can help you and maybe cure you, but we're going to put limits on it. we're going to say, you know, it's nice to have all this technology and all this great medical knowledge and great doctors and hospitals across america, and we do. we're the envy of the world on some of this stuff. the doctors and the nurses and the health care professionals and the hospitals and the technology and the knowhow. we're the eny of the world, okay? we should acknowledge that. but then we have this ridiculous system that tosses these two little girls -- that says to these two little girls, the care that we want to give you and the thrawlts we can get from that care is going to be -- results that we can get from their is going to be limited. that's ridiculous. it's an abomination. i don't understand why we've gone year after year and settled for this. why do we have limits on the kind of care that people get?

because insurance companies thought that was a good idea. i don't know why. i don't know whether it was for their bottom line or for whatever reason. but there is no excuse, no rationale for saying to someone, we can cure you but we're going to limit it. you're in real trouble and we know thousand help you but we're going to limit it. here's what stacy said. she said about her kids, "when my identical twins were both diagnosed with this leukemia that i mentioned before, at the age of four, we were told they would need a bone marrow transplant in order to survive. that's when i learned that the insurance company thought my daughters were worth only a thousand dollars each. i don't know a parent in america who believes that their -- their son or daughter -- in this case their two daughters, their twins, is worth any amount of money or their care is worth any amount of money. so why does the insurance

company do it? and then we hear stories about well, they say that's the poli policy, then they get pressure from a -- a tv station or a news organization and they -- they give the care. well, if the policy makes sense, why would pressure -- why would public pressure have you change the policy? the policy is ridiculous and insulting and it should be changed. it's one of those things we've got to make illegal, okay? and this bill does that. we should make it illegal for insurance companies to do that to children. okay? but it doesn't make a lot of sense unless you talk about it in terms of a real story. so here's what -- here's what stacie ritter said after she said about the -- the limit. she says very flatly two words about whether a million dollars is enough to care for two daughters with leukemia over -- over many, many years. not just a year or two, many

years. she said, "it's not." exclamation point. "it's not! ." "when you add up the costs involved in care for a patient with a life threatening illness like cancer, a thousand -- a million dollars barely covers it." we've got lots of stories like this. "fortunately, the hospital's social worker recommended we apply for a secondary insurance through the state considering the highly probable chance we would hit the cap. and we did hit the cap before the end of treatment. thankfully, the state progra program" -- the state program, sounds a lot like a public option. i may be wrong about that but sounds an awful lot like a public option. "thankfully, the state program kicked in and helped pay for the remainder of the treatment." so that part of the story worked itself out. now, it didn't work itself out because the insurance company said, we've got a way to help you and we're going to do it and we're going to figure out the cost another way. we're just going to make sure we help you. no. the insurance company didn't help them. it was the state program in this

case, the kind of public option that helped these kids. so that part of the story has somewhat of a positive outcome. these kids are only 11, okay? and when they were four and fi five, it -- it didn't have that kind of an outcome. but this story gets worse. this story gets worse. this is what stacie continues in her letter. "during this time, my husband had to take family and medical leave so we could take turns caring for our one-year-old son and our twins at the hospital." and then she goes on from there and says, "for the seven months my husband was out on family medical leave, he was able to maintain his employer-based insurance for us via a $717.18-a-month cobra payment." now, let me get -- let me get this straight now. we're talking now about cobra, the extension of insurance

coverage for people that are hurting, they're laid off or unemployed. that's another government initiative that was enacted by congress. and i'm sure there were some folks who thought, well, let's not extend -- let's not use government to extend health insurance. but in this case -- in this case, it was helpful to this family. but it wasn't enough. it wasn't enough. here's what stacie keeps on going with her letter. "after spending all our savings to pay the mortgage and other basic living expenses, we had to rely on credit cards" -- so we have a health care system that forces stacie ritter and lots of other families in america to rely upon credit cards so they can get the health care for their daughters who have leukemia and make ends meet so they can pay the mortgage and all the other things they have to pay for, for themselves and those two daughters and their son. that's what this health care

system has forced them to do. this isn't unambiguous. this is exactly the result of the worst parts of our health care system. but this might be the most -- this last sentence might be the most poignant. she mentions they filed bankruptcy, and she says -- and i quote -- "and when you file bankruptcy, everything must be disclosed. we even had to hand over the kids' savings accounts that their great-grandparents had given them when they were born." so that's another problem with this messed-up system we got. it forces this family not only to -- to worry about whether or not their -- their daughters are going to be taken care of with leukemia, it not only says to them, you probably have to declare bankruptcy to protect yourself and to get them the care that they need, but in the course of -- of the bankruptcy proceedings, they had to turn over savings accounts.

i don't care if it was a dollar or -- or a thousand dollars or a much higher amount. i don't really care. what the amount was. we should never allow a system to force two little girls with leukemia to turn over their savings accounts that their great-grandparents started for them. that's how bad this system is. and i'll -- i'll -- i'll spend lots of time complimenting doctors and hospitals and nurses. we've got a lot of things we can brag about in our system: good technology, and i said -- i've said it twice now, okay? so i'm acknowledging all that. but this system is messed up when you have this happen to -- to one family. i don't care if it's one family or a million families, but we know there are lots of them out there that face similar -- similar circumstances. well, some people might say, well, you're talking about this family and you're talking about all these problems; what does your bill do? it just so happens that the

first provision in the bill, go by the table and contents and then go to page -- i don't have it in front of me, i think it's page 16 -- the first provision in the bill talks about not having limits on lifetime coverage. now, if that were in effect when stacie miller -- or stacie ritter, i'm sorry, and her -- and her husband got this diagnosis for their daughters, if that was in effect, the following things would have happened, and this is irrefutable. number one is, as upset they were and as worried as they were about their -- their daughters -- the two daughters' leukemia, at least they would have the peace of mind to know we don't have to worry about it costing too much to get them the care, we don't have to worry about this causing bankruptcy. so at least we would give them some peace of mind and some security. and then on top of that, we would have given them the kind

of care that they need, not just when they're four or five with leukemia but all the years after that, all of the -- all of the follow-up care. so when some people around here say, "oh, well, we're going t to -- you know, we need to debate a little longer, a couple, six months more, three months more, let's -- let's talk about it some more for a couple more years," we've talked this issue to death for years. we know exactly what's wrong. this is what's wrong. that loan -- this story alone is reason to pass the bill, but there are lots of other reasons, lots of other tragedies that are preventable if we do the right thing here. so we got a bill that we're going to pass and the first provision speaks to this issue or speaks to this -- this family's challenge. let me read one more letter and i'll stop because i know i'm

over time. we've heard a lot of discussion the last couple of days about -- about people whose -- whose own personal tragedies bring us to -- bring all of us to our sense when's we get lost in the policy. i received a letter this fall that i think sums it up in -- in a way that both hannah and madeleine's story does as well. this is a letter that i received from a woman in havertown, pennsylvania, in suburban philadelphia. she says in this letter, "on september the 9th, 2009, my sister-in-law's cousin had to take her three-week-old son off of life support. he took two shallow breaths and passed away peacefully. he did not have to die.

he did not have to be on life support, and he did not even have to be in the neonatal intensive care unit," the so-called nicu, as we call it. "at 36 weeks gestation, his mother was told that she had placenta previa, but the insurance company and the doctor were in a tug-of-war on getting it covered." this is america. why should a doctor have to be in any tug-of-war about whether or not this mother, who's pregnant, is going to -- whether or not her problem is going to be covered? that shouldn't even be a discussion. they shouldn't have to have any discussion about that. but that's how messed up our system is. "at 39 weeks, brandon" -- talking about the -- this woman's unborn child -- "brandon's umbilical cord respecruptured. his mother karen was rushed to the hospital and brandon was

taken to jefferson hospital in philadelphia to undergo brain cooling treatment to return brain activity. it was too late. after minimal return of brain activity, it was decided after three weeks to remove life support." and she concludes with this haunting sentence, this haunting reminder of how -- how bad a case this is. she says, "who saved money here? was it worth a child's life to save a few dollars? and i'm sure three weeks of life support cost more than a c-section." that's the end of her letter. so anyone who says that, well, you know, we've got to make a couple little changes on the margins here but we've got to -- we've got a great system here, you know, it is not in need of

major reform, i need only point to these two examples. it's all the information i need. but fortunately we've got thousands, hundreds of thousands of additional examples, literally millions of people denied coverage because of a preexisting condition. sometimes the fact that a woman has been the victim of domestic violence, that's been used as a preexisting condition in the united states of america in terms of whether or not she gets health care. so we have a really messed-up system when we -- we allow these tragedies to happen day after day, year after year, and we have people in washington who say, "well, we just couldn't get it done. we have to wait a little longer. we have to debate a little longer." we have to get a bill passed, and we're going to do that in the next couple of weeks. and take whatever steps are necessary to get this legislation passed, because we -- we cannot say to -- to

this woman who wrote to me fro from -- from havertown, pennsylvania, nor can we say to these two girls and to their parents, we can't walk up to hannah and madeleine and young kids like them across the country and say, well, we tried to get this lifetime limit thing done but it got a little contentious. but, no, we've got to get it done and we will get it done because we're summoned here bi a lot of things but i think we're summoned by our conscience to get this done and to make sure we can do everything possible. no system is perfect but do everything possible if prevent these tragedies. mr. president, i would yield the floor.

mr. sanders: mr. president? the presiding officer: the senator from vermont's recognized. mr. sanders: mr. president, let me begin by thanking senator casey for his consistent efforts in fighting to make sure that every american has good-quality, cost-effective health care. he's been a leader on this issue and i just want to congratulate him. mr. pr -- mr. president, i just want to touch on some of the health care issues that are out there. tell you what i think is positive in the bill that we are dealing with here in the senate and tell you what i think is not so positive. to begin with, as senator casey as aptly described, we have a system which in many ways is disintegrating. it is an international embarrassment that in the united states of america we remain the only nation in the industrialized world who does not guarantee health care to all of its people as a right. the result of that is some 46 million americans today have

no health insurance. even more are underinsured with large co-payments and deductibles. we have some 60 million americans today who because of our very poor primary health care outreach network do not have access to a doctor on a regular basis and the result of that, mr. president, as incredible as it may sound, according to a recent study at harvard university, some 45,000 people die every single year because they don't get to a doctor when they should have. and as a result, by the time they walk into the doctor's office, their illness may be terminal. in addition to that, god only knows how many people end up in the hospital at great expense to the system because they do not get care when they should have. meanwhile, as senator casey indicated, bankruptcy is an an

enormous problem because of our health care system. close to one million americans will go bankrupt because of medically related bill. when we talk about economic growth in america, all of us understand, small businesses, medium-sized businesses are plowing an enormous amount of money into health care for their workers rather than reinvesting that money and expanding their operations to create jobs that we need as a nation in the midst of a very deep recession. so we have got a major, major problem. and at the end of the day, despite so many people uninsured, under insured, so many people dying because they don't have it, we spend twice as -- almost twice as much on health care per capita than any other nation. it is clear to me and the vast

majority of the american people that we need real health care reform. and what real health care reform must be about are at least two things. number one, providing coverage to all americans as a right of citizenship and, number two, doing that in the most cost-effective way that we possibly can. to my mind, quite frankly, there is only one way that i know of that you can provide universal cost-effective and comprehensive health care for all of our people. and that is a medicare for all single-payer system. and, very briefly, the very reason for that is that we are wasting about $400 billion every single year on administrative costs, on profiteering, on advertising, on billing, all in the name of profits for the private insurance companies who

have thousands and thousands of separate plans out there creating an enormously complicated and burdensome system. and each one of their thousands of plans. if you're young and you don't get sick and you're healthy, they have a plan for you. if you're older and get sick, they've got another plan. 13,000 private insurance companies with thousands and thousands of plans and to administer all of this costs and hundreds and hundreds of billion dollars of. that is money going into doctors. not money going into dentists, many areas, including vermont, serious dental access problem, not money going to nurses. we have a nursing shortage. this is money going into bureaucracy, profiteering, and excessive salaries for the c.e.o.'s of insurance companies, it's going into inflated prices for prescription drugs in this country and as a nation we pay the highest prices in the world for prescription drugs. to my mind as a nation, what we

have got to finally deal with is that so long as we have thousands of separate plans, each designed to make as much money as possible, you're not going to get a handle on the cost of health care in america. and in the bill that we are now talking about here in the senate we've got to be clear that the projections, according to the c.b.o., is that everything being equal over a 10-year period, the cost of health care for most americans is going to continue to soar. that is the reality. and this is bad not only for individuals, not only for businesses, this is bad for our international competitive capabilities. because we're starting off from the position that today we spend much more than any other country. and guess what? while this bill does a number of very good things, it is not strong on cost containment. mr. president, if we are going to do and try to improve cost

containment. and i wonder how much we can do within the context of this particular approach to health care without being a medicare for all single-payer system, at the very achilles -- a least weg public option. there is widespread mistrust of private health insurance companies for all of the right reasons. most americans understand that the function of a private health insurance company is not to provide health care, the function is to make as much money as possible. people do not trust private health insurance companies and they are right in terms of their perceptions. people are entitled to a choice. if you want to stay with your private health insurance company, great, you can do it. but as many people as possible in this country should be able to say, you know what? i'm not comfortable with the private insurance company. i'd rather have a medicare-type plan. and i think poll after poll

suctsuggests that the american people want that public option much so that's point number one. freedom of choice. people should have that choice. if they don't want it, that's fine. point number two may be even more important. if we're going to get a handle on exploding health care costs, somebody is going to have to rein in the private insurance companies whose only function in life is to make as much money as they possibly can. we need a nonprofit government-run public plan to do that. and if we do not have that in this bill, i am not sure how you're going to get any handle on cost containment. so i will fight to make sure that we have a strong -- as strong a public option as we possibly can. as i have said publicly many times, my vote for this legislation is not at all certain. i have a lot of problems with this bill. and we've got to have at least, among other things, a strong public option.

let me tell you something else that i think we have got to address in this bill. as mentioned a moment ago, we have a disaster in terms of primary health care in america. some 60 million americans are findinfinding it difficult to ga doctor on a regular basis. and that is just dumb in terms of the health and well being of our people and it is also dumb in terms of trying to control health care costs. if somebody does not have a doctor that they can go to when they get sick, where do they end up? they end up in the emergency room. and everybody knows that the emergency room, by far, is the most expensive form of primary health care. you have millions of people -- yet, millions of people have no other options. they end up in the emergency room. if they have bad cold, medicaid may pay $500 to $600 for a visit to the emergency room that. is totally absurd. furthermore, if you have a primary health care physician, that person is working with you

on disease protection, helping you with getting you off cigarettes or with alcohol or drug problems and a myriad of issues in terms of disease prevention and good nutrition, et cetera, et cetera. so if we have a disaster in primary health care which is driving people to the e.r. rooms makes no sense at all. as i mentioned the other day, there is a provision in this legislation in the senate which authorizes a very significant expansion of federally qualified community health centers, which in a nonpartisan way -- bipartisan way is widely supported by i suspect everyone here in the senate and in the house as well. and these community health centers today allow 20 million people to access not only good quality primary health care, but dental care which is a huge issue, mental health counseling, a very big issue, an low-cost prescription drugs. while the health centers do an

excellent on, there are not enough of them. so in this legislation, we have greatly expanded community health centers. and if we as a congress are talking about bringing 13 million, 14 million, 15 million more people into medicaid, i am not quite sure how a medicaid program is going to accommodate those people unless we provide the facilities and the medical personnel to treat them. so we need this. we need to expand primary health care, community health centers are the most cost-effective way i know as to how to do that. there are studies out there to suggest that by providing that kind of primary health care, keeping people out of emergency rooms, keeping them out of hospital because they've gotten sicker than they should have gotten, we can, in fact, pay for these community health centers by themselves over a period of years by simply saving money. so in the senate we have very good language authorizing an expansion. in the house they have similar

language, except in the house they have a trust fund which actually pays for this. so i'm going to do my best to make sure that we adopt the house rage wage, which pays for through a -- house language that pays for through -- and an expansion of the national health service corps, which is the federal program that provides debt forgiveness an scholarships for medical students who are prepared to serve in medically underserved areas in primary health care. we desperately need more primary health care physicians an dentists and nurses. so my hope is that the senate will adopt the house provision which already has a trust fund to greatly expand the health service corps and the health service programs. that is an issue very important to me. let me touch on another issue that is clearly going to be contentious. and that is at the end of the day we are going to be spending

on health care somewhere around $800 billion to $1 trillion. and the american people want to know a couple of things. they want to know, is this going to raise our national deficit? and what c.b.o. tells us is, no, it will not. more money is going to come in than go out. there be savings inkorptd into the legislation. -- incorporated into the legislation. we have a dz 12-d $1 billion nal debt. so people ask, how are you going to pay for this? and here's where we have a difference of opinion. in the house, i think that they have, once again, done the right thing. and what the house has done is raise $460 billion with a surcharge on the top three tenths of 1 -- three-tenth of 1%

of taxpayers. these are the wealthiest people in the country. what the house has said is that at a time when the gap between the rich and everyone else is going wider and the top earn more income than the bottom 50%, it is appropriate to ask the wealthy to pay their fair share of taxes so that we can provide health insurance to tens of millions of americans. that, in my view, is exactly the right way to go. unfortunately in the senate we have not done that. what we have chosen to do in the senate is to raise about -- well, i don't know the exact number right here. but we have chosen to impose an excise tax of 40% on so-called cadillac plans. well, the problem is that given the substantial increase in

health care costs in this country, a cadillac plan today in five or 10 years may be a junk car plan. and i believe that with a struggling middle class out there, where people -- with people desperately trying to hold on to their standard of living, the last thing that the united states senate wants to do, is to impose a tax on millions and millions of working people who have fought hard to get a halfway decent health care plan. let me very briefly, mr. president, read right from a fax sheet that came from the communication workers of america. c.w.a. is one of the largest unions and almost like every united younion they are strongl, prosed to the ex cease -- opposed to the excise tax. this is document from the cw.o. the legs will vote on --

employer health plans. the tax will be passed directly on to working families to avoid the tax employers will try to significantly cut benefits for active workers and premedicare retirees. how the health benefit tax works, they describe it again. it is a 40% excise tax that would be assessed on the value of health care plans, exceeding $23,000 per family and $8,500 per individual starting in 2013. levels are higher for premedicare retiree plans and high-risk industry plans. $26,000 and $9,850. these thresholds would increase -- and here's an important point, because while people may not have to pay this tax in a couple of years with health care costs soaring, they will have to pay this tax in the reasonably near future.

these thresholds would increase at the rate of general inflation plus 1 percentage point or 3%. this is well below the medical inflation right, 4% and about half the right, 6%, at which employer and union plan costs have been increasing. in other words, the costs of health care is rising a lot faster than inflation which today is almost zero, and may actually even be below zero. the point being that a number of years so-called cadillac plans are going to risch the threshold upon which middle-class workers are going to be forced to pay a lot in taxes. let me go back to the c.w.a. now. they write -- "health benefits tax will hit c.w.a." -- and when they say c.w.a., they are talking about many union workers. "c.w.a. plans result in deep

cuts. in 40 of 43 states examined over ten years, 2013-2022, the average excise taxes assessed on each worker and c.w.a.'s most popular plans will be $13,300 per active worker in the family plan." that's for a ten-year period. $13,300. $5,800 per active similar worker. $13,300 for pre-medicare retiree in the family plan. $1,400 for pre-medicare retiree in the single plan. the bottom line is the middle class in this country is struggling. we are in the midst of the most severe recession since the great depression of the 1930's. people are working longer hours for lower wages. middle class is on the verge of collapse. the united states senate should not be imposing an additional

tax on middle-class workers. the house got it right. the senate got it wrong. and, mr. president, i intend to offer an amendment to take out this tax and replace it with a progressive tax similar to what exists in the house. let me conclude, mr. president, by simply saying this: i understand that the leadership wants to move this bill forward as quickly as possible. i understand that. but in my view, we have got a lot of work in front of us to improve this plan, among many other things, many other things. and i know many members have different ideas. at the very least, states in this country, individual states, if they show choose, should be able to develop a single-payer plan for their states, because at the end of the day, in my view, the only way we are going

to provide comprehensive, cost-effective universal care is through a single-payer. i know some people are saying well, we're dealing with health care, we're not going to be back for a long time. if this bill would pass tomorrow, trust me, we will be back in a few years because health care costs are going to continue to soar. winston churchill once said that the american people always do the right thing when they have no other option, and i think that's what we're looking at right now. we're running out of options. what we have put together is an enormously complicated patchwork piece of legislation. it's going to help a lot of people. it involves insurance reform which is absolutely right. we have got a lot of money into disease prevention, which we should have. a lot of very good things in this bill, but it ain't going to solve in my view the health care crisis. costs are going to soar. at least ifway don't have the courage as a body to take on the insurance companies, to take on the drug companies, at the very least let us give states, whether it is vermont, pennsylvania, california, or

other states the right to become a model for america, provide health care to all people, in a cost-effective way through a medicare for all single-payer system. so we have got to do that. the other thing we have got to do, in my view, is get rid of this tax on the middle class by taxing health care benefits. mr. president, you will recall that a year ago we were in a heat -- a highly controversial and difficult presidential campaign, and one candidate who happened to have lost that election, a member of the senate, senator mccain, came up with a plan that was exactly or very close to what we are talking today, and the senator barack obama who won that election came up with a different plan. he said that wasn't a good idea. well, how do you think millions of american workers are going to feel when they say wait a second, the guy who won told me he was against taxing health care plans and now we are adopting the program of the guy who lost?

how do we have faith with the american people? and people who voted in that election if we do exactly what we said we would not do? so we have got to move toward a progressive way of funding this health care plan. so, mr. president, you know, i sit here right now saying that this plan has a lot of good stuff in it, but there are a lot of problems in it, and i very much look forward to the opportunity to be able to offer a number of amendments to strengthen this bill, and it is very important, i think, for the people of vermont and people all over this country, not only i but you and other people have a right to offer amendments, because if this bill just gets whizzed right through and is not as strong as it possibly can be, i think we will not have done the job that we need to do. mr. president, with that, i would yield the floor and thank you.

mr. sanders: it appears that i am going to be closing here tonight. the presiding officer: the senator from vermont is recognized. mr. sanders: let me ask unanimous consent that the senate proceed to a period of morning business with senators permitted to speak for up to ten minutes each. the presiding officer: without objection. mr. sanders: mr. president, i ask unanimous consent that when the senate completes its business today, it adjourn until 9:30 a.m. wednesday, december 9. that following the prayer and pledge, the journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the senate resume consideration of h.r. 3590, the health care reform legislation. that following any remarks of the chair and ranking member of the finance committee or their designees for up to ten minutes each the next two hours be for debate only, with the time equally divided and controlled between the two leaders or their

designees, with senators permitted to speak for up to ten minutes each, republicans controlling the first 30 minutes and the majority controlling the second 30 minutes, with the remaining time equally divided and used in an alternating fashion. further, that no amendments are in order during this time. the presiding officer: without objection, so ordered. mr. sanders: mr. president, roll call votes are possible throughout the day tomorrow. senators will be notified when any votes are scheduled. if there is no further business to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the senate stands in adjournment until 9:30 a.m.

c-span.org/health care. c-span's 2010 student cam contest is here. $50,000 in prizes for middle and high school students. top prize is $5000. just create a five to eight minute video about one of our country's greatest strengths. deadline is january 20. winning entries will be shown on c-span. grab a camera and get started here it go to student cam.board for rules and info.

>> the senate voted to remove an amendment that would bar federal funding and health care bill for most abortions. here's in our portion of that debate. >> madam president, i rise today to talk about another amendment that is pending the nelson patch casey amendments. and this is the amendment that i think has been discussed in the last day as well. that is the amendment that would assure that no federal funds are spent for abortion. that was unclear. it is unclear in the underlying bill and i think it is very important that we talk about it, that we make sure that it is very clear, exactly what the nelson-hatch-casey bill does. it would bar federal funding for abortion which is basically applying the hyde amendment to the programs under this health

korbel. since the hyde amendment was first passed in 1977, the senate has had to vote on this issue many, many times, probably just about every year. and i have insistently voted to prohibit federal funding for abortions as i know my colleague and friend from utah has done as well as the democratic sponsors of this amendment. and yet, it seems that some members were on the floor last night misconstruing exactly what the nelson-hatch-casey amendment does. specifically they are claimed was that the hyde language only bars direct funding for elective abortions while the nelson-hatch-casey amendment bars funding of an entire benefits package that includes elective abortions and therefore is unprecedented. so i would just like to ask the distinguished senator from utah what exactly did the hyde

language day. let's identify what hyde was that we can determine if your amendment is the same. >> thank you so much. the amendment and hhs appropriations act says the following. section 507 na. none of the funds appropriated in the fact that none of the funds in a trust fund to which funds are appropriated in this act should be expended for any abortion. none of the funds appropriated in the fact that none of the funds at any trust fund to which funds are appropriated in this act should be expanded -- extended for health benefits coverage includes coverage in abortion. >> so that his federal funds prohibited from being used in abortion in that particular bill. but what about programs like chip? that was created in a balanced budget act and in 2009 it was reauthorized by congress and signed by the president earlier this year. so what about the chip program?

>> it was the hatch kennedy belt. i was one of the original authors of the program and insisted that the following language be included in the original statute. limitation on payment for abortion. in general, payment shall not be made to a state under this section for any amount expended in the state plan to pay for any abortion or to assist in the purchase in whole or in parts of health benefit coverage that includes coverage of abortion. exception, subparagraph a. should not apply to the abortion only if necessary to save the life of the mother or if the pregnancy as a result of an act of or. the chip bill. >> so i would assume you do know it is a not though. what about the federal employees health benefit plan? what does this say? >> and yet he agreed to that language. now the federal employee health benefit package are the

following language in the financial services and general government appropriations act for fiscal year 2009. section 613. no funds appropriated by this act should be available to pay for an abortion by the administrative expenses in connection to any health plan under the federal employees health benefits program which provides any benefits or coverage for abortions. section 614, the preventions of section 613 shall not apply with the life of the mother would be in danger if the fetus were carried to term or the pregnancy as a result of an act of rape or incest. >> well, if not the same as the language of the nelson-hatch-casey amendment? >> you're absolutely right. let me read that language for you. the nelson-hatch-casey amendment. in general, no funds authorized or appropriated by this actor and amendments made by this act may be used to pay for any abortion or to cover any part of

any health care plan that includes coverage of abortion. >> so based on what you've said, this is not new federal abortion policy. the hyde amendment currently applies to the plans discussed, including the plans that members of congress have antiabortion protection for all of the federal health programs all say exactly the same thing. and that we should -- the amendments that we are going to vote on, that is the nelson-hatch-casey amendment would preserve the three decade long precedent and that's what your amendment does. and that we must pass it if we are going to guarantee that the bill that is on the floor is properly amended so that it is the same as our 30 years of abortion federal policy in this country.

>> the reason it's so critical that we pass the nelson-hatch-casey amendment is that it is the only way to guarantee that a taxpayer dollars are not used by the insurance plans under the democrats fail to pay for abortions. in other words, the hyde language is in the appropriations process we have to do it every year rather than making it a solid amendments. but this bill is not subject to appropriations. so this bill, if we leave the hyde language out of this bill and the language that we have in the amendment of nelson-hatch-casey amendment, then we would be opening up the door for people who believe that abortion not to be paid for by the federal government. and we should close that door because that's been the rule since 1977. >> well, i just thank you for the explanation. i think the senator from utah

because i do think it's important that people know. there have been a lot of questions raised about the bill and whether it would be a foot in the door for a policy -- for changing a policy that billy has been the law of our country and accepted as such, whether it was the democratically controlled congress or a republican-controlled congress. i think everyone has agreed that this hyde amendment language has protected federal taxpayers who might have a very firm conviction against abortion would not have to be subsidizing this procedure. >> we really appreciate the distinguished senator from texas pointing this out. the current bill has language that looks like it is protected, but it is not. and that's what we're trying to do is close the loophole in a language and get it so that we live up to the hyde amendment, which has been in law since 1977. and to be honest with you, i

don't see how anybody could argue that the taxpayers ought to be called upon to foot the bill for abortions. let's just be brutally frank about it. the taxpayers should not be paying for abortions. the polls range from 61% of the american people including many pro-choice people who do not believe taxpayers should pay for abortion to 68%. the polls are from 61% to 60% do not believe that the taxpayers ought to be paying for abortions except to save the life of the mother or for or incest. and we provided for those approaches in this amendment. so anybody who argues that otherwise is just plain not be inaccurate. >> with the senator from utah be able to yield for a question? >> sure. >> my question relates to the

provisions of the appending bell, section 1303, to be, which specifies that the plan will not allow for any payments of abortion and where there is as provided under section 1303, today there will be a segregation of funds. so that under the existing statute that there is no federal funding used for abortion, but an individual may buy additional funds, a woman having a right to pay for her own abortion

coverage. and with the status of medicaid for the prohibition of lives to anybody, any federal funds being used to pay for an abortion, there are 23 states which allow for payment for abortion coverage coming out of state funds. so once the provision of this statute for which enable a woman to pay for abortion on her own exactly the same as what is now covered under medicaid without running against the violation provisions of the hyde amendment? >> the way we view the current language in the bill is that there is a loophole they are whereby they can even use federal funds to provide for abortion under the segregation language. and that's what we're concerned about. we want to close that loop all

and make sure the federal funds are not used for abortion. like i say, there are millions of people who are pro-choice who agree with the hyde language. all we're doing is but the hyde language into this bill in a way that we think will work better. >> if the senator would yield for a comment. >> i'd be happy to yield. >> in responding to the senator from pennsylvania at while i would like to quote part stupak. in the same sort of questions naturally were coming out saying okay you're blocking abortion funding of the individual. and he said this and i'll just quote him directly for a representative stupak. the caps amendment which is in the base we bill here departed from hyde in several important and troubling ways by mandating that at least one plan and the health insurance exchange provide abortion coverage. i requiring a minimum 1 dollar

monthly charge for all covered individuals that would go towards paying for abortions by allowing individuals receiving federal affordability dollars to purchase health insurance plans that cover abortion. and all those ways, the cap amendment which is in the reid dell expands and does federal funding of abortion that we haven't done for 33 years. going on the stupak, it prohibits direct federal funding of abortion. the stupak amendment, which is also the nelson hatch amendment is a continuation of the 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 at the senator from utah, the senator from nebraska is putting forward in this amendment. and i think my colleague for yielding for that. >> the segregation language and here is a very private matter language enough overtime to

resolve. and we basically have all agreed with the hyde language since 1977. and this would in effect incorporate the hyde language in the bill. >> senator yield for another comment. >> sure. >> senator hatch, if i might just offer a thought here on that language. the national right to life group saw through that gimmick immediately. i mean 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 somehow there would be some segregation if the federal money went into your left pocket, but to pay for abortions out of your right pocket. and it doesn't make any sense. that segregation is it going to work. they thought the attempt of the gimmick of us. 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 really doing here is we are saying very 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. >> how can you disagree with the provisions of section 1303, 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 provides coverage or services for abortion, the issue or the plan shall not use any amount of

the federal funds for abortion. so there is a flat-out prohibition for use of federal funds and then under section 1303 there is a segregation of funds which is identical to medicaid. so however you may want to characterize it, how do you respond to the flat language in the statute which is contradicting the purpose of the hyde amendment and allows for payments by collateral funds just as medicaid pays for abortions without federal funds? >> i'm not going to ask another of firms questioned. if that's true, then why have the top language in their? why do we just take the hyde language which is what we're trying to do? we know under this bill there is some sedation to help people to pay for health insurance. in fact, the subsidization can go to people up to $80,000 a

year. and that can be indirectly used for abortion. it is a loophole that hyde closes. end of the distinguished senator from pennsylvania believes that the what it's been since 1977. what's wrong with putting the hyde language in here in solving the problem once and for all. we see it as really 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 is no federal funding of elective abortion or plans that include elective abortion except in the cases were the life of the mother is in danger of the pregnancy is caused by rape or

incest. the amendment allows individuals to purchase a supplemental policy or a plan that covers selective 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 ended in abortion coverage by private health plans or providers within such plans. and insurance plans 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 the same as that of the house bill changed by the stupak amendment. now look, if the distinguished senator from pennsylvania believes that the top language is the same as hyde, he was wrong. and he who believes that does what hyde would do is wrong they

are and why not just put the hyde language and once and for all which has been there since 1977. that's what the stupak languages. the hyde amendment specifically removes abortion from averments programs. but the read bill specifically allows abortion to be offered into huge new government programs. the reid dell tries to explain this by calling for the segregation of federal dollars when federal subsidies are used to purchase health plans. this quote segregation unquote of funds actually violates the heideman meant was provides funding of abortion in not only underfunds but under state matching funds within the same plan. simply put, today federal and state medicaid dollars are not segregated and so that's the difference. now, if the distinguished senator from pennsylvania

believes that the current language in the reid bill meets the qualities of the hyde language. why not put it in once and for all. since it's been law since 1977. it's important to note today there is no segregation of the 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 the state medicaid dollars. for that i know i have some colleagues who asked to have time to speak. so i'm going to yield the floor. >> will the senator yield? >> i yield the floor. >> senator from utah has not yet answered the question. >> senator from louisiana. >> thank you madame president. i strongly support the senator from utah's effort along with senator nelson, senator casey. i think this exchange in this colloquy is very helpful.

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. in this amendment. and that's essentially exactly

put we have in this amendment. similarly the u.s. conference of bishops, they are very supportive of the concept of the underlying bill but have said clearly that the rebuilding is completely unacceptable, quote, completely on acceptable, end of quote on this abortion issue. and, quote, is actually the worst bill we have seen so far on the life issues, end of quote. so this colloquy involving the distinguished senator from pennsylvania, the debate i think proves the point clearly, and again i compliment the senator from utah along with senator nelson, senator casey, others on the co-sponsor of the amendment on this effort we need to pass this on the bill. this will do away with the loophole. this will be real language to truly prohibit tax payer funding of abortion and.

this constitute the same as the 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 there are no mandates for elective abortion coverage. plans and providers are free from any government mandate for abortion under this amendment language. it would mean there is no federal funding of elective abortion or plans that include elective abortion except in the cases in the life of the mother is endangered or in cases of rape or incest. it means this amendment would allow individuals to purchase a supplemental policy or plan that covers elective abortion as long as that separate policy is purchased completely with private dollars. it would prohibit the public plan from those portions and

prohibit the federal government from mandating abortion coverage any plan. insurance plans or not prevented from selling truly private abortion coverage including from the exchange but taxpayer dollars would have nothing, absolutely nothing to do with it. bottom line abortion funding and mandates is exactly the same as the distinguished tradition of the hyde amendment with this amendment and would be the same as the stupak language of the house side. 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 brighter and white and to keep 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 support and passed again and again and again in congress with democratic majorities and republican majorities. it is a solid consensus. represents the common sense of the american people and certainly i will follow a certain pride and tradition of louisiana senators supporting that consensus. every senator from louisiana since the hyde amendment adopted has strongly supported this strong common sense view, every senator and everyone from me has been democrat, but every sitting senator from louisiana has supported that common sense consensus view and i surely hope that tradition as well

continues. again, i applaud the senator from utah and his lead and co-sponsor, senator nelson, senator casey on this effort and i encourage all of my colleagues, democrats and republicans to come around with the american people consider a real no-brainer. true consensus. something that clearly reflect the common sense of the american people. is abortion a divisive issue? yes. is using taxpayer dollars to fund abortion a close question, no. there is a clear consensus in america not to use any taxpayer dollars to fund abortion. it's crystal clear to continue that we need to pass this amendment and the underlying language and the reid bill is unacceptable. with that, madam president, i

yield the floor. >> the distinguished senator from texas, distinguished senator from louisiana and from nebraska, and of course the distinguished senators from kansas and montana, not montana but self dakota here on the floor and participating in this i believe we have on till 12:27 so i'm going to relinquish the floor and leave it up to you. >> before the senator leaves i want to put a fine point on something he said, the senator from pennsylvania, about the use of medicaid funds in the states because there's a number of states that do provide programs and have abortion funding, but i think there is a clear distinction that needs to be made. medicare funds which are matching funds and none of those can be used to fund abortions and you said that in response to his question that needs to be made very clear because the senator from pennsylvania was in

plugging some house since states created programs to fund abortions and since medicaid is a federal-state program that somehow those two are being mixed and this idea because we are -- they are calling for 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 are going to the medicaid program, the provision that exists on federal funding of abortion applies to medicate 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. >> i'm glad the distinguished senator made that even more clear but less like a number of democrats got on the floor and distorted this issue. look, if they think that the capps language equals the hyde language why not put that languages? they don't want it in because they wanted from the bush in any way they possibly can and not

only be able to fund a variety of ways with federal dollars, if we don't put the height of language and so that is what this is about. i would be happy to yield. >> i've got another point on this as well. if you're not clear about this abortion will be funded. so let's just kind of be fauzi about this and not be clear. the commonwealth of massachusetts recently passed a state mandated insurance, welfare without an explicit exclusion on abortion and guess what abortion also funded immediately in fact common wealth website abortion is covered as an outpatient medical care so that's the point about being clear with the heiberg language which is the nelson hatch language as it specifically says know we are not going to fund this we're going to further this policy and

if we do fund abortion and put the capps language that funds abortion last time federal government funded abortions was the three year period after roebuck before i'd and refunding about 300,000 abortions a year. federal tax payer dollars funding of abortion through medicaid. i cannot believe 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 legal, safe and rare. 300,000 a year wouldn't be in that ballpark and that is the past number that happened when you didn't have the height language in place at the federal level. >> it's a big excuse. all this yelling and screaming when they say it equals the hyde language it doesn't, that's the problem. and if they -- if they want to solve the problem why not use the hyde language exited by the

congress since 1967 and your right, 300,000 abortions for 1973 and 1927 because we didn't have the hyde language, we got tired of the tax payers, 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 in vigorous. it would allow that and anybody who is arguing this is the same as the hyde language hasn't read the capps language, and we want to change it so that if we go with hyde that is going to affect the right to abortion at all except we are not going to have taxpayers paying for it. >> if he would yield on that point, and that's what the stupak and other members of the house of representative sold is this created tremendous

ambiguity and the sought to tie the knot and reinstate what has been longstanding policy with regard to federal funds and they are used to finance abortions since 1977 and the hyde language and so the stupak language to the house bill as you recall past with to entered 40 votes. there's a sizable decisive majority of members in the house of representatives who sold through with the ambiguity that exists with regard to the house bill and the senate bill but this is intentionally ambiguous for the reason you just mentioned. all this does is clarify once and for all what has been standard policy here at the federal level going back to 1977 and was stated earlier i believe represents the consensus view in america both republicans and democrats on think believe that this is ground that we all can stand on your respective where people come down on this issue that the idea that somehow federal funds of two, taxpayer

funds ought to fund abortions is something most americans disagree with, and that's why i think there has been such a broad bipartisan support quebec to 1977 for this particular policy and why you should be extended into the future and as you said the senator from utah said 61%, i've seen polls and suggested higher than that. it would be higher than that in my seed south dakota but i commend the senator for seeing his way to offer an amendment that clarifies and removes all of this ambiguity is clearly intentional ambiguity with regard to this issue and the underlying bill. >> there is consent senator cornyn has co-sponsored the hatch pc amendment -- >> how much time is left on our site? >> let me say i have been on the floor in number of times now debating this issue a while that

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 sold over the last half the number of debate on the senate floor. you leave 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. our colleague from texas said this is a foot in the door and i agree with her. if this 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 is why we are guinn to end up with. a couple of weeks ago i came to the floor when we were debating the motion to proceed and i said at that time you know, to me this is the pro-life vote because of this bill goes to the floor we now need 60 votes to get an amendment passed and i said i don't count to 60 a kind of issued a challenge than i said if there's any member who does have a list of 60 who will vote for this amendment i'm willing to take a look at that and change my view of the world. that hasn't happened. in fact there are many predictions being made that sadly and unfortunately this amendment won't get 60 votes needed. let me put this in context. for pro-life seven terse this is the vote but it doesn't stop here. in my estimation you are pro-life on every vote. you don't get a pass on this

vote or that a vote or the next vote or whatever the vote is. were pro-life all the way through. and even if this amendment doesn't pass i want it 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 is what this country wants. many senators, the senator from soft dakota, senator from kansas have very clearly made the case. the people in the united states do not want their tax dollars go to body and abortions. and so my hope is 60 will step on this amendment. i'm going to support it. i will speak everywhere i can in support of it. i just am so appreciative that senter nelson and senator hatch and senator casey brought this forward and i'm glad to be a

co-sponsor. and it is my hope, it is my hope this amendment will pass, but then it is my conviction we need to stand strong throughout this debate and make sure this language doesn't end up in the final bill. i yield the floor. >> senator from kansas. >> i think the catholic bishops put it as concisely as anybody, they put it in this term. they said any major federal program where funds combined with nonfederal funds to support or purchase health coverage congress has consistently sought to ensure the package of benefits excludes elective abortions. that is what we've done. that's what we've done for 33 years until this moment. until the language sets the pace in the reid bill and now we would flood that on its head and say you can combine federal funds with nonfederal funds to pay for elective abortions.

that was the policy prior to hyde and 77 that funded than 300,000 abortions roughly a year at that point in time. there was no way in this country that's the policy that the american people support. they don't. it may be divided about abortion they are not divided about federal funding for elective abortions. no decision about that at all. very consistent policy until you see the reid bill in this particular piece of legislation and we've been quite consistent about this so it would be my hope my colleagues would say i may be pro-choice but i've consistently supported high because we shouldn't be funding elective abortions and i would hope they would vote for the nelson hatch amendment because the very features. it isn't about abortion it's about funding of elective abortions. and we wouldn't go that direction. on net yield the floor.

>> why are women being singled out here? it is so unfair. we have had a full-year wall in place 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 illegal and it is. brophy we'd need it to legal in the early stages of pregnancy. women have had the right. what this amendment does is it says there's one group of people here we are going to treat differently and we are going to take one procedure that only applies to them and say they can't buy health insurance for that procedure. only if it is a separate writer. which everyone knows is unaffordable, in practical and will not work. so i don't see any amendment here saying to men if they want

a procedure that relates to their reproductive health they can't use their own private money to buy coverage for its. no, it's not in there. q. don't tell men that if they want to make sure they can buy insurance coverage through their pharmaceutical plant for viagra that they can do it, no. they don't do that and we wouldn't support that. it would be wrong. well it's wrong to single out women and to say to the 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 this amendment to really understand how pernicious it really is. because whole point is, and five male colleagues from the other side of the ogle were there for

at least an hour talking about this amendment, and, you know, one thing about each and every one of them they want to make abortion illegal. there is no question about it. they want to take away the woman's right to choose even in the earliest stages of the pregnancy. even if it impacts her health, ability to remain fertile, ability to avoid a very serious health issue such as a heart problem, stroke. they don't want to have an exception for a woman's health. no question that is what they want. >> i guess the senter's ten minutes is up. >> i would ask unanimous consent for an additional 30 seconds and then i will turn to senator lautenberg. >> without objection. >> so, to sum up my part here, the amendment that has been offered by senators nelson and

hatch and vitter and 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. so i hope we will vote it down and i will yield the floor and note senator lautenberg was here for five minutes. >> senator from new jersey. >> may i say in the order it will senator murray from five -- >> thank you, mr. president and madame for your debate on this and for outlawing 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 choices this amendment would eliminate. mr. president, we cannot allow a

bill that does so much for women and families and businesses and future strength of this nation to get bogged down and ideological politics and 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 women across america. already so far the senate has passed senator mikulski's amendment to make sure all women have access to quality preventive service and screenings the verso critical to keeping women healthy are available. the bill, this underlying bill will also help women by ending discrimination based on gender bias preexisting conditions.

on covering maternity care, covering preventive care and screenings including mammograms and a well baby care. expanding access to coverage even if an employer doesn't cover it and giving freedom to those forced to stay in abusive relationships because if they leave they or their julca and could lose their coverage. but mr. president, now the amendment that is 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 we 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 market place. if this amendment were to pass

it would be the first time 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 of for months arguing that this bill takes away choice. mr. president, this bill doesn't take away choice but why this amendment sure does. this amendment stipulates any health plan receiving any funds under this legislation cannot cover abortion care even if such coverage is paid for using the private premiums health plans received directly from individuals. simply put with this amendment does is it a health plan wants to offer coverage to individuals who received affordability credit the matter how small, that coverage cannot include abortion care. and it this way the amendment doesn't just restrict federal funds, it restricts private funds. and it doesn't just affect the

was receiving some amount of affordability credit, it also impacts people who are paying the entire cost of coverage but happen to purchase the same health plan as those with affordability credit. 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 further than current law. no matter what our colleagues on the other site content. currently 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 before us represents genuine compromise, prohibits federal funding of abortion either than the exhibition's i mentioned but it also allows women to pay for coverage with their own private funds.

maintains current law. but this amendment before us would be an unprecedented restriction on women's health choices and coverage. of 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. women already pay higher costs for health care to read we shouldn't be forced into limited choices as well. so mr. president we are standing on the floor today having a debate about a broken health care system. it is broken, for women denied coverage or charged more for pre-existing conditions or pregnancy or c-sections -- i ask for an additional 30 seconds. >> without objection. >> women with domestic violence, c-sections considered preexisting conditions. it's broken when the charge women of child-bearing age more

than men that don't cover maternity care, only offer for hefty additional premiums. mr. president, the status quo isn't working. women and families need health insurance reform that gives options and doesn't take them away. so i urge my colleagues stand up for the reform, reject this shortsighted amendment. thank you, mr. president. i yield the floor. >> the senator from california. >> i won the unanimous consent request to give senator lautenberg eight minute and myself to minutes followed by senator cardin for five. >> without objection so ordered. the senator from new jersey. >> mr. president, throughout my service in the senate on 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 is why i strongly oppose the amendment offered by my friend, the senator from nebraska. i think that he's wrong. what this amendment does is remove a woman's right to make her own decision as a practical matter. it is to prohibit any of the health plans on exchange for covering a portion and would ban coverage for women who don't get a dime and federal spending. women's reproductive rights or always been challenged here in the congress. what about maine's reproductive rights? -- men's reproductive rights. let's turn the table. what if we were to vote on a viagra amendment, restricting coverage for male reproductive services? the same rules would apply for

viagra as being proposed for abortion. and of course that means that no health plan on the exchange would cover viagra available. how popular that demand be around here? mr. president, i understand 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 man'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 politicians making decisions for my daughters or my granddaughter's when it comes to their health and well-being. but that is exactly what this amendment does. nothing made me happier than when any of my daughters announced their pregnancy and why i watch 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 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 want to stand here and think that somebody is going to make a decision in this room that affect what my granddaughter or daughters have to think about. if they want to restrict themselves, let them do it.

but why can we stand here and permit this to take place when we are trying to make people healthier and better and informed? but this amendment wants to take away their right. right now the majority of health insurance plans to offer abortion coverage. now this amendment would force private health insurance companies to abandon those policies, eliminate services and limit a wollman's option. the amendment does not contrary to statements made, being made here on the 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 per premiums all of her own pocket to purchase a private health plan that offers her the right to choose what is best for her, her health and her family's well-being. we've been working hard for a long time to eliminate discrimination against women in the current health care system. right now our health care bill takes a balanced approach to abortion coverage. it preserves existing federal law we. women have fought this nation -- since this nation's founding to have full rights under the law we including many other things. but i am forcing -- this amendment would force them to take a step backwards, and i

don't want to see that happen. and i urge my colleagues please, use your judgment, which you're own judgment about your own family. make your decisions as to what you would recommend to a daughter or a wife but for god sakes let the woman choose what is best for her and i urge my colleagues to vote against it and with that i yield back my time. >> senator from maryland. >> mr. president, thank you. i rise in strong opposition to the nelson-hatch amendment and let me start by saying that i support a woman's right of choice. it's a constitutionally affirmed blight and leah understand how difficult this issue is. and that is why the underlying bill we have before us carries out the compromise that is already been reached between the pro-choice and pro-life supporters. it represents maintaining the

federal prohibition on the funds, federal funds for abortion that allows a woman to pay for abortion coverage through the use of her own funds. that is the current law and with the underlying bill makes sure that we continue. many of us felt the healthcare debate is critically important. it's controversy. let's not bring the abortion issue into the bill. the nelson-hatch amendment would go beyond. it would restrict a woman's ability to use her own funds for coverage to pay for abortion. it blocks a woman from using personal funds to purchase insurance plans with abortion coverage. if enacted for the first time in federal law this amendment would restrict what individual profit dollars can pay for in the private insurance marketplace. i must 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 be real 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. and it's quite clear the senate reform bill already includes the language banning the federal funds for abortion services so supporters of this bill are not satisfied with the current funding than. they are trying to use this to move the equation further in an effort to defeat the bill. and i also point out that this is really wrong as it relates to women in america. i am outraged that the suggestion women who want abortion should be able to purchase a separate writer to cover that. why would we expect this overwhelmingly male senate to expect women to shop for a

supplemental plan in anticipation of an unintended pregnancy or pregnancy with of complications? who plans for that? the whole point of health insurance is to protect against unexpected incidents. currently there are five states, idaho, kentucky, oklahoma, missouri and north dakota that only allow abortion coverage through reuters. guess what? the individual market does not accept this type of a policy. it doesn't exist. abortion writers severely undermine the patient privacy. as a woman would be placed in the position of having to tell their employer or insurer and many cases has been an 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 friends on the other side of the ogle that the statements

we make, that is those that support the bill, the underlying bill, that this allows individuals who have current insurance to be able to maintain their current insurance build on what's good in the health care system. this amendment takes away their rights people already have. so if you have insurance today as an individual that covers abortion services, if this amendment were adopted or 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. it is it the policy is wrong on this bill it is wrong. i urge my colleagues to accept the compromise reached on this bill. the compromise. many of us who would like to see us be more progressive dealing with this issue remove the discriminatory provisions in the es system will, we understand we 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 women that's right or wrong. i urge my colleagues to reject the nelson-hatch amendment and with that i yield the floor. >> the senator from california. >> mr. president, i would like to the three senators murray, watch and bird and carvin for participating in this half hour of debate at that time. our black time is almost used but i would like to close this half-hour by saying one word that i think is a beautiful word and that is fairness. fairness is a beautiful word and it should always be the centerpiece of the work here. we should never sing aloud one group of people for -- as target's peery 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 the winning dee dee colin and they can't use their own funds to purchase coverage for the wide range of reproductive procedures. it doesn't say that to a man, you can't use your own funds to cover the cost of a pharmaceutical product you may want for your reproductive health. it doesn't say that you can't use your own private funds for a procedure they may choose. that is in the arsenal de me choose for their own reproductive rights. so we say to the men of this country we are not singling out any procedure or pharmaceutical product you may want to use for your reproductive health care.

we are seeing if a private insurer offers it you have the right to buy it. we are singling out women, and again, let me say this has clearly as i can, mr. president. we have had a fire wall between the use of federal funds and private funds. senator reid has kept the fire wall in place in the underlying bill. he keeps the status quo of the hyde amendment. the group here coming on the floor most liebman so far there may be some women on their behalf but i haven't heard it are basically saying forget the firewall. forget it. women, and you can't use your private funds and the government will tell you what you can or can't do. i tell you something, that isn't what uncle sam should do. on goals and should respect women, man, and i hope we defeat

this amendment and i yield the floor. the senate voted to table or set aside the nelson amendment that would have put tighter restrictions on abortion and health care bill. a short time ago senate majority leader harry reid announced agreement reached by democrats meeting about the legislation. this is about five minutes. >> kind of a long journey. we've confronted many hurdles and had to take big steps and a lot of little steps. but tonight we have overcome a problem that we had. i think it's fair to say the debate at this stage has been portrayed as a very divisive one and many have assumed people of different perspectives cannot come together. but i think that we are able to work out the last few days belays that fact.

we have broad agreement. i know people are going to give me every detail of this. i talked 20 minutes ago and told the head of the cbo that we were going to send him something tomorrow that he would have to score, and the reason i mention that to you is we also went over some detail about what we were awful nice to say about what we were going to send and we know what we are going to send we have to write up in legislative language. and he said the same as when you send over your bill. we have had a rule here for 40 years however long in existence, and we start talking about the plan, shipping it around and would be made public and we want them not to be the case because we want to know the score before we start getting all the details

even terrell were allowed members. so you're not going to get answers to those questions. i asked senator schumer and senator pryor to work together with a group of moderates and progressives. everyone thought it's an impossible journey. but these two fine and senators have done an outstanding job of leading the these two groups of people. everyone knows who the tanbark. they worked very hard for days now. this is a consensus that will help ensure the american people win in a couple of different ways. one, insurance companies will certainly have more competition, and number two, the american people will certainly have more choices. i already know that all six dissenters in my caucus don't agree on every piece of the

bill. i know that we've sent over there to the cbo, tamar, not everybody's going to gregory on every piece we sent but it doesn't mean everybody disagrees on what we said. i applaud and congratulate the ten senators led by senator schumer and senator bayh. i think it's important to mention their names. brown, carper, feingold, nelson, rockefeller, as i indicated we can't disclose the details of what we've done but believe me when we've got something this could and i feel for osset moves this bill we down the road. >> senator schumer, you gave details earlier today. can you just at least tell if any of those have dramatically changed? >> we are not going to talk about what we are sending to marra for the reasons that leader reid said.

>> things change all the time. >> we have seen all kind of articles in the newspaper said schumer, senator pryor, i have said things, other parts of the ten. as elmendorf and i talked to light of the things you've read in the newspapers, all the things you for the newspapers for a simple one of our people, and i won't mention which of them, the public option isn't going to work. that isn't true. so we are not going into detail but what you have heard to this point you can be surprised what we have sent to cbo. >> you said you have reached broad agreement -- seabeck we have reached agreement. >> would you share in the broad points of what is in there, not the details? >> i did that. i said we are going to have more choices for consumers, more competition for the insurance companies.

>> [inaudible] >> have you talked to senator snowe? >> you mean today? i talked to her lots of times today. >> the proposal. >> we just finished it. she's at dinner now with staff. a couple of more questions than we are going to quit. >> is the end in sight for passage? >> why don't we talk to some of my people. the question is this having been done -- was the question? >> is the end in sight? >> the answer is yes. [laughter] >> senator reid, on cbo -- dannel conversations [inaudible conversations] senators talking about health care negotiations. the associated press is reporting democratic senators

have a tentative deal to drop a government-run insurance option from the health care legislation. senators have been negotiating on a proposal that would open medicare to uninsured americans beginning at age 55. earlier the senate defeated a measure by john mccain on the medicare advantage private insurance plan. the amendment would have sent the measure back to committee to expand benefits for medicare advantage in laws. here is the date on that amendment. >> i ask unanimous consent the next 30 minutes to engage in a colloquy with my colleagues. >> without objection. >> i would like an note -- i talked a lot about c-span, i agree admirer of c-span and how the president at least when he was running also believed in c-span because he said c-span will be in on the negotiations. it was posted by political last night at 5:48 p.m. the title no c-span here. the reporters said right now a

group of moderate senators is meeting behind closed doors to try to hash out a compromise on the public auction. reporters waiting for the meeting to break were just moved out of the corridor nearest corner making it harder for the press to catch the senators as they leave. c-span this was not. the beat goes on. could i remind my colleagues of the amendment we are discussing here is directed to prevent a drastic medicare cuts from impacting all seniors in the medicare advantage. this amendment says simply let's give seniors who are members of medicare or enrolled in medicare advantage the same deal senator nelson was able to get for the state of florida, at least most of the seniors enrolled in medicare advantage programs. there are a 11 million american seniors enrolled in medicare advantage programs. this amendment would allow all

11 million to have the same benefits and there would be no carvel out for the various crops of seniors just because of the influence of a member of this body. i want to quote again "the new york times" my favorite source of information, quote, senator tries to relate years on health overhaul. mr. nelson, a democrat, has a big problem with the bill taken this week by the committee would cut medicare payments to insurance companies that care for more than 10 million older americans including nearly 1 million flora. the program known as medicare advantages popular etc., etc.. it would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under medicare. said mr. nelson dealers with calls and complaints of constituents. i'm offering amendment to shield seniors from those benefit cuts.

i'm offering an amendment to shield all senior citizens and 11 million of them under medicare advantage as the senator from florida said to shield seniors from benefit cuts. that is what this amendment is all about. we shook off a car about him 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 my colleagues will understand that this is simply in the name of fairness this amendment is proposed and i would ask the senator from tennessee and from texas large numbers of enrollees in the medicare advantage program also and how this would be unfair as well. >> i thank the senator from arizona for his amendment and i thank the senator from florida

because medicare advantage is very important to tennessee. we have to under 43,000 tennessee ins who opted for medicare and vantage, about one-fourth of all americans who are on medicare have chosen medicare and vantage because it provides the option for increased health care, for vision care, hearing coverage comer reduced hospital deductibles and the benefits. it is 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 contrary to what our friends on the other side are saying this bill cuts those medicare advantage benefits and the director of the congressional budget office says that fully half the benefits on medicare advantage for these 11 million americans will be

cut. welcome our space friends stayed know that isn't true. we are going to cut a trillion dollars out of medicare over a fully implemented tenure of part of this bill but nobody's going to be affected by it. the senator from florida apparently doesn't believe that, and he says we have 900,000 floridians who don't want the medicare advantage cut, and we don't trust she 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 of florida and the senator from florida don't trust the democratic bill to protect medicare advantage why should 240,000 tennesseeans trust the democratic bill to protect medicare advantage? >> while i agree with the distinguished senator from tennessee and arizona that what is good enough for the seniors ought to be good enough for all seniors and in my state of texas we have a 532,000 seniors on

medicare advantage and they like it for the reasons the senator from tennessee mentioned and they don't want us cutting those benefits. but i would ask the senator from arizona and tennessee, i seem to recall we had amendments earlier it would have protected everybody from cuts in their medicare benefits, and now we have a targeted effort negotiated behind closed doors to protect states like florida and pennsylvania and others and i wonder whether this was an amendment to protect seniors in florida will even be necessary for colleagues across the aisle have agreed with us that no medicare benefits should be cut under the bill. >> as the senator from texas points out just a few days ago week, by 100 to nothing vote passed an amendment proposed by the senator from kill the battle, senator bennett who said protecting and improving guaranteed medicare benefits

nothing in the provision of or amendments made by this act shall result in reduction of guaranteed benefits under title 18 of the social security act. is there any number 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 a 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 received those benefits the are guaranteed benefits as well. and i would ask -- we have the two physicians here on the floor who both have the opportunity of dealing directly with the medicare advantage program. if you have a patient come in and sit by the way, we -- you are having your medicare advantage program cut but don't worry we are protecting the guaranteed medicare benefits you think they understand the

language? >> i would respond to the senator from arizona with the following first of all they won't understand that language but more importantly if you look at bill walters medicare a, b, c, d. they all kaw and what is guaranteed under the kaw today's if you want madrid and if you can have it. and what is going to change is we are going to take away the guarantee. we are going to modify medicare part c which is the care of vantage, as we have this confusing state to say we are not taking away guaranteed benefits but in fact under the current law nutter of advantage is guaranteed for anybody that wants to sign up for it, so it is to push as at best to say we are not cutting your benefits when in fact you are. let me just speak to my experience and then i will yield to my colleague, an orthopedic

surgeon from wyoming is what is good about eckert advantage? busheir that 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 the poor medicare folks. medicare advantage court meets the care and when you coordinate care, when you do is decrease the number of tests, prevent hospitalization, you get a better outcomes and consequently you have healthier seniors. so when it's looked at medicare and advantage really doesn't cost more it actually saves medicare money on an individual basis because if you forgo the interest of a hospital where you really start incurring costs when you have done is saved the medicare trust fund but have also given better care. the second point i would make many people on medicare

advantage cannot afford to buy medicare supplemental policy. 94% of people in this country on medicare who are not on medicare advantage or body of the supplemental policy. why is that? because the basic underlying benefit package of medicare is not adequate. so here we have a group of people who get benefited because they chose a guaranteed benefit of medicare part c and we say timeout, you don't get that anymore. >> [inaudible] -- people who enrolled in medicare advantage are low-income people and a love of them are for residents? >> a lot of rural, i don't know the income level but i know there's propensity that you ought to get savings because you don't have to buy a supplemental policy if you are on medicare advantage. >> i would add to that following with my colleague from oklahoma there is the quarter made care. that's one of the a vintage as the the tenet vintage. there's also the preventive

component id if we talk about ways to help people keep health care costs down it has to do with coordinating care and preventing illness. we just heard we want to put in a preventive packaging to the program, a freshman from the other side but yet we want to take a preventative package out of medicare advantage. interesting mix of amendments, isn't it? >> we want to keep seniors of the that's one way that they can stay out of the hospital, out of the nursing home, stay active. but yet this cuts medicare advantage and the democrats voted to do just that, but all the money out of the program that seniors like, 11 million american seniors who depend upon medicare for their health care choose this because there was advantage to them. a call from oklahoma, the other physician of the senate, talked as i have extensively about patient-centered health care, not a government center, medicare helps keep it

patient-centered to read when i see the deals cut behind closed doors they are cutting off people from all across the country and it seems there's a sweetheart deal now to help the seniors on medicare the vantage of florida to try to encourage one member of the senate to vote a certain way. but what about the seniors from the rest of the country? texas, oklahoma, tennessee and arizona, a lot of seniors who have great concern and i would hope that they would call up and say this is wrong. we need to know what is going on and why is it that there is a sweetheart deal just for once elected senator and one selected state when we want to have the same advantage and why are the democrats voting to eliminate to cut all of this medicare money? private-sector alternative or choice to medicare, which is a government-run program. and i'm deducting throughout all of this bill sort after 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 dollar propensity in this bill? mr. alexander: i would say 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 chosely, we find basically a big increase in government-run programs, and what does that 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 on the floor of the mentioned on the floor of the >> by many on the other side as an example of controlling

costs is beginning to say we cannot take patients from a government run programs. in some cases, because we are not reimbursed properly. what will happen in the, behind all of this heavy talk we're hearing with health care, we will find more and more low-income patients don't into a program called medicaid where half of the doctors won't see a new medicaid patients by giving is some when a bus ticket to a bus line that runs half the time and medicare will increasingly find itself in the same shape just as the mayo clinic and perhaps others will say we cannot afford to serve patients from a government round round -- run program. the senator from texas is right. we do not have to persuade 11 million americans that have chosen that medicare advantage.

they like it. more than 600,000 people signed up for its part of it like it. i think and away the senator from florida may have base 3r deal but in the way he has done as a favor because we have been trying to say all week that the democrats are cutting medicare. they are saying, trust us. we are not. the senator from florida said floridians do not trust to prepare you are cutting their medicare advantage and i want to have an amendment to protect them and mccain said let's protect all seniors medicare advantage. >> for the record again again, september 20, 2003 there is a letter to the conferees of medicare urging them to include a meaningful increase in medicare the vantage funding for fy 2004/2005 a group of 18 senators including senator

schumer, a luxembourg, mcclinton, why did make several including senator kerry who now obviously wants to reduce funding for medicare advantage. perhaps that was before he was against it. also like to point* out as a short of a time ago as 2009 a group of senators including murray, specter murray, specter, senator bennett, senator klobuchar and others wrote to mr. delaware act saying it minister for medicare and medicaid services "we right to express our concerns is regarding the services proposed changes to medicare advantage rates for calendar year 2010. the advanced notices raised two important issues

implemented that will result in a highly problematic increase in benefit reductions for medicare advantage enrollees across the country. i again, a short time ago, there was concern on the other side about cuts of medicare advantage program. >> is a senator where there's 181,000 people in an alabama that would get it cut and in arizona it is 1,606,000 people. seniors that will have benefits cut. colorado, 190,000 to have benefits cut. georgia :1 hundred 76,000. illinois:176,000. indiana when it 48 kentucky 151. massachusetts 200,000. michigan 406,000. that is what michigan reads right now. is annette? to have have seniors' benefit cutbacks minnesota 284.

missouri 200. 104,000 a bad. state of new york 853,000. ohio 499,000. pennsylvania and baby are maybe not because they may have got the deal 865,000. tennessee 2,223,000 according to members. washington state 225,000. wisconsin to the 43,000. i will ask unanimous consent for the enrollment of medicare advantage as of august 2009 into the record. >> the point* of all of this? the point* of this is that the senator from florida, member of the finance committee felt so strongly that advantage was a risky decided to carve out and get a majority on a party-line vote from 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 the senator from oklahoma -- oklahoma just made reference to the has that same protection for of that is all this amendment is about too. >> if you will yield for a question, if this amendment does not pass which protects all medicare advantage beneficiaries come all 11,532,000 in my state, and as a result of not only these cuts but additional cuts to come in the future which make it harder and harder for medicare beneficiaries to get coverage, i would ask your colleagues are particularly our doctors, what is the impact on eliminating medicare advantage and levying people with medicare fee-for-service which is the

amendment survey which is yet to parcel language? said dr. unguaranteed benefits but the senator from oklahoma makes a good point* right now medicare vantage aren't guaranteed benefits and we will cut those but what is the consequence of seniors losing medicare advantage can be forced only on a fee-for-service program? >> ltd. preventative trading no coordinated care. loss of access to certain drugs. accessory things i'd vision, hearing, supplementa ls but more importantly, it will be poor health outcomes. that is what it will be. or a much smaller check book. wonder the other. because now the government will not pay for it. you are. if the check book is limited you get the poorhouse outcome.

>> the senator from arizona started by talking about the closed-door meetings people hiding secretly trying to come up with things there is an article today that democrats are starting to throw more people on to medicare and medicaid as they try to come up with a compromise. the idea is it will be compromising the care of the people of america upper trying to put more people into medicaid as the senator from tennessee has said. many physicians do not take those patients because the reimbursement is so poor and it puts people into a boat that is already sinking. more people in medicaid and more on medicare but at the same time they're cutting medicare by $464 billion. it is a program we already know is going broke what they want to have people age 55 through 64 added that is

a program of great concern is. adding people of this is not sustainable use of the deals being cut haoles 100 feet from here when we're out here debating love for the things that we think are important for health care. jobs will be lost as a result if this bill gets passed. people who have insurance will pay more in premiums if this bill is passed and people who pay-- to tenet health care medicare advantage your regular health care will see health care do carry. return the senator from arizona who has been a special student of this. >> seniors, by losing medicare advantage, would then lose a certain provisions that medicare advantage provides them and

then there would be forthcoming if they can afford it which now they pay the $0 because it is medicare advantage in they would have to buy medigap policies because it would make up for those benefits they lost when they lost medicare advantage and guess who offers a those medigap insurance policies in? the friends at aarp that average $175 per month. we're telling people we're on medicare advantage today, when they lose it, they can be guaranteed if they want to make up the benefits, they will pay $175 per month memo for a medigap policy for a lot of american seniors cannot afford that. that is a fact. $2,000 per year they cannot afford it. >> i would make one other point*. over the next 10 years come a 15 million baby-boomers

will go into medicare. 15 million. we're taking 465 billion out of medicare did in a 10 year picture, 1 trillion so we will add 50 million and cut $1 trillion. what do think will happen to care for everybody in medicare? what will happen? the old cement is we will rationed care for seniors in this country. if this bill comes through. life expectancies will drop. >> 35 minutes remaining. >> five minutes remaining for use the mack dr. barrasso have you treated people under medicare advantage? >> i have people and wyoming know that there is an advantage to this program. that is why they sign up and citizens have signed up for

medicare advantage because they realize there is value in prevention and coordinated care. there is value in having the eye care, dental, hearing care, dental, hearing, there are a advantages to want to stay healthy to keep down the cost. >> even though it may cost more, the fact they you have a more well and fit group of senior citizens, dot dot in the long line at reduce health care costs because they take a vantage of the kind of car that overt -- kind of care that over time will keep them from going to the hospital earlier or see the doctor more often? five that is the reason it was brought forth for i know a lot of senators from the rural states supported because it allows people in small communities to have the advantage to be in a program like battered doctors to go into those

communities and the 11 million people who are on medicare advantage in this country know they are on medicare advantage. it is the fastest-growing component because people realize the advantages of being on medicare advantage. they want to stay independent and healthy and fit they sign up for medicare advantage of would think all of the people listening to this debate who are seniors would want to say why didn't i know about this program? senior sen years when the east at senior centers talk about this i hear their concerns. they convert and enjoy signing up for medicare advantage rica is they know there are advantages. democrats say i want to slosh over $100 billion. people of america understand this is that a great loss to them and a peril to their own health as a loose the

coordinated care. >> alaska 10 1/3 -- senator from tennessee do not an expert that believes you can make these kinds of cuts in medicare vantage and still preserve the same benefits the enrollees have today? >> the answer to the senator is no. i do not know of one but i do know one senator who does not believe it. that is the senator from florida. it is interesting that all week we have been going back and forth and said to the democrats you are cutting medicare benefits and they said no. yes you are. near you are not. people of holmes a who is right? the senator from florida sits over there and says i'm not willing to go back to florida to say to the people that your benefits will not be cut so i want an amendment to protect you. says the senator from texas and oklahoma and louisiana and wyoming and tennessee

and senator from arizona is saying we believe you are cutting medicare advantage benefits teeeleven million americans and we don't trust your bill, we don't do there we want an amendment that for tax 11 million seniors. >> would ask your senators with a brief time that we have come it seems like all of the discussion of health care reform his about accountable care organizations coordinating care the latter part of life but when i was that the clinic in houston texas they told me medicare advantage allows them to be able to coordinate care and hold down costs and keep people healthier longer. the irony to me it seems by cutting medicare advantage benefits as we go backward rather than forward when it comes to that coordinated, less expensive

care. would you concur? vivica would concurred takes a step backward that is why the senator from florida demands they make accommodations for florida. wyoming was the same accommodations as texas because 118 million americans have chosen the medicare advantage program to help coordinate care, preventive care, keep it patient centered as opposed to government centered and insurance companies centered. they can keep their independence and live longer lives. we have seen cuts across the board with home health, hospice, medicare advantage they are cutting in a way that certainly the seniors of this country do not deserve. they paid into the program many years. >> one other thing we have talked about from our good friend from florida who has spent so perspective -- perceptive to

notice they may lose medicare benefits, i hope he is as a perceptive. >> your time is expired. >> what ask the senator i believe there are other benefits likely to be cut it will cut hospice, hospital hospice, hospital, and cuts to home health care that we talked about yesterday. if of floridians don't trust the democratic bill to protect benefits from medicare vantage why should they trust the democratic bill to protect any benefits? >> medicare part c which is medicare vantage is part of the law and to treat it in any way as different because those on the other said i do not like it come i think that is the abrogation of the responsibilities we have to our seniors in the country. high-yield the floor. >> senator mccain's motion was defeated. of the measure would have

expanded benefits for the enrollees the vote was 42/57. of the senate is back tomorrow morning for more work on health care legislation for gulf war intimation visit c-span.org/health care.

>> lays in and gentlemen to introduce the president of united states plays will come brookings institute president strobe talbott. [applause]

>> huckabee have been forming i do not get that very often. [laughter] 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 year, he has honored brookings by bringing many colleagues on to his team. at the white house, state department, treasury, defens e, energy, commerce, and the key embassies around the world. we do not regard those departures as a loss. we regard them as a donation to the public good. government service is a longstanding brookings tradition perk up 35 years ago the founding director of the cbo was a brookings scholar and still is.

alice rivlin right there. in greenberg of the current director also came from brookings. so did his immediate predecessor peter orszag who is here with us as director of the omb pricing goal them now because of their contributions as dollars and public servants are pertinent to what the president will be speaking about shortly. but i could just as easily cite their experts who have worked here and in the government to education and health care, infrastructure, innova tion, a smart growth, our power, a climate change, non-proliferation, a piece. those subjects of course, are all on the president's agenda. today and every day. but no matter what else he

is dealing with, he is always thinking about the troubles that the sapped the american economy and what it will take to fix them. for us, that is what he might call the all hands on deck challenge. the week before last thomas dollars from four of the research programs joined the business committee for a two day brainstorming session benefited from the participation of the former colleague larry summers as well as caramels gum and valerie jarrett who were also with us this morning. of those resonated from the ones that followed up the white house jobs summit and the president's recent visit to hard-hit communities in pennsylvania. he has been out there listening to americans who were suffering from unemployment and we have been listening to him as he

grapples with the remedies. we thank him for coming to brookings today with his message, with his respect respect, for good ideas as a basis for good policies with high standards, ability, public discourse and of course, with his leadership. ladies and gentlemen,, it is my pleasure to introduce the president of the united states. [applause] >> thank you. thank you so much. have a seat. they do so much. for your extraordinary leadership hear a brookings and thanks to all of you in attendance. almost exactly one year ago come on a frigid winters day i met with my new economic team at the headquarters of

my presidential transition office in chicago. over the course of four hours my advisers presented an analysis of where the economy stood accompanied by a chilling set of charts and graphs predicting where we might end up. it was an unforgettable series of presentations. christi rummer who is here today, was the council of economic advisers, as well as their summers described the imminent downturn compared wall and a severity too almost nothing from the 1930's. tim geithner my incoming treasury secretary reported the financial system shaken by the subprime crisis had halted almost all lending which in turn threatened to the broader economy the downward spiral. peter orszag closed out the

proceedings with a dismal report on the health of the country. of there growing deficits. having concluded there was too late for me to request a recount. [laughter] i passed my team with mapping out a plan to tackle the crisis on all fronts. it wasn't long after that meeting, as reshape to this economic plan, that we began to see some of these forecasts materialize. over the previous year, it was obvious that will serve facing hard times. as i travelled across the country during the campaign, i would be men and women bearing the brunt of not only a deepening recessions but years even decades of growing strains on the middle class. but now the country was experiencing something worse. our gdp this sum total of all that our economy produces fell at the fastest rate in a quarter-century.

$5 trillion of american's household wealth evaporated in just 12 weeks has 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 was that we were rapidly plummeting toward a second great depression. in the weeks and months that followed undertook a series of difficult steps to prevent that outcome. we were forced to take those steps largely without the help of an opposition party which, unfortunately come after having presided over the decision-making that have led to the crisis decided to hand over to others to solve. to do get lending flowing again so businesses could get loans to buy equipment

and ordinary americans could get financing for homes, cars, college, a start businesses. we enacted measures to stem the tide of foreclosures in our housing market helping responsible homeowner stay in their homes and helping to stop the broader decline in home values. to prevent economic collapse we were forced to extend the assistance and to some very banks and financial institutions whose actions have helped to precipitate that turmoil. we also took steps to prevent the rapid dissolution of the american auto industry to prevent the loss of hundreds of thousands of jobs during an already fragile time. these were not decisions that were popular or satisfying, these were decisions that were necessary. even as we were to address the crisis in our banking sector and housing market

and auto industry, we also began attacking our economic crisis on a broader front. less than one month after taking office re-enacted the most sweet kate -- sweeping economic recovery package in history the american recovery and reinvestment act. 1/3 with four small businesses and 95% of working families. another third was emergency relief to help folks who have borne the brunt of this recession in. we extended war and increased unemployment benefits for more than 17 million americans. made health insurance for families on cobra ad for state and local governments facing historic budget shortfalls we provided assistance that has saved the jobs of hundreds of thousands of teachers and public-school workers and firefighters and police officers.

alas third is for investments to put americans to work for the work that needs done. doubling our capacity in renewable energy, wind and solar, computerizing medical records, providing the barges boost to medical research in history, renovating classrooms and school laboratories, upgrading roads and railways as part of 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 spur growth we have not let up in our efforts to take every responsible action to get the economy growing and america working. i signed into law more than 30 billion in tax cuts for struggling businesses and extended the effective tax credit for home buyers and provided additional unemployment insurance for 1 million americans and the

treasury is continuing to adapt our financial stability plan. helping to facilitate the flow was small credit small businesses and families and in addition were working to break down barriers and open overseas markets so we can compete globally and create jobs to export products around the world. partly as a result of the steps we're in a very different place today than one year ago. we may forget, but in a very different place. we can safely say we're no longer facing the potential collapse of our financial system and we've avoided the depression many feared. our economy is growing for the first time in a year and the swing from contraction to expansion and is the largest in nearly three decades. we're no longer seeing severe deterioration in the market that we wants were. we learned on friday the

unemployment rate fell slightly last month. this is welcome news. made possible in part by a 1.6 million jobs at the recovery act has already created and saved according to the cbo program here today because our work is far from done. even though we've reduced the day louche of job losses to a relative trickle, we're not yet 318 jobs at a pace to help all those families who've been swept up in the flood. there are more than 7 million fewer americans with jobs today than when this recession began. that is a staggering figure and one that reflects not only the depths of the hole from which we must descend but a continuing human tragedy. i was in allentown pennsylvania this past weekend and went to a job center where people were and

job search and it ran the spectrum. blacks, whites, hispanics, y oung people gorgeous starting in their careers, individuals 50 or 60 looking for a job. they were putting a brave face on it and confident 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's hard to break out of the bubble here in washington and reminders sells the behind the statistics are people's lives and their capacity to do write by their families. it speaks to an urgent need to a accelerate job growth will and the short-term while laying a new foundation for lasting economic growth. economic team has been considering a full range of

additional ideas to help accelerate the pace of private sector hiring. we held a job as format the white house that brought together small-business owners, ceos, union members, economist banished officials to talk about job creation. i have asked people in their own communities to send their results to be severe hearing as many places as possible. we have heard of many good ideas. i want to outline the broader steps that 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 a kitchen tables in family meetings and when an entrepreneur takes a chance and when a worker decides this time she became her own boss. these are also companies that drive innovation producing 13 times more patents per employee than large companies. every wants in a while the small business becomes a big business and changes the world. that is why a disown ford we help small businesses struggling to stay open or struggling to open in the first place. building of the tax cuts in the recovery act we are proposing a animation 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. i believe it is worthwhile to create a tax incentive to

encourage small businesses to add and keep employees and i'm going to work with congress to pass one. these steps will help but we also have to address the continuing struggle of small businesses to get loans that they need to start and grow. we're proposing to waive fees and increase the guarantees for the sba backed loans and i masking by treasury secretary to continue to mobilizing the remaining t.a.r.p funds to facilitate lending to small businesses. second come a were proposing a boost in investment of the nation's infrastructure beyond what was included in the recovery act. to continue modernizing our chance petitioning communications networks. these are needed public-works batting cage private-sector companies during hiring all over the country. within 10,000 projects have been funded and by design, recovery act work on

roads, bridges, water systems come a superfund sites, broadband networks and the energy projects will all be ramping up in the months ahead. it was planned in this way for two reasons. 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 at a fast pace was enormous purpose of ast vice president biden and others to make sure to humanly possible extent that investments were sound, projects were the. this means we will see even more work can workers on recovery projects in the next six months then we saw in the last six months. even so, there are many more were the projects and 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 year's beyond that. so adding to this initiative to rebuild america's infrastructure is the right thing to do. third, i called on congress to consider a new program to provide incentives for consumers to 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. i am proposing that we expand the recovery act initiatives to promote energy efficiency and clean energy jobs which happen proven to be popular and effective. it is a positive sign that many of these programs do so many applicants for finding that they will leverage private capital and create jobs quickly, did not make

the cut. with additional resources in areas like advanced manufacturing of wind turbines and solar panels come mugabe can help turn good ideas into good private-sector jobs. finally as we move forward in these areas we should extend the relief and recovery act including emergency assistance to seniors, unemployment benefits, cobra and relief to prevent layoffs. this will hopefuls weathering the storm as well boosting consumer spending and promoting job growth. of course, there's only so much government can do. job creation will ultimately depend on their real job creators businesses across america up. we were encouraged today to hear from the business roundtable but the survey showed greater confidence and greater potential investment coming out of the business community. government can help plan the groundwork on which the

private sector can better generate jobs, a growth come and innovation. after all small business tax relief is not a substitute for ingenuity and industriousness by our entrepreneurs but it can help those with good ideas to grow and expand. in it and disincentives to promote energy efficiency do not automatically create jobs but these steps provide a framework to compete and innovate and reduce energy consumption. and while modernizing the physical and virtual networks that connect us will create jobs but they will make it possible for companies too easily and effectively move their products across this country and around the world that will create more jobs. given the challenges of decelerating the pace of hiring in the private sector, the target of an it -- targeted initiatives are right and indeed in. but with a fiscal crisis to match or economic crisis we

must be prudent about how we find it. to help support the efforts we are going to wind down the entire program to find-- the fund created to stabilize the financial system so banks would lend again per car to have to tell if there has rarely been a less loved or a more necessary emergency program than t.a.r.p. which has galling as the assistance of banks may have been coming indisputably helped prevent a collapse of the entire financial system. launched hastily, understandably but hastily and alaska administration, the t.a.r.p. program was flawed and we have worked hard to correct those flaws. today it has serve the original purpose and at a much lower cost than we expected. because of our storage of this program and the transparency and accountability we put in

place, t.a.r.p is expected to cost the taxpayers $200 billion less than what was anticipated just this past summer. and the assistance to base once thought to cost untold billions is on track to 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 shift funds it would have gone to help the banks on wall street to help create jobs on main street. small business is coming infrastructure, clean energy come in these areas in which we can put americans to work well putting our nation on a sturdier economic footing. that foundation for sustained economic growth 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 go back to an economy that yielded cycle after cycle of speculative booms and busts but we can continue to accept an education system in which our students trail their peers in other countries and the health care system which exploding cost of our business is at a disadvantage. we cannot continue to one-- to ignore the clean energy challenge for global leadership in the emerging industries of the 21st century. that's why even as we strive to meet the crisis of this moment, we have insisted all laying a new foundation for the future. because an educated work force is essential to its

21st century global economy we've launched a competitive race to the top fund to reform schools and raise achievement especially in math and science. we've made college more affordable and proposed a historic set of reforms and investments and set a goal of once again leading the world and producing college graduates by the year of 20/20 because even the best trained worker in the world can't compete with our businesses are saddled with rapidly increasing health care cost we're fighting to do what we have discussed in this country for generations fine and 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 come on his dealings and long-term growth, we've proposed the most ambitious financial reforms since the great

depression. will set and enforce clear rules of the road, close loopholes and oversight and turgid an agency with protecting consumers, address the dangerous systemic risks that brought us to the brink of disaster. these reforms are moving through congress and we're working to keep them strong and looking forward to signing them into law. because our future and working to create the incentives to build a new clean energy economy. we know the nation that leads and clean energy will be the nation that leads the world for i want america to be the nation. i want america's prosperity to be powered by what we invent and pioneer not just what we borrow and consume. i know we can and will be that nation of weird willing to do what it takes to get there.

there are those that claim we have to choose between paying down our deficits and investing in job creation on the other. this is a false choice. ensuring that economic growth and job creation are strong and sustained is critical but it seemed that spending things on unemployment insurance our deficits will start coming down. the same time instilling confidence in our commitment to be fiscally prudent gives the private sector confidence to make long-term investments in our people and in america. one of the central goals of the administration is restoring fiscal responsibility. even as we had to spend our way out of the recession in the near term we've begun to make hard choices necessary to get our country on a more stable fiscal footing in the

long run. let me be clear. despite what some have claimed, the cost of there recovery act is only a very small part of the 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 coming in. falls pass tax cuts in entitlement programs without paying for any of it even as health care costs calibrating -- rising year after year progress result the deficit reached one point* $3 trillion when we walked into the white house. these budget busting tax cuts and spending programs were proved tremendously people who are now waxing political fix goal -- fiscal responsibility well pose a reference to reduce deficits by getting health care costs under control. it is a sight to see. the fact is we have refused

to go along with business as usual and taking responsibility for every dollar we spend. says we have done what some said was impossible to prevent wasteful spending and outdated weapons systems that the pentagon said it did not want. we've combed the budget cutting waste and access wherever we could prime committed to having the deficit we inherited by the end of my first term and cutting in half. i eighth made it clear from day one i would not sign a health insurance reform bill to raise the deficit by one time and neither bill does. we've begun natalee chain in policies in washington, avoid also began to change the culture. in the end the economic crisis of the past year is not the result of weaknesses of the economy but also of our political system because for decades to many in

washington put off the hard decisions. for decades efforts to solve the problems had fallen prey to the bitterness of partisanship and politics the ever quickening new cycles and of nablus campaigns focused on scoring points instead of me team challenges. we have seen the consequences of this failure of responsibility. the american people paid a heavy price. the question we have to answer is will we learn from our past? even in the aftermath of disaster we will repeat those same mistakes. as the alarm bells fade the din of washington rises, forces of the status quo marshal resources, we can be sure answering this question will be a fight to the finnish markka i have every hope and expectation

rican rise and transcend the failures and once again take responsibility for our future. every night i read letters in the mail sent to me from people across america. ordinary folks. people who share hopes and hard chips and the faith in this country and frustrations of what has happened in this economy. they are from small business owners worried about making payroll and mothers and fathers, sons and daughters to have seen one or two or more from remembers out of work. it's the toughest letters are in the children's handwriting that right to me. my dad just lost his job my grandmother is sick and cannot afford health insurance. kids who cannot just be kids because they're worried

about moms year and have eight hours cut or dad's losing jobs or family without health insurance, these folks are not looking for a handout or a bailout. just like those people. and allentown pennsylvania. they're looking for a chance to make their own way to work, to succeed using their talents and skills. they're looking for folks in washington to have a seriousness of purpose that matches the reality of their struggle broke everywhere i've gone, every stop, there are people like this. men and women who have faced misfortune of the stand ready to build a better future. students ready to learn, workers eager to work, a scientist on discovery come on to

procures seeking the chance to open a small business. are everywhere i go there are shuddered factories just waiting to were back to life in burgeoning industry's. there is a nation ready to meet the challenges of this new age and to lead the world in this new century. as a look back on the progress of the past year, and look forward to the work ahead, i have every confidence that we will do 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 a more. thank you very much. [applause]

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>> i apologize for the delay but with this committee coming up we are a little busy. we will convene this hearing today. we have had a series of conversations obviously on an ongoing basis with a variety of people.

we have a great frustration at the failure of the combined efforts of the federal government to make a substantial impact on the foreclosure issue. programs have been put forward but no one can think we have done a satisfactory job. part of it this mistakes of the past and one of the things we're determined to do going forward, it is to change so that some of the problems that we have now will not continue. namely, we will not have a continuation where there are mortgages that we believe in the public interest to

modify and no one has the authority to modify or if they do, he or she will dodge the responsibility by revoking some share responsibility that cannot be allowed to continue. we will straighten that out going forward. but we're in a current situation and many of us feel the bankruptcy from press their residence is ultimately going to be necessary to have substantial improvement and those who disagree, i think a particular burden in my mind to show it is possible to show foreclosures with all of the negative consequences through society without it. do want to stress what we talk about mortgage foreclosure, we're not talking about compassion in this circumstance, some were misled and others were irresponsible part of the

problem is even if people want to say they made their bed and let them live with it has reverberating consequences for the whole society. foreclosures create a circle of harm to the individual family to the neighborhood and municipalities and the whole economy because of the widespread disparity of mortgage-backed securities. slimming down the rate of foreclosures is important. this week we will be including a provision that will deal with a new class of foreclosure, those who took out mortgages who are unemployed and do not want to make an issue if it is your sole source of and come. there is another program from philadelphia that will lend money to those

unemployed and face the loss of their homes for the duration of their unemployment or some other point*. but we still have a problem of the mortgages that need to be disentangle. the we're doing with that the housing subcommittee has 10 minutes on each side is been i thank you for holding this hearing this morning. i share his frustration we're both well aware of the very issue of tracking progress with the head ministrations program.