied under section 36-b of the internal revenue code of 1986, or, two, i gs i i, i guest is, other nonfederal payments required by states or localities contribution of medicaid matching funds." under the nelson-hatch-casey amendment, women are allowed to purchase separate elective abortion coverage with their own money. i wish they wouldn't, but we allow that. and anybody who says otherwise is misrepresenting what we're doing here with this amendment. and i'm sure not intentionally misrepresenting but, nevertheless, misrepresenting. so have fair warning.

and it is also true that our amendment allows women to purchase a health plan that includes coverage of elective abortions in addition to the supplemental abortion policy. our language allows women to purchase both a supplemental policy for the coverage of elective abortions and a comprehensive health plan that includes coverage of -- coverage of elective abortions as long as they pay for it with their own money. so those who oppose abortions say that a woman would never want to purchase abortion as a separate ryder, they are -- ride, they are truly misunderstanding what our language allows, the language also permits women to purchase an identical exchange plan that includes coverage of elective abortions in addition to other health benefits. a woman may purchase with her own funds either a supplemental policy which covers elective abortions or an entire health plan that covers elective abortions. today federal funds may not pay for elective abortions or plans

that cover elective abortions. to be clear, the nelson-hatch-casey language does not prevent people purchasing their own private plans that include elective abortion coverage. this is the fundamental component of the hyde language. in addition, our amendment explicitly states that these types of policies may be offered. in other words, our amendment does not restrict these policies from being offered. the only caveat is that they may not be purchased with federal subsidies. we want to make that clear. let me read thew section of the nelson-hatch-casey amendment for my colleagues. it may be found on page 4, line 3 of the amendment. "number 3: option to offer supplemental coverage or plan." get this. "nothing in this subsection shall restrict any nonfederal

health insurance issuer offering a qualified health plan from offering separate supplemental coverage for abortions for which funding is prohibited under this subsection or a plan that includes such abortions so long as (a) premiums for such separate supplemental coverage or plan are paid for entirely with funds not authorized or appropriated by this act; nb) administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and (c) any such nonfederal health insurance issuer that includes coverage for abortions for which fund something prohibited under this subsection also offers a qualified health plan through the exchange that is identical in every respect except that it does not cover abortions for which funding is prohibited under this subsection." our amendment has the support of the united states conference of catholic bishops, the national

right to life committee, the family research council, the ethics and religious liberty commission of the southern baptist convention, concerned women for america, the national association of evangelicals and americans united for life action. polls across the country indicate that a majority of americans do not want their tax dollars paying for elective abortions. according to a cnn opinion research corporation survey, 6 in 10 americans favor a ban on the use of federal funds for abortion. i think anybody who understands that i.g. knows that there are people whpro-right people who ar ban on the use of federal funds for abortion. it also indicates that the public may favor legislation that would prevent many women from getting their health insurance plan to cover the cost of an abortion even if no federal funds are involved. this poll indicates that 61% of the public opposes the use of

public money for abortions for women who cannot afford the procedure. with 37% in favor of allowing the use of federal fund. so my dwoa my fellow senators is the following: when is this congress going to start listening to the american people? people on both sides of this issue who do not feel that taxpayers ought to be saddled with paying for abortion through their tax dollars. or in any other way, for that matter. i urge my colleagues to support the nelson-hatch-casey amendment. do the right thing and support our amendment which truly protects the sanctity of life and provides conscience protections to health care providers who do not can't to perform abortions. that's an important aspect of this and i avoided just till the last minute to say something about that. why should people of conscience be forced to participate in any aspect of elective abortions?

they shouldn't. people have deep feelings of conscience should not be forced -- that includes nurses, doctors, health care providers, hospitals -- they should not be forced to do this, just because of the radicalness of some people who exist in our society today. and some think some radicalness of some in this body and in the other body. it is radical to expect the american taxpayers to pay for elective abortions. especially when such a high percentage, up to 68% according to some polls -- and i think even higher -- do not want to have federal dollars used for this purpose. mr. president, i appreciate my colleagues, i appreciate what my colleagues stand for. but this is very, very important stuff. i would like to at this point put a number of constituent letters into the railroaded an i

ask unanimous consent to do so. the presiding officer: without objection. mr. hatch: i also ask unanimous consent that the balance of my remarks -- i understand that there is a desire to move ahead here -- and the balance of my remarks be placed in the record at this point. the presiding officer: without objection. a senator: mr. president? mr. president? the presiding officer: the senator from nebraska. mr. baucus: mr. president, i -- the presiding officer: the senator from montana. mr. baucus: i ask that the senator from nebraska now be allowed to speak for up to ten minutes. the presiding officer: without objection. mr. nelson: mr. president, i rise to discuss the bipartisan amendment which i have proposed with senators hatch and the presiding officer and others. as my good friend and colleague from utah has so eloquently explained, our amendment mirrors the language offered by representative stupak that was accepted into the house health care bill. our view is that it should become part of the senate health

care bill we're debating as well. it's a fact that the issue of abortion stirs very strong emotions involving strongly held principles all across america from those who support the procedure and those who do not. and we're hearing that passion at times here on the senate floor. but we're not here to debate for or against abortion. this is a debate about taxpayer money. it's a debate about whether it is appropriate for public funds to, for the first time in more than three decades, cover elective abortions. in my opinion, most americans and most of the people in my state would say "no." and as it is currently written, though the senate health care bill enables taxpayer dollars directly and indirectly to pay for insurance plans that cover abortion, we should not open the door to do so. and as i said yesterday when we introduced the amendment, some suggest that the stupak language

imposes new restrictions on abortion, but that's not really the case. we're seeking to just apply the same standards to the senate health care bill that already exist for many federal health programs. but the bill does set a new standard. it's standard in favor of public funding of abortion. and our amendment doesn't limit the procedure, nor prevent people from buying insurance that covers abortion with their own money; it only ensures that when taxpayer dollars are involved, people aren't required to pay for other people's abortions. and some have claimed that the amendment restricts abortion coverage, even those -- for those who pay for their own plan. that isn't true. according to politifact.com, a prize-winning fact-checking web site which looked at similar claims by a house member during house debate on the stupak

amendment, politifact found, first she suggests the amendment applies to everyone in the private insurance market when it just applies to those in the health care exchange. second, her statement that the restrictions would affect women, even when they would pay premiums with their own money is incorrect. in fact, women on the exchange would pay the premiums with their own money, will be able to get abortion coverage, so we find her statement false. end of the quote. now, the nelson-hatch-casey amendment only incorporates the long-standing rules of the hyde amendment which congress approved in 1976 to ensure that no federal funds are used to pay for abortion in the legislation. this standard now applies to federal health programs covering such wide and broad groups as veterans, federal employees, native americans, active duty service members, and others, all of whom are covered under some

form of a federal health program. thus, the standard applies to individuals participating in the children's health insurance program, medicare, medicaid, indian health services, veterans health, and military health organizations. and i'd like to emphasize another point. all current federal health programs disallow the use of federal funds to help pay for health plans that include abortion. our amendment only continues that established federal policy. some have said that the hyde amendment already is in effect in this bill, but that's really not the case at all. 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 cover abortion and one that does not cover abortion be offered on every state insurance exchange. 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 -- let me repeat the word -- eases the standards established by the hyde amendment. the claim that the segregation of funds accomplishes the hyde intent false short. segregation of funds is an accounting gimmick. the reality is, taxpayer-supported federal dollars would help buy insurance coverage that includes covering abortion. i'd like to offer some other points about the effect of the nelson-hatch-casey amendment. under the amendment, no funds authorized or appropriated by the bill could be used for abortions or for benefits packages that include abortion.

the amendment would prohibit the use of the affordability tax credits to purchase a health insurance policy that covers abortion. it would also prohibit federal funding for abortion under the community health insurance option. in addition, the amendment makes exceptions in the case -- cases of rape or incest or in cases of danger to the mother's life. in addition, the amendment allows an individual to use their own private funds to purchase separate supplemental insurance coverage for abortions. perhaps even what is called a rider to an existing plan. the amendment allows an individual whose private health care coverage is not subsidized by the federal government to purchase or be covered by a plan that includes elective abortions, paid for with that individual's own premium dollars. and you under the amendment, a private insurer participating in the exchange can offer a plan

that includes elective abortion coverage to nonsubsidized individuals on the exchange as long as they also offer the same plan without elective abortion coverage to those who receive federal subsidies. 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 have also 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. but perhaps most importantly, there is no federal law, nor is there any state law, that requires a private health plan to include abortion coverage. but the bill before us, as written, does. so, mr. president, as i've said, the current health care bill we're debating should not be

used to open a new avenue for public funding of abortion. we should preserve the current policies which have stood the test of time, which are supported by most nebraskans and americans. the senate bill, as proppe prop, goes against that majority opinion. i think most americans would prefer that this health care bill remain neutral on abortion, not chart a new course providing public funds for the procedure. public opinion suggests so. so does the fact that over the last 30-plus years, congress has passed new federal laws that have not broken with precedent. finally, as president obama has said, this is a health care reform bill. it is not an abortion bill. so it's time to simply extend a long-standing standard disallowing public funding of abortion to new proposed federal legislation. mr. president, i yield the floor.

the presiding officer: the senator from montana. mr. baucus: mr. president, i yield to the senator from california. it is our understanding that senator reid will soon come to the floor to speak. mrs. feinstein: as soon as he comes in, i'll be happy to yield. the presiding officer: the senator from california. mrs. feinstein: thank you very much, mr. president. mr. president, simply put, i believe this amendment would be a harsh and unnecessary step back in health coverage for american women. what this amendment would do, as i read it, is to prohibit any health insurance plan that accepts a single government subsidy or dollar from providing coverage for any abortion, no matter how necessary. that procedure might be for a woman's health, even if she pays for the coverage herself. now the proponents of this amendment say that their sole aim is to block government funds from being used to cover

abortion, but the underlying bill already does that. in the bill before us, health plans that opt to cover abortion services in cases other than rape, incest, or when the life of the mother or at stake must segregate the premium dollars they received to ensure that only private dollars and not government money is used. they argue that segregating funds means nothing. you heard that. and that money is fungible. however, this method of separating funds for separate uses is used in many other areas, and there is ample precedent for the provision. for example, charitable choice programs allow agencies to promote religion to receive federal funds as long as these funds are segregated from religious activities. we all know that. we see it in program after program. if these organizations can

successfully segregate their sources of funding, surely health insurance plans can do the same. additionally, the skra*eur health and -- the secretary of health and human services must certify that the plan does not use any federal funding for abortion coverage based on accounting standards created by the g.a.o. this amendment would place an unprecedented restriction on a woman's right to use her own money to purchase health care coverage that would cover abortions. now let me give you one example, one quick example. recently my staff met with a bright young married attorney who works for the federal government. she and her husband desperately wanted to start a family and were overjoyed to learn she was pregnant. subsequently she learned that the baby she was carrying had

anacephaly, a birth defect whereby the majority of the brain does not develop. she was told the baby could not survive outside of a womb. she ended the pregnancy but received a bill of nearly $9,000. because she's employed by the federal government, her insurance policy would not cover the procedure. her physician argued that continuing the pregnancy could have resulted in -- quote -- "dysfunctional labor, postpartum hemorrhage which could increase the risk for the mother." the physician also warned that the complications could be life-threatening. however, o.m.b. found that this circumstance did not meet the narrow exception of a woman's life. not her health to, put her in danger. the patient was told a fetal anomaly presented no medical danger to you, despite the admonitions of her physician. and the best she could do was to

negotiate down the cost to $5,000. now this story, without question, is tragic. a very much wanted pregnancy could not be continued. and on top of this loss, the family was left with a substantial unpaid medical bill. now, health insurance is designed to protect patients from incurring catastrophic bills following a catastrophic medical event. but if this amendment passes, insured women would lose any coverage included in the underlying bill, even if she pays for it herself. why would this body want to do that? i can't support that. a woman's pregnancy may also exacerbate a health condition that was previously under control. or a woman may receive a new diagnosis in the middle of her

pregnancy. it happens, mr. president. if this amendment passes, women in these circumstances would also learn that their insurance does not cover an abortion. in some cases it may be unclear whether the woman's health problem meets the strict definition of life endangerment. the national abortion federation has compiled calls that they receive on their hotline which are available to women who need assistance obtaining abortion care. let me give you a few examples. molly was having kidney problems and was in a great deal of pain. she couldn't go to work. she couldn't provide for her two children. when she became pregnant, she made the decision to terminate the pregnancy in order to have her kidney removed to begin her recovery. she knew carrying the pregnancy would create additional health problems and would leave her

unable to provide for her family. jamie already had severe health problems when she learned she was pregnant. she was a severe depwe particular and her -- diabetic and her low blood sugar levels caused her to suffer from seizures. she was able to continue her pregnancy but had difficulty affording the procedure. another -- doctors were unsure of the cause but she was in a great deal of pain. she already had children she could not care for because of this pain. the tests she needed were incompatible with pregnancy. none of these women experienced immediate threat to their lives, so under this amendment their circumstances would not meet the narrow exceptions permitted for abortion coverage. this is really a problem.

how can one say we're going to provide insurance but we don't like one aspect of it, we don't want the government to pay for it. okay. okay. but the woman herself can't pay for it. that's the extra step that this legislation takes. to this date it is still legal to have an abortion, and women in this situation don't buy insurance for abortion, but they buy a policy that may cover them -- married women -- should something happen in a pregnancy, in the third trimester they find a baby is without a brain. she can have an abortion, and it is covered. you know, one of the problems with this whole debate is everybody sees something through their own lens. they don't see the grief and

trouble and morbidity that's out there and the circumstances that drive a woman to decide -- married -- she has to terminate her pregnancy for very good medical reasons. nobody considers that. this is all i had i don't see logic, and -- this is all ideologic, and it deeply troubles me. i hope this amendment goes down. thank you very much, mr. president, and i yield the floor. mr. nelson: mr. president? the presiding officer: the senator from nebraska. mr. nelson: i'd like to summarize the reasons for the intent of the amendment that senator hatch and you and i, together with others, have proposed to the health care bill. first of all, i should say that the examples that our very good friend from california have outlined would not have been covered under the federal employees health benefit plan

because the federal employees health benefit plan does not provide abortion coverage for such circumstances. now, our amendment mirrors the language that's offered by -- has been offered by representative stupak that was adopted into the house health care bill, and we believe that it should be applied to the senate bill as well. and as i said earlier, the issue of abortion certainly prompts strong opinions, fierce passions and deep-seated principles for millions and millions of americans, those who support the procedure and those who don't. but our amendment does not take sides on abortion. it's about the use of taxpayer money. the question before us is whether public funds for the first time in more than three decades should cover elective abortions. numerous public opinion polls have shown that most americans, including the number who support abortion, do not support public funds paying for abortion.

but the senate bill we're debating allows taxpayer dollars directly and indirectly to pay for insurance plans that cover abortion, and that's out of step with the majority of nebraskans and of all americans. our amendment does not impose new restrictions on women despite what some have claimed. and i respect -- expect they strongly disagree with them. we're seeking to apply the same standards to the senate health care bill that already exists for every federal health program. our amendment does not add a new restriction, but the bill does add a new relaxation of a federal standard that has worked well for more than 30 years. under our amendment abortion isn't limited nor would people be prevented from buying insurance on the private market with their own money. our amendment only insures that when taxpayer money enters the picture people are not required to pay for other people's

abortions. the nelson-hatch-casey amendment incorporates the longg standing standard established by the hyde amendment which congress approved in 1976. today it applies to every federal health program. that includes plans that cover veterans, federal employees, including members of congress, native americans, active-duty service members, and a whole host of others. now some people have called our amendment radical. nothing could be further from the truth. it is reasonable. it is rational because it follows established federal law. and it's right. taxpayers shouldn't be required to pay for people's abortions. it's just that simple. thank you, mr. president, and i yield the floor, and i note the absence of a quorum. the presiding officer: the clerk will call the roll.

quorum call: #

quorum call: quorum call:

mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: mr. president, are we in a quorum call? the presiding officer: the senator is in a quorum call. the presiding officer: i ask consent that it is rescind. the presiding officer: without objection. mr. reid: mr. president, there were 45,000 funerals this year. these funerals stood out from the rest of the funerals. why? they were tearful as all funerals are. they filled loved ones with sorrow and grief as many know firsthand. but these 45,000 funerals were avoidable. that's why they were more tragic than most. because 45,000 times this year,

nearly 900 times a week, more than 120 times each day, about every 10 minutes in america every day someone dies as a direct result of not having health insurance. that's really a sickening number. you'd have to be heartless not to be horrified. it doesn't even include those who did have health insurance, but died because it was not enough to meet their most basic needs. that's what this is all about. but it's not even just about death. how many citizens in each of our states are bankrupt and broke because of our broken health care system? how many have to choose between their mother's chemotherapy and their daughter's college tuition. how many have to work two or three jobs to provide for a family that they never have time to see all because of an accident they had or illness

they acquired that some insurance big shot calls a preexisting condition. so many of these tragedies could be prevented if our nation truly values the sanctity of life, as i believe it does, we'll do everything we can to prevent them. that's why we're pushing so hard to make it possible for every american to have good health. that's why we can't take no for an answer and i will not let the american people down. that value is also evident in the amendment before us today. as some know, mr. president, for many years, nearly 28 years as a member of the house of representatives o, the united states senate, and majority leader, i consistently cast my vote against abortion. to me it's not about partisanship of any kind or political points or even polling data. to me it's a matter of

conscience. i might not be the loudest on this topic, but that doesn't make any beliefs any less strong. i might oppose abortion, but that doesn't mean that i'm opposed to finding common ground for the greater good. we can, mr. president, find common ground. my belief in the sanctity of life is why i voted against using taxpayer money for abortions. it's why i repeatedly voted against covering abortions in federal employees health insurance plans and using federal facilities for being used for abortion. but i recognize that abortion is an emotional issue. many senators in this body disagree just as many citizens around the country disagree on this issue. but divisive issues do not have to divide us. there's value in finding common ground. among this institution immortals is senator henry clay who worked under the premise that he said, and i quote -- "all legislation is founded upon the principle of

mutual concession." it is in that spirit i've been able to work with my colleagues to my left and to my right, congressmen and senators, who are pro-life like i am, and those who are pro-choice. one of the ways i have done this is reduce the rate of unintended pregnancies. our great country leads the world in many ways. but this area is not one in which we take much pride. the united states has one of the highest rates of unintended pregnancies among all industrialized nations, and that's an understatement. half of all pregnancies in america, every other one is unintended. and of those, more than half result in abortions. i've worked to stop this problem before it starts. in 1997, senator olympia snowe and i started the first of many efforts to improve access to

contraception much we said that a health plan should treat prescription medication the way it does other prescription medications, we ensured a law that federal employees has access to contraception. this proves that senators with different backgrounds can work with each other instead of against each other. in this case a pro-life democrat and pro-choice democrat worked with common sense and found common ground. i've always been appreciative of senator snowe for her cooperation and really her courage. i continue to this day to be grateful. let's not forget that this historic bill now before this body will continue those efforts. by making sure that all americans can get good health care, we'll reduce the number of unintended pregnancies at the root of this issue. that's a goal that both democrats an republicans i hope can agree is worthwhile. let's talk about current law and

this bill. in that end, and in many other respects, this bill before us is a good, strong and historic one. it is a bill that will affect the lives of every single american and do so with the better -- for the better. it will, as you heard me say many times, save lives, save money, save medicare. but you've also heard me say that this bill deserves to go through the legislative process. that process includes amendments. it warrants additions, subtractions, modifications, as the senate sees fit. this is an appropriate process, one that has served this body well for more than two centuries. the amendment before us today offered by senator nelson of nebraska, would make dra the make -- dramatic changes to law in america. it is worth examining what that law says how this bill would treat it and what this amendment would require in addition and then value whether -- evaluate whether it improves the overall ef fomplet this law dictates not a single taxpayer dollar can be

used to pay for an abortion much there are very few, but very serious exceptions to this rule. those are explicitly limited to cases where the life of the mother is in danger, when the pregnancies result from rape or incest. this law is called the hyde amendment. it has been in books since the late congressman henry hyde wrote it in 1976. i have great respect for henry hyde who served in the house. i recall with fondness how this illinois republican congressman came to nevada to campaign for me. we worked together in a time when a republican could campaign for a democrat and visa versa and not fear retribution or condemnation from his own party. when we drafted the health reform bill, now under consideration, we worked hard to come up with a compromise between pro-life and pro-choice senators.

on one side there are some senators who don't believe abortion should be legal let alone mentioned in my health plan. on the other side there are senators who don't want a woman eac s. to legal abortion to depend on which health plan she can afford and they wanted that reflected in this bill. and so legislation in pursuit of mutual concession, as senator clay advised, we struck a compromise. it recognizes that people of good faith can have different beliefs. instead of trying to settle the sensitive question of abortion rights in this bill, we found a fair middle ground. that compromise is that we maintain current law. we're faithful to the hyde amendment which has been in place now for 33 years. let me be clear, mr. president, as our bill currently reads, no insurance plans in the