every day, canadians cross over to minnesota to work and make purchases and fish and do all kinds of things. likewise, minnesotans cross over to canada every day to work and make purchases and fish. it's no big deal. we're not afraid of canadians. and minnesotans know that canadians pay less, much less for many of their prescription drugs. beginning in the 1990's, the minnesota senior federation started organizing bus trips for seniors to go up and cross the border into canada so they could get affordable prices for the drugs that they depended on. the senior federation also introduced a prescription drug importation program using its buying power to negotiate directly with canadian mail order pharmacies to provider lower cost prescription drugs to minnesota's seniors. but drug prices in the u.s. just continue to go higher and higher and higher so the pressure to find some relief kept growing. finally, some state governments decided to take their own initiative to help their residents purchase lower cost

drugs from canada. minnesota was one of the very first. there was broad bipartisan support for this with the republican governor and democrats and republicans in the legislature. in february, 2004, the state of minnesota established r.x. connect, the first state-run website to provide citizens with information on how to safely purchase drugs from canada. the website lists the prices for hundreds of brand name and generic medications as well as phone mail and email contact information. the american pharmaceutical industry, mr. president, likes to use scare tactics to keep people from buying their medications in canada. well, look at what's happening. you don't see a lot of problems in canada with their drugs. the dorgan-snowe amendment takes on renewed importance and urgency because the american pharmaceutical industry has been imposing some very suspicious price increases this year. last month "the new york times" reported that drug makers have been busy raising prices for the most common prescribed medicines

in anticipation of possible health care reform. the newspaper quoted industry analysts as saying that in 12 months ending in september 30, drug makers have raised the wholesale prices of brand-name prescription drugs by about 9%. overall, that means an additional $10 billion in health care spending. the increase is the largest one since 1992 and it happened even as the consumer price increase declined during this same 12-month period. some analysts that these prices are being inflated artificially in expectations of new reforms that could otherwise reduce prescription drug prices. a similar trend was observed just before medicare part-d took effect. just last week, an economist at the university of minnesota said "curiously, prescription drug prices appear to rise more rapidly in periods just prior to major policy changes. brand-name and specialty drug prices accelerated before the medicare part-d program was enacted and implemented." that's what we're talking about

here. this amendment would allow u.s. licensed pharmacies and drug wholesalers to import f.d.a.-approved medications from canada, europe, australia, new zealand and japan and then pass on savings to consumers. real health care reform requires real changes from business as usual, and this amendment would start to bring some real changes. opening up new choices to american consumers and injecting new competition into the pharmaceutical marketplace. thank you, mr. president. and i yield the floor. a senator: mr. president? the presiding officer: the senator from south carolina is recognized. i'm sorry, louisiana. okay, senator vitter, i'm sorry. mr. vitter: thank you, mr. president. [inaudible] mr. president, i rise also in strong support of the dorgan reimportation amendment of which i'm a coauthor, and i'm glad to support this important amendment and it's a bipartisan effort. unfortunately most of this

debate and most of this effort about the underlying bill is anything but bipartisan. this is a welcome contrast to that, a bipartisan effort around a very important reform propos proposal: reimportation of prescription drugs. now, mr. president, we face an interesting situation. the united states is by far the biggest market for prescription drugs in the world and yet with all that buying power and all that activity, we pay by far the highest prices in the world. and it's for a simple reason: we don't have a true worldwide free market in prescription drugs and we need to do that in part through reimportation. americans need lower prices, they need the sort of prices being offered elsewhere, and we need to break down this system by which the big drug companies can and do offer the same drugs

at very different prices in different countries, and, of course, offer them at the highest prices in the world in the united states. americans shouldn't have to choose between their lifesaving medicines and other basic needs like food and utility bills. by voting for the dorgan amendment and enacting comprehensive reimportation, we can directly address access to health care and truly lower health care costs which i believe should be our top goal in this entire debate. that's what this amendment does. it gives americans immediate relief from outrageously high prescription drug prices. our amendment allows individuals the freedom to buy their prescription drugs at affordable prices while providing oversight to assure that only f.d.a.-aexpreufd safe drug-apprs

are permitted. our amendment would close loopholes that big pharma has been using to fight reimportation, such as shutting down drugs to wholesalers who participate in reimportation. our amendment would close the poison pill loophole requiring h.h.s. certification which has left it up to administrations to deny reimportation by making that comprehensive reimportation discretionary. we shut down that poison pill loophole. we would make it mandatory that americans have affordable choices for prescription drugs. now, mr. president, many of us, democrats, republicans, certainly including and starting with senators dorgan and snowe, have long fought for this comprehensive solution. we've made important steps forward. the senate has adopted amendments to allow personal

reimportation. just last year we voted overwhelmingly, 73-23, that we need to enact this sort of comprehensive reimportation reform and we've taken concrete steps like those personal reimportation provisions, such which i have authored and passed through the senate. but we need to go further and we need this comprehensive approach. obviously, mr. president, the big stumbling block in the way is the powerful pharmaceutical lobby, big pharma. they've spent millions in lobbying to stop this comprehensive approach. just this past summer, senator mccain read an e-mail here on the senate floor from a big pharma lobbyist outlining their strategy to derail those efforts in the senate. more recently, there are reports that they may have struck a deal with the white house to derail these sorts of efforts and offered to spend tens of

millions in support of so-called health care reform, perhaps with a deal to derail these efforts. that's why i'm so glad democrats and republicans are coming together around this amendment to say enough is enough. we need to fight all of these backroom deals. we need to fight this pervasive influence by pharma and finally stand with average americans and pass real, comprehensive reimportation reform that will bring down prices, bring down health care costs, which should be all of our top, top priority. we all say that we want to lower health care costs. that's been a big issue in this overall debate. well, this amendment will absolutely do that. congressional budget office says that. independent analysis says that. so let's take an important step and do what we all say should be

a top priority, actually lowering in real terms health care costs. again, mr. president, i urge all of my colleagues, democrats, republicans, to come together in a bipartisan way. i wish more of this debate, more of this effort was designed from the beginning to be truly bipartisan. but this amendment and this effort is. this amendment and this effort has been for years. let's finally get it done with a bipartisan healthy vote to pass comprehensive reimportation. with that, mr. president, i yield the floor and suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

the presiding officer: the senator from montana is

recognized. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i ask -- i ask further proceedings under the quorum call be dispensed with. the presiding officer: without objection, it's so ordered. mr. baucus: mr. president, i ask unanimous consent that we extend the period for debate only until 2:00 p.m. with the time equally divided with senators permitted to speak up to ten minutes each with no amendments in order during this time. the presiding officer: without objection, it is so ordered. mr. ensign: mr. president? mr. baucus: mr. president? the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, the senator from texas and others talked about premiums so i'd

like to discuss the effect on premiums of health care reform. affordability is at the crux of this debate. in fact, reducing costs and making health care premiums more affordable and predictable while improving quality is the impetus for this bill. and i must underline this point, this bill cuts costs and improves quality. two analysis have now been released that show americans will pay less and have more choices under this bill. the first is by the congressional budget office. it found that the legislation will lower premiums for millions of americans. according to the congressional budget office -- there are a lot of claims around here to the contrary but they're just claims. it's not documented. the documentation is the congressional budget office. according to the c.b.o., in the individual market, health insurance premiums under the senate plan would fall by 14% to 20% compared to the same plan

under current law. if you compare apples with apples, premiums under senate plan will fall in the individual market by 14% to 20%. these savings come from lower administrative costs, from increased competition and better pooling of risk to include healthier people. so, again, in the individual market, premiums will fall 14% to 20%, you know, comparing apples to apples. let me be clear, the c.b.o. does say that those buying health care in the individual market will pay 14% to 20% less under this bill than they would for the same plan under current law. i've said that three times now. if you currently have coverage that you like, you can keep it. and you will pay 14% to 20% less for that coverage than you would pay under current law. if, on the other hand, people in the individual market are unhappy with their coverage, what can they do? they can choose to purchase the

more comprehensive coverage available in the exchange. you can keep what you have, but if you don't like it, you can choose to buy something else in the exchange. but unlike most of the coverage available in the individual market today, the coverage in the exchange will ensure access to preventive benefits. this is a very important point, mr. president. unlike most of the insurance that's available today in the individual market -- that is, people who are buying just for themselves -- the quality of the insurance that they will get because of very dramatic insurance market reforms will be much greater than they have to date. qualities much better than they have today. what are some of those quality improvements? well, first of all, the bill will ensure that insurance companies cannot deny coverage based on preexisting condition. moreover, people with will access to -- pleem have access to preventive -- people will have access to preventive benefits.

the bill we're debating today will guarantee every policy has an out-of-pocket limb. that's want true today. this legislation is going to place a limit on out-of-pocket costs. the insurance companies have to provide the insurance so they can't thriment and say you can can't -- limit it and say you can't -- they cannot provide a policy that says we'll only play so much. the legislation will eliminate discrimination by insurance companies against those who have been sick in the past or have a preexisting condition. that is, they cannot deny coverage based on health status. can't deny that anymore. the health legislation will keep companies from rescinding policies if you get sick. how many times have you heard that. insurance companies rescinding your policy when you get sick because they find something that has nothing to do with your illness that you didn't perhaps report, a preexisting condition someplace else. for small businesses the congressional budget office estimates that premiums in the

small group market could be 2% lower than under current law and for workers in small firms eligible for the tax credits, premiums would be 1% to 11% lower than under current law. those savings alone make this legislation worthwhile for small business. there are enormous benefit for small business under this bill is predictable premiums. under current law if you're a small employer and one of your employees gets sick, your premiums get double, tripled in the next year. i've experienced that many times, mr. president. i'm sure most senators have. they talked to small businessmen at home and that businessman says, my gosh, my insurance policies have doubled, tripled, quadrupled over the past year. why? one of my employees as a preexisting condition and i'm placed in a terrible dilemma. as it key employee. i can't fire that person to get a lower premium, but i can't pay

the increased premiums if i do. one contractor i talked to in my home state of montana about this, he felt so bad he couldn't let somebody go, one of his best employees, he kept that employee and shopped around and shopped around and found a carrier that didn't increase his premiums because this employee that had a preexisting condition but not as much as the previous carrier, it was a 20% increase. that happens today and it is wrong. wrong, wrong, wrong. if you're a small business person under this bill, you're going to find your premiums are going to be much more stable and they're going to be much greater pool of people into it so your premiums actually, as i said earlier, and the c.b.o. said, will be less. not by a lot, a little bit less. but stable, not worrying about the insurance company coming to you next year and saying, we're going to charge you more. under this legislation, the insurance companies can't

discriminate against small employers when an employee gets sick. i hear from small businesses say they like to provide health insurance to employees, bus too expensive and the cost is unpredictable. they want to. they just can't afford it. this legislation helps solve that problem. this bill creates an environment that i lows small businesses to provide health coverage to their workers. little reduction in premium, and much more predictability and higher quality insurance all at the same time. in the large group market, that is, companies with more than 50 employees, what does c.b.o. say about that? what about their premiums? i've heard before all of these allegations that people in -- employees that work for larger companies are going to find their premiums increase. that's the assertion. that is flatly not true. at least not true according to the congressional budget office. the budget -- the congressional budget office estimates that premiums could be up to 3% lower

than in current law. that's not a big reduction. it's a reduction nonetheless. the c.b.o. said that premiums for employees will find that their premiums will go down by a little bit. the assertion is that the premiums will go up. the assertion that s- that they will go -- is that they will go down. not by a huge amount, but they will go down. that 3% could be the difference an employer needs to -- that difference to make a difference whether an employer decides to keep employees or not. 3% reduction in premiums will help that employer keep that employee working for him. according to the congressional budget office, five out of six americans get their coverage through employers of this size, fieft out of six americans work for larger companies. this means that 83% of americans will see no change or perhaps a slight decrease in the premiums. that's the congressional budget

office, that's what they say. black and white print. it's right there. the remaining individuals, that is, 17% purchase their coverage on their own in the individual market. of those many will choose to retain the coverage they have and they'll see a reduction of 14% to 20% in their premiums of those who choose to purchase more comprehensive coverage in the individual market, the vast majority, nearly 60%, will see a reduction in premiums, and guess what, mr. president, that's a big reduction in premiums. they will see a decrease of 56% to 59% due to the tax credits provided in this bill. let me restate that point. for majority of those who choose to buy insurance in the exchange in the individual market, the majority will see a reduction in premiums according to the congressional budget office a whopping reduction of between 56% and 59% due to the tax credit provided in this bill. that's pretty important.

the remaining few -- the remaining few individuals may see an increase of up to 13%. but those who experience an increase in premiums, let's remember, will do so because they have much better insurance. and the quality of -- the increased quality of insurance they're going to get, in my judgment, is going to outweigh the -- the increase of premiums that they have to pay. because they're going to -- a lot more for the buck. a lot better insurance than they otherwise would get today. if you buy a new car, rather than a used car, as most people think they may pay a little more for a new car because it's newer and better, you might pay a little more, but you're going to get better insurance. the congressional budget office, therefore, is good news for health care reform. the analysis does not take into account some of the senate bill's other policies like catastrophic option available to young adults. some young adults, otherwise

known as young invincibles, think, i'm not going to get sick, so i'll get a catastrophic plan. i'll get low premiums, that's available in this legislation. the congressional budget office also does not incorporate the potential affect of this proposal on the level growth rate of spending. for example, c.b.o.'s analysis does not capture the effect of the excise tax onigcost plans that will also help -- mr. president, i have more to say. but too much more than a traditional minute. so i'll continue at a later time. mr. ensign: mr. president? the presiding officer: the senator from nevada is recognized. mr. ensign: mr. president, i want to rise to speak about the senator from idaho, senator crapo's motion to recommit the bill to the committee on finance.

in order that this bill doesn't increase taxes for individuals with incomes of less tha than $200,000 or families with incomes less than $250,000. well, let's start by looking at three basic promises that president obama campaigned on to get elected. promises that almost no one on the other side of the aisle talks about anymore. here's those promises. these are his quotes. he says, "let me be perfectly clear. if your family earns less tha than $250,000 a year, you will not see your taxes increased a single dime." promise number 2, "nothing in this plan will require you or your employer to change the coverage or the doctor that you have." let me repeat this, "nothing in

our plan requires to you change what you have." his third promise, quoting, "under the plan, if you like your current health insurance, nothing changes except your costs will go down by as much as $2,500 per year." i think these are three promises that should be the test when we are judging this health care bill. and i certainly agree with president obama on all three of these points. the nonpartisan joint committee on taxation has recently confirmed that this bill in no uncertain terms is a middle-class tax nightmare. even after you account for taxpayers who receive the tax credit, 24% of tax filers who make under -- so that's a quarter of all tax filers who make under $200,000, will, on average, see their taxes go up. and only 8% of all taxpayers

receive the premium tax credit, which, by the way, is a new entitlement program, not a tax cut as democrats claim. this news should not be a surprise to anyone. we've known for a long time that the largest tax in the bill, the so-called cadillac insurance plan, tax falls heavily on the middle class. 84% -- let me repeat this. 84% of the people who pay the tax have incomes of less tha than $200,000 per year. so what's wrong with this bill? this bill contains nine -- that's right nine -- new taxes that will affect every american. and i want to walk you through those brand-new taxes now. first we have the 40% insurance plan tax. this is the biggest tax and it's

designed to make insurance companies and employers drop their premium insurance plans and leave people to buy cheaper plans. as a result, this tax violates promise number and number three that president obama had made that i showed in my first chart. it also violates the first promise because 84% of the people paying this tax are in the middle class, according to the nonpartisan joint committee on taxation. the insurance tax, tax number two here, is another tax that will raise the costs of everyone's insurance plans. according to the analysis from the nonpartisan congressional budget office, which i want to quote now, they say that these taxes would increase costs for effective firms which would be passed on to the purchasers --

in other words the employees -- and would ultimately raise insurance premiums by a corresponding amount. in addition to violating the first promise not to raise taxes on middle-class americans, it also raises premiums and violates the third promise. this is not a good start for the american people. tax number three, employer tax. for businesses that are struggling to stay afloat and to not layoff employees, especially during these tough economic times, this tax will make it much harder and may result in further layoffs in our weakened economy. i thought our goal around here was to create jobs and to strengthen our economy. the drug tax, this is tax number four, this tax will increase pharmaceutical prices. in fact, my colleagues should not be surprised that drug companies are already increasing

their prices ahead of this bill. because they know that they're going to be taxed. tax number five, the lab tax. if you need clinical laboratory tests, then here's another way that government is going to pick your pocket. tax number six, the medical device tax. if you need surgery, there's a new tax on medical devices, things like pace makers, and other lifesaving devices. tax number seven, failure to buy insurance tax. if you do not buy insurance, as this bill mandates, then you must pay a penalty tax. don't be fooled by the new bill as it changes the name from tax to penalty. if you -- if you -- it's still money out of your pocket. and, by the way, 75% of that is

on people who make less tha than $200,000 a year. once again, violating president obama's first promise. i also want to note that unlike the protection we included in the committee's bill to waive interest in criminal and civil penalties on people who do not pay this tax, the current bill on the floor only stops criminal penalties and certain enforcement mechanisms. this bill still allows the i.r.s. to go after people who don't buy insurance. what's the maximum penalty allowed? for a civil penalty in this bill, $25,000. for not paying this tax. that's what americans can be penalized if they just fundamentally don't agree with this tax. some people, like myself, do not believe it's constitutional that the federal government would require us to buy our health

insurance. well, if you believe strongly in the constitution and you don't believe that this is a constitutional provision, the i.r.s. could come after you and require up to $25,000 fine. the next tax to talk about about about -- about here. cosmetic surgery tax. ironically, democrats want to tax the most market-oriented aspect of medicine that has resulted in lower prices, safer procedures, and more consumer satisfaction by taxing cosmetic surgery procedures. tax number nine, increased employee medicare tax. lastly, for the first time, some americans will pay higher medicare taxes and have the money used to finance an entirely new entitlement program. according to the nonpartisan joint committee on taxation, as i mentioned before, 84% of the

people who pay the so-called cadillac insurance plan tax are in the middle tax. let's consider the whole tax-paying pop laying of the u.s. according once again to the nonpartisan joint committee on taxation, 8% of the population or slightly more than 13 million will get benefits that the democrats tout under this bill. that's about 8% of our population. the other side is wrong to say that this bill delivers a broad tax cut to all americans. it does this for only 8%. and only after shifting half a billion dollars worth of new taxes around to the rest of americans. what about the rest of americans? they are either clear losers or come out roughly even by getting a tax credit to balance their tax hike. even after you account for

taxpayers who receive the tax credit, about a quarter of all tax filers under $200,000 will on average see their taxes go up, not down. about 157 million americans who get health insurance through their employers will not be eligible for the tax credit. this does not take into account the higher premiums, medical devices, drugs, lab tests that the nonpartisan joint committee on taxation says will be shifted to consumers, but they did not break those tax impacts down by income level so we can't tell you exactly where they fall, but since most americans make less than $200,000 a year, most of those taxes will be borne by common sense by americans making under $200,000 a year. most of the nine brand-new taxes in this legislation violate the president's promise to leave

middle-class families from having to pay more taxes. the purpose of the crapo amendment is to inject honesty into the health care debate and to hold congress to the promises that were made to the american people. before we vote on this, i want to remind my colleagues of a very similar vote that we had last year. i had an amendment to the budget act that was passed 98-0 by this body. my amendment last year said it shall not be in order in the senate to consider any bill, resolution, amendment between houses, motion -- the presiding officer: the senator has used his ten minutes. mr. ensign: i would ask for an additional one minute. the presiding officer: without objection. mr. ensign: thank you. it shall not be in order in the senate to consider any bill, resolution, amendment between houses, motion, or conference report that includes a federal tax increase which would have widespread applicability on middle-class taxpayers. that passed 98-0.

that provision was adopted. unfortunately, it was stripped later when the budget resolution went to conference. so let me say in conclusion, madam president, despite the actions by my colleagues on the other side of the aisle made toward following that policy of not raising taxes on middle-class families, we can -- we continue to see legislative proposals, and the bill before us is exactly one of those legislative proposals that do just that. so i support senator crapo's motion to recommit this bill in order to remove these onerous tax burdens on the american people. my argument is simple -- let's do what we said we would do and protect middle-class families from these new taxes. madam president, i yield the floor. mr. casey: madam president? the presiding officer: the senator from pennsylvania. mr. casey: madam president,

thank you very much. i rise this morning -- this afternoon now i guess it is to speak about health care, but in a very particular context, one that -- an area of our health care debate which we unfortunately haven't spent enough time on. and the purpose of -- of my remarks today will focus on an amendment that i will be filing today very soon that is entitled "support for pregnant and parenting teens and women." it's a challenge within our health care system which i think has gone largely unaddressed or at least for a segment or a category of pregnant women in our society. we know that many teens and women who face an unplanned pregnancy do so with little or no support.

this amendment, the pregnant and parenting teens and women amendment, offers teens and young women the support they need to finish their educations and provide for their children. it's especially important to those who are teenagers, those who are victims of domestic violence or other -- other kinds of violence, and also as well women on college campuses. just a quick overview of the amendment, and then i will walk through some of the main reasons why i think it's important we make this a priority. first of all, the amendment will provide assistance and support for pregnant and parenting college students. secondly, the amendment will provide assistance and support for pregnant and parenting teens. third, it will improve services for pregnant women who are, as i mentioned before, victims of domestic violence, sexual violence, and stalking.

and fourth and finally, it will increase public awareness of the resources available to pregnant and parenting teens and women. i will go through some of the background as well in the time that i have, but the way i look at this and i think the way that a lot of families look at this challenge in america is that often after a woman becomes pregnant, under our law she has a decision to make. she can carry the child to term or not. we want to make sure that if she decides to carry that child to term, that she has all of the help that she needs. not just a little help, not just a program or two here and there, but the full range of help that we can provide. in addition to what so many people do, and so many do it well, so many individuals and organizations in the nonprofit sector.

there are great programs out there right now that help women with their pregnancies. but i look pong this challenge as one that is faced by pregnant women of all incomes, of all backgrounds, of all circumstances. often, even a woman who is -- who has the resources, the means often feels that she has to walk that path alone. sometimes her family abandons her or doesn't provide her the help that she needs, but it's especially urgent and especially difficult when a woman is both pregnant and without means or is pregnant and poor, pregnant and vulnerable to all of the challenges that -- that she will face. and if -- the way i like to think about it is she has got a -- if she makes the decision to -- to bring a child to term

and to have that child, she often does that all alone. she walks that road all alone. and what we have to do here, i believe, not just as democrats and republicans, that really doesn't matter, candidly, on this, but what we have to do as americans, if we really believe what we all say, we really say that we want to help people who are vulnerable, we really want to help people with their health care, and many of us say over and over again, people in both parties say this that we want to help women at a -- at sometimes a difficult time in their life. i realize for some people this is not an issue. pregnancy is a time of joy and a time when they have no challenges and they have -- they have -- they bring a child into the world and they have a lot of support, and they are -- they have all the help that they need. but there are plenty of women out there who have to walk this

road all alone, all alone. and if we really say what we believe as americans -- forget parties here, but if we really believe what we say as americans, we will do everything possible, everything to walk that road with her. if she wants the help and if she -- if she can benefit from the services we're talking about, why should a woman on a college campus who makes a decision to have a baby, why should she be left alone? why shouldn't we be giving her help? and we don't do it now. i know some do it and i will hear from others saying well, this group does this and this group does that, but unfortunately, it's not nearly enough, especially someone who happens to be a teenager. a woman who is pregnant, a young woman who is pregnant as a teenager or even before -- before the age of 18. are we doing enough to help

that -- that woman who happens to be pregnant get through the challenge of a pregnancy? and finally and most horrificcally, if someone is -- if a woman is both pregnant and the victim of domestic violence, sexual violence or stalking, what are we doing to help her? unfortunately, the answer to that is very, very little, very, very little, and i think that this is a criticism that i'm making of both political parties. we could have a debate about who is doing more, and that might be instructive, but neither party is doing enough for at least those three categories of pregnant women -- teens, women on college campuses, and women or victims of violence. so i believe we're going to have an awful lot of support for this amendment. i think it's an essential part of this health care debate.

and i believe it's an opportunity to -- to bring people together to agree on something around here. we have had a lot of disagreement. but also i think it's vitally important to -- to our society in general. it's not just a good thing to do. it's not just the right thing to do, the compassionate thing to do, but it's also, i believe, a -- a very important part of how we deliver tk and how we help people through what is often a crisis, but also the kind of life that that mother will have during her pregnancy and after her pregnancy and the life that that child will have while that child is in the womb and then after that child is born. if that pregnancy goes well, that child will learn more. if the pregnancy goes well, that child will grow and develop appropriately, so that they can be healthy. if a pregnancy goes well, that child will contribute a lot more

to society, but the real challenge, the urgent question for us is what are we doing to help pregnant women especially in these -- in these particular categories? i have been so fortunate and grateful to work with senator klobuchar on this amendment. we'll be talking about it more, but i wanted to provide a summary of it. madam president, i will yield the floor. a senator: madam president? the presiding officer: the senator from nebraska. mr. johanns: madam president, over the weeks and months that we have been here, we have talked a lot about the economy and the challenges that we face in the economy. we have spent time trying to figure out the best approach when it comes to job creation. we went through a debate earlier

this year about a stimulus package that when you add interest was eye popping, a trillion dollars. we were promised by the president that, boy, if you pass this gargantuan stimulus package, that unemployment won't go over 8%. we stand here today with unemployment of 10%. we look at that and we recognize, though, that that 10% number doesn't tell the true story of the suffering that is going on out there. when you read much further on any analysis, you begin to realize it's not 10%. when you add in those who have just flat given up, those who are underemployed, those who maybe are piecing one or two or three jobs together to try to just pay the bills, that we're really closer to the 17.5% range. and yet, over the last days, we

have been talking about a piece of legislation that because of mandates and tax increases and burdens placed upon the middle class and our job creators, our small businesses, we can see that very clearly what we're going to end up with here is just only adding to the misery of the american people. let me if i might start out by focusing on a specific piece of this to get started and that is the employer mandate. now, the bill here and the bill in the house have a common element. certainly different mandates, certainly different amounts of the mandate. the common element is that under both pieces of legislation, there is a washington way or the

highway sort of approach and it just basically says to employers, thou shalt do it our way or there's the highway. it basically says to our job creators out there, our medium size, even some of our small job creators are going to be pulled into this. it says, look, you either do it the washington way or we're going to penalize you. and we're going to use the internal revenue code in the full force and effect of this mammoth government bureaucracy called the internal revenue service to get you, to get that money out of your business because you haven't complied with the washington way of this legislation. we're going to put a tax on job creators, a penalty on job creators that is -- that are

already facing the dilemma of how do they keep their employment steady when we have a time when unemployment is 10% and real unemployment is actually in the vicinity of 17.5%. well, the result is obvious, and you don't have to study this very long to figure out that if this bill is passed, you're hammering the very people that are supposed to be creating the jobs. according to our congressional research service -- and i'm quoting here -- they say -- quote -- "economic theory suggests the penalty" --by that, they mean the employer mandate -- "should ultimately be passed through to lower wages. if firms cannot pass on the cost in lower wages, the highest cost of workers may lead firms to

reduce output and the number of workers." well, let me kind of pierce through that fancy language, if i might. it kind of talks -- it kind of sounds like washingtonspeak to me. what the congressional research is saying is this: if you are a worker out there in the united states, you are literally going to be faced with lower wages. and if that doesn't work, if that doesn't work, then it may be your job -- it may be your job that is at stake. now, like every senator in this body, i get across my state, i try to listen to people, i have town hall meetings, we try to keep an open-door policy so if somebody wants to talk to me, they can. and i tell ya, the human misery

of losing a job is just unbelievable. it does something to a person. it makes them look at themselves very, very differently. it makes them wonder, is there hope out there. you know, this administration ran on this notion of hope and promise, and according to our congressional research service, when you pierce through that washingtonspeak language, what it really says is that this bill by this administration is going to create more human misery because they'll impact jobs. nonpartisan analysis says employer mandated will either decrease wages or lead to layoffs. wow. this is my first year in the united states senate. what a legacy for your first

year. that you get to go home at some and you say, you know, i voted for a bill that according to the congressional research service we either cause more layoffs in my state or reduce wages. employers will look at their balance sheet. they have to. they don't have the ridiculous opportunity that we have here of just spending crazily and running up the federal deficit. they've got to make it work or they go out of business. for them, it has to be a cost-benefit analysis. and, you know, many have looked at this bill and says, gosh, i think i've figured something out here. i don't like the mandate, they tell me. but then they say, but we've studied this and if there has to be that result, it is cheaper for us to try to figure out a way to drop our health coverage

and pay the penalty. the average employer that provides a health care plan pays about $4,000 per employee for health coverage. well, if the mandate were something like $750, do the math. the cost-benefit analysis is going to lead to one conclusion. drop the health plan. we know employers are already considering it. my office recently -- recently met with a human resources manager from one of nebraska's largest cities. she noted how much cheaper it would be if they could just do that. many employees will lose their coverage and if that happens, then all of a sudden the doctor-patient relationship is impacted. remember all those promises, your taxes aren't going to go up, you get to keep the doctor that you like, if you like your plan, you're not going to lose

it? well, we have ripped those promises up with this legislation. you would think at some point somebody in the administration would stand up and say, hold everything here. we're making shambles out of what we thought we could do. true health care reforms should lower costs for businesses. so they can hire workers, so they have more capital to work with, not dismiss them. and i would say this bill just completely misses the mark. i would also suggest that this is a step in the wrong direction in terms of health care. making matters worse, the people that this bill supposedly help will be disproportionately impacted. a professor study on employer mandates recently said this -- and i'm quoting -- "workers who would lose their jobs are disproportionately likely to be

high school dropouts, minorities and females." and the quote continues: "among the uninsured, those with the least education face the highest risk of losing their jobs under employer mandates." is it a surprise that business groups are opposing this legislation? u.s. chamber, wholesale distributors, general contractors, independent electrical contractors all sent a letter recently and they said this -- quote -- "perhaps no sector has been more passionate, more active than the small business community in working to advance reforms that lower health coverage costs." the presiding officer: the senator has used ten minutes. a senator: may i have an additional minute, by unanimous consent. the presiding officer: without objection. a senator: the letter continues: "the senate health care bill will lead to higher costs and increased burdens on small businesses. the bill will cause greater damage to our economy.

we all agree on some basic premises. one is that about 60% to 70% of jobs in this country are dependent upon small businesses. isn't this a time for us to take a step back and ask: what are we doing to our economy here? what are we doing to these job creators? and work together to get a true bipartisan bill that builds our economy and protects our jobs. thank you. i yield the floor. mr. baucus: madam president? the presiding officer: the

senator from montana. mr. baucus: it's been alleged here on the floor that the underlying bill raises taxes. madam president, the legislation does not increase taxes. essentially. there is a slight modification to that but i'll explain that later. in fact, the bill represents a tax cut. the bill does two things: it provides tax credits to low- and middle-income individuals and families to help purchase health insurance and, second, it results in increased wages for those receiving employer-sponsored insurance. let me go first through how the bill provides a tax cut. the chart behind me basically shows that for a family of four with an income of $66,000, the left, the light blue indicates that the cost of that health

insurance is going to be about $14,100. that's basically health insurance costs today for a family of four. that's today. that's what people pay today. after this legislation, let's look at the bar there on the right. again, family of four, income $66,000. those persons will receive an $8,000 tax cut in terms of credits, what that family will get, with a net result of a health insurance policy that costs $6,100. health insurance is going to cost less for a family of four with income of $66,000. and that's fairly representati representative, you know, family of four, $66,000. just to repeat, on the left, the current health insurance policy for family of four at that income level is about $14,000, $14,100. but after the health care affordability tax credit kicks

in, that is, once this legislation kicks in, that same family, same income, same four people will find that they're going to be paying only $6,000 net for their health insurance. why? because they get a tax cut of $8,000. i might add too, madam preside madam president, let's look at the next chart. who gets a tax cut? an individual with income of $32,000. earlier it was a family of four, $66,000. this is an individual with income of $32,400. currently, today, before health care reform is passed, that individual will pay roughly $5,000 in health insurance. but after this bill is passed, that same individual with an income of $32,400 will find that health insurance will cost not $5,000 but much less, it costs about $3,000. why? because that person gets a tax

cut in terms of a credit of $2 $2,200. that's a pretty important point to make. and while i'm at it, i think i'll get to the next chart. now, there are some who are saying that this legislation will result in increased taxes for -- for higher-income people, that is, people whose income is, say, around $200,000. well, there's something to that argument but that's not the whole story. let's look at the whole story. if we look at the whole story, and this is -- this legislation s is portrayed by this chart. that is, the high cost insurance excise tax leads to increased wages. why increased wages? because the congressional budget office -- maybe it's the joint committee on tax -- the joint committee on tax concludes that because of that provision in the bill, that is, the excise tax on

companies that provide high -- high policy, more expensive policies, that, in effect, that those policies will be modified or changed and, in effect, the premiums for those policies in the so-called cadillac plans will actually go down according to the congressional budget office between 7% and 12%. but that's premiums. the discussion right now is on taxes and those folks will be paying a little more taxes. that is true under this legislation. but again, what's the whole story? why are they going to pay more taxes? they're going to pay more taxes because they've got a lot more income. their wages and salaries will increase tremendously. let's look at the chart over here on the left, the bar on the left. this is the year 2013. the percent of the total tax revenue due to increased wages, about 90%, but that person will also pay about a 10% increase in taxes. wages -- wage increases, salary

increase, far -- is far greater than the tax increase. that's true for every year, 2013, 2014, 2015, all the way up to 2019. it's proportionally basically the same, roughly around 80% of increase in wages and roughly maybe about less than a 20% increase in taxes. so those persons will be doing pretty well. madam president, i ask consent that the balance of my statements with concrete examples be inserted in the record at this point. the presiding officer: without objection. mr. baucus: i also, madam president, would like to just, again, remind everyone the effect of this legislation on premiums. earlier i discussed with what the congressional budget office says about peeps with our bill in summary the congressional budget office concludes that 93% of americans receive decreases

in premiums. about 93% of americans net will see a decrease in premiums. that's not these charts. that's in the congressional budget office letter much and of that 93%, 10% will see decreases of 56% to 59% because of new tax credits. it's amazing. we're talking in the individual market. about 60% of those who will be getting insurance in the individual market in the exchange will get tax credits which result in about roughly 60% reduction in premiums. 60%. i mean it's between 56% to 59%, that's pretty close to 60%. the remaining 7% would pay slightly higher, 7% slightly higher because they will -- guess what. they get much better insurance for that same dollar. when you buy -- when you have a

choice between buying a used car and new car, probably expect to pay more when you buy the new car. hopefully it's a little better, higher quality, drives faster, safer all of those things, expect to pay more for new car, you get more. same here. you pay a little more, only 7% will see their premiums go up according to the congressional budget office, and those 7% are people who do not get tax credits because their income's a little higher, but they'll be getting much better insurance, higher quality insurance. c.b.o. says that, much higher quality insurance, so, in effect, they're probably getting at least the same. no increase in premiums. maybe even net less -- maybe less -- maybe no increase at all. maybe a reduction in premiums if you calculate the higher quality of insurance that they're going to have. in addition the congressional budget office, i might say that -- that the -- that m.i.t.'s

john gruber did a study and he concludes using congressional budget office data, that the senate bill could mean that people purchasing individual insurance would save every yea year $200 for single coverage and $500 for family coverage in 2009. most people think he's -- he's one of the best outside experts, mr. gruber, at m.i.t. he has big computer models and takes the c.b.o. data and he helped the c.b.o. by giving some information to c.b.o. that either wise does not have. mr. gruber also concludes that people will low -- points out that people with low income receive premium tax credits, reduce the price that they pay for health insurance by as much as $2,500 to $7,500. we are have seen several studies

funded by the insurance industry. i don't want to be disparaging here. but to some degree, you've got to consider the source. i've been citing c.b.o. i think that most people believe they're a highly professional outfit. don't have an ax to grind, sometimes they upset those for health insurance reform, sometimes they upset people against health insurance reform. there are those studies by the insurance industry, those studies find that it will increase premiums. but these studies are flawed. frankly some of them -- the authors of these studies admit they're fraud and they're looking at selective parts of the legislation, not all parts. and they're pushed by the industry to issue a report very, very quickly. they've admitted that. and each of them fails to take into account all aspects of the

proposal. as i said, they selectively choose the provisions that will increase premiums, and they ignore premiums that will lower premiums. why do they do that? well, basically the insurance industry wants to kill this bill. i can understand if i were the insurance industry, i wouldn't want my apple cart upset either. they do just find under the status quo, thank you very much. they don't want to see any changes. some insurance companies want to continue their current practices of denying you coverage if you have a preexisting condition. that's how they made their money in the past. they make most of their money on -- the on -- by denying coverage by underwriting insurance rather than making money on conventional insurance. anyway these companies want to continue their current practices of denying you coverage if you have a preexisting condition. some want to charge you unaffordable premiums if you've been sick in the past and some

want to rescind your coverage once you've been sick. that's their m.o. and they've done pretty well under the status quo. the congressional budget office and professor gruber are credible and unbias sources, not bought and sold by the insurance industry. the congressional budget office and m.i.t.'s gruber confirmed what many of us have known, that it will lower premiums and create many options for comprehensive coverage. that is very important, as we all know, that is with the exchange setup and other provisions in this bill, many more options for individuals to buy insurance with. that creates a lot of competition and with the health insurance market reform, that means that insurance companies are competing more in price than quality of coverage. this legislation provides a much-needed assistance, as well, to lower-income americans struggling to pay their health insurance premiums. madam president, the senator

from nevada, senator i ensign, said that people would pay more because of industry fees in this bill. well, let's address that point. the recruxe reduction in premiud by the congressional budget office -- determined by the imong imong, took into account any impact of the industry fees. also there is no lab fees. i know the senator from nevada, it's an honest mistake on his part, i want to indicate that there's no lab fees in this bill. he's talking about lab fees. the bottom line is -- and for the overwhelming majority of americans, this bill lowers premiums. i don't have it with me. but also a section in one of the c.b.o. letters basically says that these fees will have a very members of the jura verynegligi.

i was concerned that some of these fees as determined by the congressional budget office or other analysts conclude that there is a significant impact on consumers, that is, on premiums and basically that -- what these companies have otherwise charged. the congressional budget office said that virtually the fees on the hospitals, the pharmaceutical industry and even the insurance industry, that they will have a very negligible effect on increased costs for consumers. it's very negligible according to the congressional budget office. and i thought, frankly, thought would not be the case. here is the letter. i don't have the date. but it's from the congressional budget office. it's under the section, new fees would increase premiums

slightly. i'll just read it to you the -- in fact the operable sentence is because that fee -- this is for the pharmaceutical industry, would not impose additional costs for drugs sold in the private office, the congressional budget office kitd that it will not result in higher premiums for private coverage. to be fair, i don't know -- they also address the fact that hospital fees or other provider fees, but i think it is note wortsdzy in that context for us to remember that it wasn't too long ago that when the health insurance industries got together in the white house with the president, and they promised to the president that they could reduce their costs by $2 trillion over 10 years. $2 trillion over 10 years. and this bill -- and they felt they could reduce their reimbursement by $2 trillion

over 10 years, you'd think they kind of knew what they're talking about. they've got to report to their stockholders. they have certain obligations. they said they could reduce their reimbursement then by $2 trillion. and this bill it cuts down the reimbursement increases not by $2 trillion, but by a quarter of that, roughly $4,500. and they agreed to it. and if they agree to it, they're probably going to do okay in this legislation. and it is not going to reduce in quality of care to people because they agreed to it essentially. as i pointed out, the c.b.o. said, with respect to the pharmaceutical industry, very little of that will be passed on to consumers. why is that? becausic reason there is waste in the health care system. these people know where the waste is. they can find it.

second, with increased coverage. many more americans have health insurance, currently i think it's 84% of americans have health insurance. but thunder legislation, 94%, 95% of americans will have health insurance, with many more americans have health insurance, there are patients for -- more patients for the hospitals, more patients for home health care, more medical equipment sold, more drugs provided by the pharmaceutical industry. that's the second main reason that they know that the provisions of this bill are a reduction in reimbursement to them are -- are numbers that they can live with. madam president, i know that the next two speakers, senator grassley and senator dorgan, both intend to speak more more than -- for more than 10 minutes, and i ask consent that they be allowed to speak longer under the control of their respective sides. the presiding officer: the senator from iowa.

mr. grassley: i thank the senator from montana for arranging that for me in time. i hope, yet, this afternoon to speak on the issue of importation of drugs because i support the dorgan amendment. but right now i want to address the issue of senator crapo's motion to commit and this generally deals with all of the tax provisions in this 2,074-page bill. if senator crapo prevase, and he should -- prevails, and he should prevail, the unrelated house bill, along with senator reid's amendment, would be sent to the finance committee. the finance committee would be empowered to return the bill to the full senate with an amendment that eliminates the heavy taxes in this bill. senator crapo has discussed the impact of the reid amendment on middle-class families. i'm going to lay out all the

taxes that are in this bill. out in farm country, many of us who work the land often observe big freight trains rumbling across the terrain. sometimes they scare cattle, hogs, and other animals. those freight trains are impressive in their power, in their speed, and now the -- the lengths of the train. very common, 100-car trains, 150-car trains. the partisan force with which the majority is powering this bill through the congress is equally as impressive as that of a freight train. the speed that is being displaced for such complex legislation is something to behold. most importantly, the sheer number and breadth of the new taxes in this bill reminds me of a very, very long train.

the lam almost half a trillion n taxes, fees and penalties, and i think they all have the same economic impact whether it's a tax, fee, or penalty, negative impact on the economy, these taxes, fees and penalties are so imposing, i'm calling this 2,074-page bill the tax increase express. the locomotive driving this train is health care reform driven by the democratic leadership. so we have here the locomotive that drives this tax increase. i don't think the american public knows that the bill would impose that much, a half a trillion dollars worth of new taxes, new fees, and new penalties on the american people. the american public, who supported president obama with a

majority of votes 13 months ago heard that president loud and clear, and that's why they gave him such an overwhelming majority. they understood how -- that our president pledged that he would not raise taxes on people making less than $250,000 a year. unfortunately, the democrat leadership bill would violate that clear pledge. what are the tax increases and the fees and penalties in senator reid's amendment? so let me take a moment to highlight them because every locomotive needs power to run. and the first power source, the first car of the tax increase express is the so-called fees on health insurance companies, medical device manufacturers and drug manufacturers. now, that might not sound like

something the grassroots of america would worry about, taxes on insurance companies, medical device manufacturers, drug manufacturers, because maybe they think businesses pay taxes, but businesses and corporations don't pay taxes, only people pay taxes. and so when people find out that they're going to be paying these , you know, it puts a whole new light on what's a fee and what's a tax. there have been numerous studies that have shown that these fees on, for instance, for example, health insurance will increase health insurance premiums. some say premiums would increase by $488 for a family. other studies say $500. most members on the other side of the aisle take issue with these studies. they argue that these studies were performed at the request of

insurance companies or conducted by independent experts with ties to that same industry. let me ask my democratic friends this -- do you degree the work of the congressional budget office and the joint committee on taxation? well, you shouldn't because they're like god around here. you know, when the c.b.o. says something is going to cost something, that stands, unless there are 60 votes to override it here in the united states senate. so most everything that the c.b.o. says stands. and they got respect because of the intellectual honesty of their research and the nonpartisanship that they have. and so these agencies, the congressional budget office, the committee on taxation, have testified that these fees will actually be passed on to health care consumers. check the record.

no one can dispute it. the congressional budget office and joint committee on taxation have also testified that the fees will increase health insurance premiums. check the record. no one can dispute it. my friends in the democratic leadership may say that once their health reforms are in place, premiums will go down. net of the fees. they will hail a recent c.b.o. report highlighting the winners but somehow ignoring the losers. they will say that these fees won't affect premiums for the vast majority of americans, but here's the flaw in that assumption -- in that assertion. the congressional budget office analyzed premium costs, what they are projected to be in 2016 under this legislation. what about premium costs right now in the years before these programs take effect, 2010 and

2013? why is this question important? the answer is these fees go into effect in the year 2010, not when most of the expenditure goes into effect in 2014. the majority of the democrats' reforms which are intended to lower costs do not go into effect until 2014, four years from now, and i ought to say that ten times because that's very important to how this bill came out to be revenue neutral. so we ought to look at what happens in the years 2010, 2011, 2012, and 2013. premiums will go up. why? because for one, the democrats are adding costs to the health insurance you buy by imposing these fees on health insurers, and they're giving you no government assistance to help with these added costs.

i would ask my friends in the media just dig a little bit deeper on this point, and you ought to be reporting on it. why? because the american public doesn't understand that in the short term, premiums will go up. instead, the public is simply hearing some media reports done on a portion of the premiums in 2016 and beyond, and of course that's a very long time from now. the american public doesn't want to wait for their premiums to go down, if they go down at all. it appears, my -- it appears my friends in the democratic leadership want the tax increas express to barrel through congress before the public realizes what health care reform actually means, and that's higher premiums as early as 2010. now let me turn to the second

car of the tax express -- tax increase express. this car is the proposal to restrict the eligibility criteria for claiming the itemized deductions for medical expenses. this proposal says that you can no longer deduct expenses that exceed 7.5% of your adjusted gross income. instead, you can only deduct expenses that exceed 10% of your adjusted gross income. so in plain english, this proposal limits tax deductions you can take for medical expenses. in other words, you will lose a portion of your tax deductions. even "the new york times" calls proposals that would take away a portion of your tax deduction as a tax increase. i ask unanimous consent to enter into the record that february 25

article from the "new york times." the presiding officer: without objection. mr. grassley: in the top line, the article says, quote -- "president obama will propose further tax increases on the affluent to help pay for health care reform." end of quote. i'm highlighting this article because the president is also proposing to take away a portion of a person's tax deduction. the president wants to limit the itemized deductions people -- of people making more than $250,000 a year, what they can take. the only difference between the two proposals is the medical expense deduction limitation affects people who make less than $250,000 a year. the same class of people that the president promised in the election that he was not going to increase taxes on. so again, don't take my word for it. data from the joint committee on tackation tells us that in the

year 2013, the largest concentration of taxpayers claiming the medical expense deduction earned between $50,000 and $75,000. people that never thought they were going to be -- to have their taxes increased based upon what the president said during the campaign. the analysis shows that a good number of taxpayers between between $75,000 and $200,000 also claim a medical expense deduction. now my friends on the other side of the aisle will argue that their government subsidized tack credit for health insurance will wipe clean any new taxes for those people below 400% of poverty. they will also argue that people purchasing insurance through the new exchange will be protected from catastrophic expenses as a result of annual out-of-pocket

limits. for this reason, my friends on the other side argue those middle-class taxpayers won't need to rely on medical expense deductions. now, i hate to break it to my colleagues, but the congressional budget office -- again, that god of capitol hill -- estimates that in 2014, only 4% of the americans will be purchasing exchange insurance and only 3% of the americans will be receiving a tax credit. by 2019 when the reid bill is in full effect, only 7% of the americans with exchange insurance will be receiving the tax credit. that leaves a heck of a lot of people below 400% of poverty with higher taxes. and what about these individuals and families above 400% of poverty? these people earn income below

the president's magic $250,000 and somehow they don't qualify for this tax credit. what they do qualify, though, for is a tax increase. after all, there is reason why this proposal raises $15 billion over ten years, and that's a heck of a lot of money. let me now turn to the third car of the tax increase express. this car is the high cost plan tax. the congressional budget office has consistently cited the two most powerful ways -- quote -- unquote, to bend the cost curve downward, meaning the cost curve of health inflation. number one is to cap the preferences for employer-provided health coverage, the so-called exclusion, and secondly,

medicare delivery system reforms. a recent letter sent to the white house by respected economists also contend that placing a limit on high-cost employer plans would slow health care spending and reduce costs. well, some of my colleagues have come out squarely in support of a cap on the exclusion. that was an intellectually honest position. my friend, the chairman of the budget -- two people. one, the chairman of the budget committee and secondly the chairman of the finance committee took the intellectually honest position. the democratic leadership, however, have squarely opposed a cap on exclusion. they argue that the cap on the exclusion would hurt middle-class workers. but in sleight of hand, this bill, this 2,074-page bill and

its authors, the democratic leadership came up with a proposal that would tax insurance companies for offering high-cost plans. it's a more complicated way of taxing the same workers. it is a sleight of hand because the democratic leadership know tax will be passed through to the worker. my friends simply want to say that, that they were taxing the workers directly, so they have decided to tax those same workers very indirectly. so in the end, the worker would be paying the tax and these workers would be middle-class workers. so again, don't take my word for it. the joint committee on taxation testified before our very senate finance committee that the high-cost plan tax would be passed on to who? the workers. joint committee on taxation data also indicates that in 2019, 84%

of the revenue generated from the high-cost plan tax comes from, guess who? individuals and families earning less than $200,000 a year. contrary to the president's promise in the last campaign that these folks would not pay any additional tax. so whether you agree or whether you disagree with the policy of limiting the tax benefit for employer-provided coverage, middle-class workers would see a tax increase. now, let's go to the fourth car of the tax increase express. carries -- this car is going to carry two new tax increases. the first tax increase is on workers who contribute to a flexible spending account, better known that is an f.s.a. under the current tax laws, a worker may contribute to an f.s.a. on a pre-tax basis and

use those f.s.a. contributions to pay for co-pays and deductible tax free. currently, there is no limit on how much a worker may contribute to the f.s.a. this 2,074-page bill put together by senator reid would limb the contribution amounts to to $2,500. statistics show that the average f.s.a. contribution is $1,800 a year. so this $2,500 limit doesn't sound that bad, right? well, i say wrong. a great number of workers who have serious illnesses contribute significantly more than $1,800. and let me say more than $2,500. on averages -- on average, these workers that i'm talking about

with serious health problems earn about $55,000 a year. and if i were to connect the dots, i would see a tax increase on workers with serious illnesses who earn $55,000 a year. well, here's how. these workers would now have to pay taxes on their f.s.a. contributions in excess of of $2,500. the democratic leadership are taxing health benefits for the first time ever. at least this benefit for the first time ever. the second tax increase in this fourth car is the elimination of the tax-free reimbursement for over the counter medicine. under the current tax rules, payments for over the counter medicine may be reimbursed tax free if a worker is covered under a flexible savings account

or under a health savings account. this 2,074-page bill takes away that tax benefit. the fifth car of the tax increase express is the new medicare payroll taxes. since the new deal, the u.s. has put into place several social insurance programs. they're part of the social fabric of america. included in those programs are social security, unemployment insurance, and medicare. they're all founded on the social insurance concept. as senator moynihan, when he represented new york, used to remind us, to ensure their constitutionality, these programs were designed to finance -- to be financed with

payroll taxes instead of insurance premiums. but to maintain the closest appearance possible to social insurance, the payroll tax looks a lot like a premium for insurance. this analogy is very intentional. it's not accidental. it is a bedrock to the sustainability and universality of social insurance programs that we all support. social security on the one hand, medicare on the other. this breaks that precedent and could startous a tax-hike-only journey to -- start us on a tax-hike-only journey to dealing with our unsustainable entitlement programs. so let me explain that. the way the payroll tax works now is that every worker pays in base odd his or her salary,

wages, or small business income. that is a single, simple and consistent tax base. also, one tax rate applies to that -- to that payroll tax base. now, for the first time -- for the very first time -- an additional second tax rate will apply to the payroll tax base. also for the first time in almost 45-year history of this great socia social insurance pr, you have before us a proposal that creates a marriage penalty in the payroll tax. now, think of the negative comments you get from a marriage penalty back at grass-roots of america. and so you have here a proposal that creates such a marriage penalty in the payroll tax. in other words, some married couples will be paying higher payroll taxes due sole to the

fact -- due solely to the fact that they are married. a tax on marriage? this is a direct result of this addition to the second tax rate. there's another matter that boggles the mind. the second tax rate kicks in if your wages exceed $200,000 if you're single and $250,000 if you're married. these dollar thresholds are not indexed. they are not indexed. so what happens to them when you have inflation? another tax where the tax base is not indexed is the a.m.t. that ought to bring back all the horror stories about not indexing something time when you first pass it. i think every member of congress knows that's an annual problem for us. in the late 1990's, commentators called the a.m.t., the tax system's ticking time bomb. fortunately, my friend the

chairman, and i started to diffuse this bomb in the 2001 tax legislation. it appears that my friends on the other side of the aisle have created another tax system ticking bomb problem. final, we have a caboose of this tax increase express. the caboose is the individual mandate penalty tax. it is a tax. it can be called a penalty but it is a tax, and all you've got to do is have the i.r.s. collecting it, as it does, and you know it's a tax. president obama does not want to acknowledge that the penalty for failing to maintain a government-approved health insurance is a tax but it's right here in black and white. the reid bill amends the tax code by adding a new excise tax

that's payable by those americans who do not purchase government-approved health insurance. i ask unanimous consent to place section 1051 of the reid amendment in the record which adds this new excise tax to our tax laws. the presiding officer: without objection. mr. grass: the kicker here -- mr. grassley: the kicker here is that c.b.o. has told congress that roughly one-half of those americans that will pay this tax are individuals between 100% and 300% of poverty. these folks earn less than the $250,000 a year. i see the light at the end of the tunnel that this tax increase express is going through. unfortunately, that light at the end of the tunnel is the tax increase express and we can derail the tax increase express if we want to. that is why today i'm supporting

senator crapo's motion to commit the reid amendment to the senate finance committee. senator crapo's motion would require that the finance committee report a bill back to the senate that does not include tax increases, fees and penalties included in the reid bill. so why should my democrat friends vote in favor of the motion? because they shouldn't want to bear the fallout of legislation that was rushed through congress like this -- like the economic stimulus package was back in february. they shouldn't want to tell their constituents that they voted in favor of a bill that increased their premiums. they shouldn't want to vote for a bill that raises taxes on many only to provide a benefit for the few. and they shouldn't want to break president obama's pledge not to take people making less than $250,000 a year.

what my friends should want is real health care reform, the kind of reform that has broad bipartisan support. i've consistently said -- i've consistently said that if congress wants to restructure one-sixth of the economy, it ought to be done on a bipartisan basis and that's not one or two republicans voting with democrats. and that's not happening around here on a bipartisan basis. we're debating this 2,074-page bill, a partisan product, a bill that was cobbled together by democratic leadership, a bill that has not received the approval of the senate finance committee. i ask my democratic friends to stop -- to stop this process right now. vote in favor of my motion -- senator crapo's motion as well -- so that we can do health care reform the right way, on a bipartisan basis, in a transparent and open way, so that the american public can

understand what we are doing. so the american public can be a part of the process, so that we can find a way to reform our health care system without burdening our constituents with these higher taxes, fees and penalties. let's reduce the out-of-control spending in the reid amendment and find savings within the health care system. let's derail the tax increase express before it steamrolls over hard-working americans and discourages employment, particularly employment in small business, where 70% of the new jobs are created. the taxes, fees and penalties don't need to be the fuel of this locomotive fire. i ask all of my colleagues to support senator crapo's motion to commit the reid bill to the finance committee. i yield the floor.

a senator: mr. president? the presiding officer: the senator from north dakota. mr. dorgan: madam president, the amendment that we are now considering is an amendment that i have offered that deals with drug reimportation. that is, the reimportation of prescription drugs from other countries. and one might ask the question: well, why -- why would we have to reimport drugs from other countries -- why would we want to reimport drugs from other countries? well, f.d.a.-approved drugs are made all over the world and they are shipped all over the world. again, f.d.a.-approved drugs,

approved by our food and drug administration, produced in plants that are inspected by our food and drug administration. the difference is -- only difference is -- when they are shipped around the world, the american consumer is charged the highest prices in the world by far. here is an example of the drug lilipitor. there are plenty of examples and i'll go through a number of them today, but this is an example of lipitor. for a any an equivalent amount f lipitor, 20-milligram tablets, the u.s. consumer paid $125. british pay $40. spanish pay $32. canadians pay $33. germans pay $48. we are charged the highest prices in the world for lipitor. lipitor, by the way, is the most popular cholesterol lowering drug -- i have a couple of bottles in my -- empty bottles, i should say, in the desk drawer here that demonstrates this drug was produced in ireland.

it was sent all around the wor world. same pill, put in the same bottle, made by same company, approved by our food and drug administration. this was sent to canada. this was sent to the united states. the difference? well, the american consumer was allowed to pay three times as much as the canadian consumer. shouldn't say allowed, i should say forced. but it's not just urs v. canada. as you can see, it's u.s. v. every other country. and so the question is, should that be the case? thud the american consumer -- should the american consumer be charged the highest prices in the world? my answer to that is no. why is it the case that we are charged the highest prices in the world? because we're the only country in which there's a special little law that prevents our citizens from accessing that f.d.a.-approved drug from wherever it is sold, at the most advantageous price. we have a voice in law that

says -- the american people don't have the freedom to import a prescription drug, an f.d.a.-approved drug that they find for half the price or 20% of the price in some other country. i say, give the american people the freedom. i hear so much discussion on the floor of the senate about freedom. this is the ultimate freedom. the freedom of the american people access those prescription drugs that are sold virtually everywhere else, brand-name prescription drugs at a fraction of the price. now, i have examples of other prescription drugs as well to show you that it's not just lipitor, although lipitor is the most popular cholesterol lowering drug. this is plavix. now, plavix is an anticoagulant. you will see that we pay higher than all of these countries by far. more than double what the british pay. more than double what the spanish pay. this is nexium.

now, if you're someone who has ulcers and you are taking nexium. for an equivalent amount of the same drug, nexium, you are charged $424 if you're an american citizen, $40 for the british, $36 for the spanish, $37 for the germans, $67 for the french. the american consumer, trying to control their condition of ulcers, pays $424, ten times the amount of money that others are paying for the identical drug. ten times. well, this kind of what i believe is gouging, that is, a pricing strategy that gouges the american consumer, can largely be resolved by the amendment that i have offered. it removes that little

sweetheart impediment in law and says to the american people, you may import prescription drugs that are f.d.a. approved from registered enterprises in other countries. we specifically delineate which those countries are. there are a handful of them that have the identical chain of custody that we have in our country. identical. we also put in this amendment unbelievable safety provisions dealing with pedigree and batch lots and tracers that don't exist now in our domestic prescription drug supply, let alone reimportation. so if we were allowing the american people to do this, the congressional budget office says my amendment will sav save $19 billion. $19 billion for the federal government over the next 10 years. but somewhere around 0 billion for -- $80 billion for american consumers above that. that's a pretty big savings.

now, madam president, here is another chart that shows what has happened in addition to the fact that we are charged the highest prices in the world. what has happened in recent months in 2009, brand named prescription drugs have increased by nine% at a time when there is no -- 9%, when there is no inflation, there is an increase in prescription drugs in this country. take enbrel you get to pay 12% more. singular, 12%, boniva, the price is 18% higher. there is nothing, i repeat nothing, in any of the health care plans, considered by the senate or the house, that addresses this piece, the escalating price of prescription drugs.

now, there are a whole lot of folks out there in this country that are not senior citizens, that are taking drugs to manage their disease. they take cholesterol-lowering medicine, medicine to lower blood pressure, they manage their disease or health issues and don't have to go to an acute care bed in a hospital, because they're doing the right things. the problem is the pharmaceutical prices are going up, up, up, way up, way above what other people in the world are paying for the identical drug. i'm saying, it's just not fair. madam president, the issue is not that the pharmaceutical industry is a bad industry or that they are infested with bad companies. i just think that they have bad pricing policies. just bad pricing policies. they are able to and, therefore, they do charge the american people by far the highest prices in the world. now, i want to talk about a

couple of important issues with respect to this issue of giving the american people the freedom to access or purchase that f.d.a. approved drug anywhere as long as it comports where the chain of custody is identical to ours, which is in our bill. the bill establishes the pedigree for batch lots and tracers that don't even exist in safety for our existing drug supply. there are some who say and who allege that you can't do this safely. it's just -- it causes all kinds of problems with counterfeiting and so on. well, the fact is the europeans have been doing it safely for 20 years. for over two decades in europe, under parallel trading, if you're a german and want to buy a prescription drug in spain, it is not a problem. if you're in italy and want to buy a prescription drug in france, no problem. they've been doing that safely

for a long, long time. to suggest that somehow we don't have the skill an capability to do what the europeans have been doing routinely for 20 years is really, in my judgment, shortchanging our government an shortchanging -- and shortchanging our consumers. now, we will, however, i think have people allege again that this is risky. it's just risky. i want to make the point about risk. because i want to demonstrate something that i think most people don't know. 40% of the active ingredients of our existing prescription drugs come from china and india. 40% of the active ingredients come from china and india. and in most places frommers that have never been inspected. now, my amendment does not allow drugs to be imported into this

country from china or india. i'm talking about the ingredients that the pharmaceutical industry acquires with which to make their drugs. we don't allow drugs to be imported from china or india as a matter of this amendment. only f.d.a. approve drugs from f.d.a. inspected plants in canada, the european countries, japan, new zealand, or australia. that's all. why? because they have an identical chain of custody to us. and that's the basis how we determine how reimportation could work and work safely. but i want to describe a recent scandal that illustrates the double standard that some want to apply to this question. and the scandal was about a drug called heparin, a blood thinner, commonly used by dialysis patients. it was linked last year to more than 62 set 62 deaths. heparin was pulled from the

market. according to baxter, the allergic reactions appeared to be caused by the contaminant in the heparin somewhere in the manufacturing process, most likely in china. "the wall street journal," did a really important story on the heparin contamination. they reported that more than half of the world's heparin gets its start in china's poorly regulated supply chain. this is what the "wall street journal" after its investigation concluded. "half the world's heparin, the main ingredient in this widely used anticlotting medicine, gets its start in china's poorly regulated supply chain." there are 40' photographs of the casing factory which processes pig intest ins used to make

heparin. i want to show some photographs that came from "the wall street journal,". this is a photograph of a facility in -- and that's the outside. here is a -- here is a photograph of someone in the facility who is stirring a rusty vat full of heparin ingredients with a tree branch. the processing of heparin from pig intestines in a facility in china in which thrusty vat the worker is stirring with a tree branch. and so are the ingredients that are used to make medicine with respect to the blood clotting issue. so when the industry and others say that we can't have drug

importation safely from canada or ireland, the point is they're getting a lot of their ingredients from china and india. and i would say, simply look at this and ask yourself whether the domestic drug supply, with respect to that ingredient and those imputes have -- inputs have sufficient safety. while the record keeping of these chinese facilities make it almost impossible to trace the con tanment from this -- co contaminant from this, clearly shows unsanitary conditions in which pig intestines are processed for that particular medicine. by contrast, the amendment we offer, would allow the importation of f.d.a. approved medicines only with a chain of custody to ensure that the drugs

are handled properly. it gives the f.d.a. the authority to inspect all facilities in all of the chain of custody. now, the amendment mandates the use of anticounterfeiting technology to track and trace for imported and domestic drugs to ensure product integrity. that doesn't exist today. that's required in this amendment. the amendment also requires pharmacies an drug wholesalers to register with the f.d.a. and be subject to strict requirements to ensure the safety of imported medications including frequent, rand remove inspections. so the amendment that i'm offering here would ensure safety and, in fact, provide a greater margin of estate that exists with all of our drug supply. and we need to have these improvements in my judgment because our own distribution drug system is not as good as we think it is. here's an excellent example of

something that took place in the united states. a 2000 -- well, this is a picture of mr. tim fagan, a young 16-year-old boy from long island, new york. he received a liver trns plant. he -- transplant. he received epogen after the transplant. he received daily injections but the red blood cell count wasn't improving. after two months tim's mom went to the pharmacy where she was told that the epogen that your son has been taking may have been counterfeit. here is an example, again, an example of counterfeiting in the existing domestic drug supply. counterfeiting in which this container held the counterfeit

medicine and this container held the real medicine. there were subtle differences, but not much. it turned out that the vials that tim was injecting contained 1-20 of the -- 1/20 of the strength. the weaker drug sells for $20 a bottle and the higher strength goes for $440 a bottle. investigators found that 110,000 of the bogus bottles reached the market in this country. and it's estimated that criminals involved with that counterfeiting in that particular case made $46 million. the manufacturer of that drug, a company called amerisource had some of the product through secondary distributors. although no one new it, that the

epogen that amer isource resold had most likely run through a cooler in the back of this strip club. in the backroom of a miami strip club called playpen south. here is the chart that shows the distribution system that this drug went through. again, this is not an import. this is a domestic drug. and you can see this unbelievable, complicated distribution system. and at the end of that, they traveled through strip clubs, they traveled through homes, they traveled through trunks of cars without proper cooling. and this story was told in great detail by some outstanding investigation by katherine eban,

in something called "dangerous doses." in that -- mr. president, i ask to be allowed to continue to use -- i ask unanimous consent that we extend the period of debate until 3:00 p.m. with senators permitted to speak up to 10 minutes each and no amendments in order. the presiding officer: without objection. mr. dorgan: i ask to speak with as much time as i may consume. the presiding officer: without objection. mr. dorgan: again, talking about the issue i just described. they traveled through strip clubs. through homes. they traveled through the trunks of cars without the proper cooling. i'm talking about the issue of a domestic drug supply that was counterfeit. well, the amendment that we are offering would fix this supply chain problem. it will require a pedigree for all drugs, not just those that are imported, all drugs -- it should have been done long ago,

and some of us have been trying a long while. it will allow us to track every single drug from where it is made to the pharmacy where it is sold. and my amendment will require a set of anticounterfeiting measures that are not in place now. now, if you think of it, i have a $20 bill. and most people who looked at the new $20 bills, there is sophisticated ain't koirnsophisg in that bill. the ability to detect counterfeiting does not exist in our drug supply. the pedigree we require, the batch lots will make a requirement in our entire drug supply. this amendment will make our entire drug supply safer.

the prices at which these same identical drugs are sold in other countries. in many cases half of the price. in some cases much, much lower, 10 person of the price that they are sold in this country. now, i want to talk just a moment about the issue of drug price inflation, because the drug price -- what is happening to us in this country is the drug price inflation, the relentless increases year after year, that's the red line. 9.3% this year, and this is the rate of inflation. so if we don't do anything to deal with the issue of the price of prescription drugs, we will have missed the opportunity to do something to help the american people. now, let me just describe a few stories about the need for this amendment. my home state, in neta, north dakota, marianne wrote to me -- "my husband has parkinson's disease so he takes a drug

called mirapex. we have mayor part-d. in 2008 when this happened, we paid $106 for his medication. it increased to $187 in october and november, $198 in december. now in september, 2009, the price was $286, $180 increase in one year. mr. mccain: will the senator yield for a question? mr. dorgan: i will be happy to yield. mr. mccain: the senator i know is aware and has talked about this. how does the senator account for the fact that there is a nearly 9% increase in the cost of pharmaceutical drugs while a consumer price index this year has gone down 1.3%? how -- what -- and this is probably the highest increase, i understand, in history or in most recent years in the cost of prescription drugs. what is the explanation between

that -- the divergence of those two lines? mr. dorgan: well, the explanation, i suppose -- it's probably better addressed to the pharmaceutical industry. how and why do you increase these prices this way? my guess is they do it because they can. the fact is the cost of living index -- the inflation rate is the yellow line. the price of prescription drugs is the red line. mr. mccain: would that have anything to do with anticipation of incoming reductions or reductions in increase in costs of pharmaceuticals? mr. dorgan: i would say to the senator from arizona my expectation is the pharmaceutical industry has said well, this is -- this is a time to increase these prices, and -- and the most important element here is there's no restraint, no one has any capability of restraining them. the only way you would provide restraint on this is if you said to the american consumer you know what, you don't have to buy it from these people at this price because it's sold in

virtually every other country at half the price. you say to the american people we're going to give you the freedom to access that drug elsewhere. i think very quickly the pharmaceutical industry wouldn't be able to impose these price increases because then you would have competition. freedom equals competition in my judgment here on this issue. mr. mccain: could i ask the senator another question? we understand that you can buy lettuce from overseas, you can buy many other products from overseas, you can buy dairy products, you can buy almost any item except perhaps prescription drugs. and yet the canadians in particular as well as the countries that are included in the senator's amendment all adhere to the same standards or higher standards than the united states of america does, and now i understand that one of the senators -- not you -- has received a letter saying that this is still a problem. i don't get it.

maybe the senator from north dakota can explain a little better. mr. dorgan: mr. president, i will say to the senator from arizona there is not a safety issue here. to the extent that there is any safety issue, it is that we intend to increase safety of both the domestic supply of prescription drugs and the reimported prescription drugs, because the fact is there is nothing at this point dealing with batch lots and pedigrees and tracing capability. that doesn't exist at this point. we will insist on it in this amendment. so for anybody to suggest that somehow we're going to end up with a prescription drug industry that is less safe or i should say prescription drug products that are less safe, that's just not the facts. as i indicated before the senator came to the floor, europe has been doing this for 20 years in something called parallel trading. for 20 years they've done it. if you're in germany and want to buy a prescription drug from spain and it's an approved drug, you can. if you're from italy and want to buy it from france, you can. they do it successfully.

i don't think anybody should tell us we are not capable of doing what the europeans have done for 20 years and that is giving people the freedom to access those prescription drugs where they are sold at a better price. mr. mccain: could i ask the senator another question? isn't it true that a letter was written to one of our colleagues and -- from the administrator of the f.d.a., the organization that would basically make sure that any product that goes to american consumers along these lines that would go through that bureaucracies. instead, it would require a significant amount of assets and resources. i have since been told there is 11,000 employees of that bureaucracy, and i wonder if -- what he thinks about that argument, and, again, was the senator from north dakota informed about this position which, by the way, is the same position as the previous administrations?

mr. dorgan: well, mr. president, the senator from arizona is correct. there is a letter from the food and drug administration. you know, the fact is we have seen this over -- over the years, that they say well, we don't have the resources or it will impose more risk. the fact is this amendment provides the resources for them because those that are going to register to be able to -- to ship f.d.a.-approved drugs into this country at a better price are going to have to pay a fee. the people that are selling will pay a fee. and those pharmacies and others in our country who will be receiving will also pay a fee. this actually funds -- mr. mccain: requires no additional funding from the taxpayer? mr. dorgan: no additional funding from the taxpayer at all. those that decide that they are going to offer these lower priced prescription drugs will be paying a fee for the purpose of being able to do that, but this is not a taxpayer-funded issue at all, and it will provide the additional resources

and pay for those resources without asking the taxpayers to come up with the money. mr. mccain: do these countries that are included in the senator's amendment, could we have absolute assurance, could we look at the american people and say those countries and the agreements we would have with them, that you could have products that are safe, that you could safely buy, and it would not pose any hazard to anyone's health? mr. dorgan: well, mr. president, the -- the countries that are involved in this amendment -- and they are limited -- are countries that have an identical chain of custody to our country. and so these are countries that are accessing the same drugs. i just mentioned -- let me do it again because i showed two bottles of medicine. they are empty, obviously. but both of these bottles contained lipitor. most of my colleagues know what lipitor is. this was made by an american company in ireland and then shipped all over the world.

this little bottle was shipped to the united states. this little bottle was shipped to canada. same bottle. one was blue, one was red in the label, but the same bottle, same pill, same company, inspected by the f.d.a. now, what's the difference? the price. the american consumer is told guess what you get to do. you get to pay almost triple. why? and it's not just the american consumer. if i can just hold up a chart that shows two drugs, i think if i can find it. one is nexium. this is advertised substantially, but nexium is an example, and i also have one on lipitor. here's the price for nexium. do you think the pharmaceutical industry is selling nexium at $37 for the equivalent quantity in germany and losing money? i don't think they are losing money at that. but instead of $37, they charge the american consumer $424. my point is -- my beef with the industry is their pricing

policy. mr. mccain: i would ask my friend a question. wouldn't the pharmaceutical companies say it costs $424 because we have to absorb the costs of all the research that went into developing nexium? mr. dorgan: i would say this. it's interesting. that is also always raised, to say well, you know, if you -- if you don't allow us to charge the american consumer the highest prices in the world, we don't get to do the research and development that produces the next new miracle drug. well, you know what? most of the recent studies have shown that those industries -- the pharmaceutical industry spends more money on promotion, marketing, and advertising than they do on research. i want them to do research, but there is one other piece. the congress gave without my support a proposal that said those american companies that have money overseas should bring it back, we'll let them pay a lower tax rate. guess -- guess which industry was one of the largest industries to repatriate profits from abroad.

the pharmaceutical industry. now, if they're making big profits abroad and charging lower prices to those consumers abroad, why can't the american people have access to those prices? it's not because they're going to lose money, because they made a lot of money abroad. that's why they repatriated much of it at a lower interest rate. mr. mccain: could i ask the senator, do the seniors from his state and other citizens from his state travel to canada and buy these prescription drugs because they know and are confident that they are getting at a much lower price the same product? and unfortunately, citizens in my state have to go south, and that's unfortunate when they have to do that because we do have a much larger problem there, i'm sorry to say. mr. dorgan: well, mr. president, the citizens from north dakota often have to go to canada to buy a prescription drug. i've told the story about the old codger that was sitting on a hay bale at a farm yard when i

had a town meeting. he was just sort of nibbling on a piece of straw. he said to me, my wife -- he is about 80 years old. he said my wife has been fighting breast cancer for three years, and he said the only way that we could pay for our prescription drugs was to drive to canada once every three months, because when you buy tamoxifen in canada, you pay like 1/10 of the price or 1/5 of the price that you pay in the united states. he said we did that every three months so my wife could keep fighting breast cancer. of course they do that. now, what is happening is consumers are allowed to bring back as an informer strategy about 90 days' worth of supply of prescription drugs for personal use only, but most american consumers can't do that. they don't live anywhere close to a border. the question is can the rest of the american people have access to the same prescription drugs that are sold at a fraction of the price? mr. mccain: but i ask the senator, isn't it true that the congressional budget office has determined that this -- this measure of yours, this modest measure of only countries that

are -- that are of the highest level of quality of inspection, of all the standards that we have, would it save the american consumer $100 billion? $100 billion, is that true? mr. dorgan: mr. president, it would save about -- the congressional budget office says it will save the federal government about $19 billion and then about another $80 billion will be saved by the consumer, so that's about $100 billion. nearly $100 billion savings in total, $19 billion of which will be saved by the federal government for its purchases and the rest by the american consumers. mr. mccain: and finally i would like to ask the senator what is the basis of the argument against the senator's amendment? what possible reason, frankly, except for perhaps the influence of a special interest in this, our nation's capital? mr. dorgan: well, i'm not a very good advocate for the other side. i mean, if one were to ask what's the best argument opposed

to my amendment, i would say there aren't any arguments that are the best. there is a range of poor arguments or arguments that don't hold much water. my own view is that -- let me just describe, i started by saying i don't have a beef against the pharmaceutical industry. i want them to do well. i want them to be successful. i want them to keep finding and searching for miracle drugs. and bite way, much of the work they will do with that comes from the national institutes of health and the massive investments we make in research. i want them all to be successful. my beef with them is i think a pricing strategy that says to the american people here's what you pay and you can do nothing about it because we have decided that's what you pay and we'll offer everything else around the world lower prices, that makes no sense to me. that's my beef. this is a pricing issue, they are wrong about it, and i think the way to correct it is to give the american people a little bit of freedom here. give the american people freedom. you'll save money for the government, save money for the american people. and i want to make one additional point while the

senator is here. yesterday i read a whole series of advertisements. if the senator from arizona is like me, when i'm brushing my teeth in the morning, i have a television blaring and i hear all these ads. go ask the doctor if the purple pill is right for you. i don't have the foggiest idea what a purple pill would do for me, but you feel -- the ads are so compelling, you almost feel i have to get out of here, i have to stop brushing my teeth, get a phone and call a doctor someplace to see whether my life might be improved by taking a purple pill. i read a whole series of these advertisements. does your restless mind keep you from sleeping? do you lie awake exhausted? maybe it's time to see if lunesta is right for you. go ask your doctor how to get seven nights of sleep lunesta free. i read a bunch of these. bladder problems and flomax and ambien, you name it. they advertise it every day. i just say knock off a little bit of that. give us better prices.

god bless you for doing all you do, i would say to the industry, but give us fair prices, fair prices to the american consumer and knock off a little of the advertising. the advertising, after all, is for a doctor that only a doctor can prescribe. you can't get this product unless a doctor thinks you need it. so stop asking me if the purple pill is right for me or asking me to ask a doctor whether the purple pill is right for senator mccain. knock it off. mr. mccain: could i say -- ask unanimous consent to just make an additional comment, mr. president? the presiding officer: is there objection? without objection, so ordered. mr. mccain: i want to thank the senator from north dakota who has been pursuing this issue for a number of years. i really believe that we are on the verge of success. i appreciate his eloquence, i appreciate his passion, but most of all, on behalf of the citizens of my state who can't get up to canada, who now are experiencing unprecedented economic difficulties, who need these life-saving prescription

drugs, many of them senior citizens, that i just want to say thank you for your advocacy. i think you've made an eloquent case, and i hope that my colleagues have paid attention and will vote in the affirmative for your amendment today. mr. dorgan: mr. president, let me say that senator mccain has been a part of this effort for a long, long time. this is one of -- it's really interesting, with all of the action on the floor of the senate in recent weeks, this is one of the few examples of a significant policy that is bipartisan. we've got republicans and democrats, over 30 cosponsors who have worked with us to make certain that we can do this, do it safely and give the american people the opportunity they deserve. this is really bipartisan. i appreciate that a lot. i want to say that the national federation of independent business supports this, the aarp supports this. we've got a long list of organizations that are strong supporters of this legislation

and -- or this amendment, i should say. and i really hope traps, today, perhaps, after long last, long, long last, after eight years, that we will get this through the senate. i have said recently the pharmaceutical industry is a formidable opponent. i understand that. and we've had difficult difficulty getting this into a piece of legislation to get signed and give the american people fair pricing. and when we do this, senator mccain, myself and others, it is suggested somehow that we have no regard for this industry. it is not the case at all. it just is not. we have no regard for a pricing policy, however, that we believe is unfair to the american peop people. and it's been that way for too long, a long, long time -- too long, and perhaps today, with the vote on this amendment i expect later this afternoon, perhaps today will be the first step in getting that changed. mr. president, i yield the floor.

mr. kyl: mr. president? the presiding officer: the senator from arizona is recognized. mr. kyl: mr. president, i believe if i am to speck for more than ten minimum -- speak for more than ten minutes, i need to ask unanimous consent. and if that is correct, i ask unanimous consent to speak for 15 minutes. the presiding officer: without objection, so ordered. mr. kyl: thank you, mr. president. i want to speak to the crapo amendment, an amendment that hopefully we'll be voting on a little bit later today, and i urge my colleagues to support the amendment of the senator from idaho. this is about jobs and it's about taxes. and i think one thing that americans don't expect out of this legislation is that they're going to have to pay a lot of taxes and that jobs are going to be killed rather than created. the president's talking about creating more jobs. everyone in america is focused on putting people back to work, ending this recession and bringing unemployment down so that we can get jobs and go back

to work. one of the problems with this bill is that it kills jobs, it kills job creation. one of the ways it does that is through the many new taxes and mandates that it imposes. naturally, we want to be sure that whatever we do here, we don't harm our economy or job creation. but this $2.5 trillion legislation is filled with new taxes and mandates that will ultimately be borne by small businesses and 9 america the amn workers. i'm going to talk first just about three. first, a new employer mandate. that says that employers have to provide insurance to their employees or face a penalty. this would hurt low-income workers, especially on according to a harvard economist. i'll be talking about that. second, there's a new medicare payroll tax. and incidentally, the revenue raised doesn't go back to medicare. it would be nice if we could help with the medicare solvency. but this, too, threatens job creation, particularly small

businesses, because it's a direct tax on hiring more people. and finally, new taxes on the health care industry can undermine its ongoing job creation gains. by the way, it's the only industry to have gained jobs since the start of the recessi recession, and this legislation will actually cause job losses. so i'll describe all three of these. first, the employer mandate. the bill imposes a requirement, a costly new mandate on employers, that will have the perverse impact of actually hurting employees, especially low-cost employees. how so? any employer with more than 50 employees who does not offer health care coverage would be required to pay an assessment for each employee who receives a tax credit for purchasing coverage through a newly created exchange. now, those are folks in the lower-income brackets, those who qualify for tax credits. so this becomes a direct tax on hiring people.

and according to the center on budget and policy priorities -- and i'm quoting now -- the particular employee provision in the finance committee bill would pose significant problems by imposing a tax on employers for hiring people from low- and moderate-income families who would qualify for subsidies in the new health insurance exchanges. it would courage firms from hiring such individuals and would favor the hiring for the same jobs of people who don't qualify for the subsidies. primarily people from families at higher income levels. and to conclude, it would also provide an incentive for employers to convert full-time workers, ie., workers employed at least 30 hours per week, to incorporate-time workers. so -- to part-time workers. so, mr. president, here you have it. a mandate in the bill that would directly impact the hiring of low-income workers, precisely the opposite of what we want to be doing these days. harvard economist kate baker examined the effect of an

employer mandate similar to one in the reid bill. she estimated that the cost of hiring a low-wage worker would rise by 33% -- one-third -- or $2 per hour on a worker earning a $6-per-hour wage. think about that. and she concluded that 224,000 workers would lose their jobs as a result of a mandate with these costs. so in addition to all of the other problems we have with growing unemployment, here's another quarter of a million people who would lose their jobs because of this bill. it makes no sense. there was a recent letter sent to the two senate leaders from the national federation of independent businesses which states -- and i'm quoting -- "mandates destroy job creation opportunities for employees. the job loss, whether through lost hiring or greater reliance on part-time employees, harms low-wage or entry-level workers the most. exactly what the other study said. and, by the way, the nfib is a

nonprofit, nonpartisan organization finding itself as the voice of small business. we're all familiar with the good work that it does. i think it would know what's best for american business and workers. now, the second way that this bill imposes taxes and hurts workers, it actually creates a payroll tax, in other words, a tax on hiring people or keeping them on your payroll. it raises the medicare payroll tax by a half a percent on small businesses with taxable seat res of $200,000 a year or $250,000 if the small business employer filer is married, because many small businesses pay taxes at the individual level, imposing higher individual taxes hurts these engines of job creation. the joint committee on taxation recently estimated that one-third of the income that could be taxed under a similar house proposal comes from small businesses. and let's remember, as president

obama reminded us earlier this week, small businesses generate 65% of the job growth between 1992 and 2008. and represent about half of the private-sector employment of the united states. so this huge potential engine for job creation is going to get whacked by the imposition of a new tax which is a direct tax on the hiring or retaining of employees. the joint committee estimates that this increase in the medicare tax would raise $54 billion over the next ten years. mr. president, that's $54 billion of resources that could have better been used in the private economy, in these small businesses to expand job creation. each new tax dollar paid by these small businesses is one less dollar that could go toward the hiring of new employees, or, for that matter, preventing layoffs or even giving raises to their existing employees. a group of organizations recently told us in a letter --

and, by the way, these are all organizations that represent small businesses in their communities. but they opposed this bill because it would do to their small businesses. and i just want to read the -- the groups who represent these folks. the associated builders and contractors, the associated general contractors, the international food service distributors association, the national association of manufacturers, the national association of wholesale distributors, the national retail federation, the small business and entrepreneurship counsel, and the u.s. chamber -- council, and the u.s. chamber of commerce. here's a telling quotation from this letter. "in order to finance part of its $2.5 trillion price tag, h.r. 3590 imposes new taxes, fees, and penalties totaling nearly half a trillion dollars. this financial burden falls disproportionately on the backs of small business. small firms are in desperate need of this precious capital

for job creation, investment, and business." mr. president, that's exactly what president obama said yesterday. we've got to get more capital into the hands of these small businesses so that they can either continue their businesses with their employees or potentially, at least soon, begin hiring more. and yet as this letter points out, this bill imposes taxes with a burden that falls disproportionately on the very firms that we're trying to help. in a november 19 statement, the national federation of independent businesses said that this bill's impact would be as follows -- and i'm quoting now from their letter -- "we oppose the reid bill due to the amount of new taxes, the creation of new mandates and the establishment of new entitlement programs. there is no doubt all these burdens will be paid for on the backs of small business. it's clear to us that at the end of the day, the costs to small business more than outweigh the benefits they may have realized." they go on, "the gract these nem

these new taxes, an impact that is more costly than what we can afford today, a new government entitlement program and a hard employer mandate equals disaster for small business." mr. president, they know what they're talking about. these are the folks that we're depending upon to create jobs. and we're punching them right in the stomach, right where it hurts with respect to their ability to create these new jobs with the new taxes and mandates imposed in this bill. let me share a brief letter from one of my constituents. he's a small business owner in tempe, arizona. his name is just inpaige. he'd like to be able to grow his business but the burdensome new taxes in this bill would force him to lay off workers and cut hours from his payroll. here's what he says. "dear senator kyl: as a longtime tempe and arizona resident who has been operating a small business for the past 19 years, i urge you to not vote for the health care bill as it is currently proposed and as recently passed by the house of

representatives. my business has taken a severe financial hit in the past 18 months with several employee layoffs, reduced hours for current employees, heavier workloads, et cetera. my answer to increased health care costs and additional small business taxes is to lay more people off. not good for my employees and not good for me. but survival is my primary goal right now. reform is essential, but please do it in a bipartisan manner and within a timetable that allows for constructive debate. this is too important. important." so, mr. president, small businesses have some very real concerns about this legislation and good reason to worry they'll be victims of its destructive policies. obviously, it's not the kind of legislation that small business owners or the american worker wants, and, of course, not particularly in times of double-digit unemployment. we need to listen to the people out there who are actually creating jobs, who have to meet a payroll, balance a budget and

know what's necessary to run a successful small business. they are not happy with this legislation. the third and final point is the new taxes on the health care industry which, of course, get passed through to the people who ultimately have to buy insuran insurance. let me just discuss one, the medical device tax. this medical device tax, it is a tax on things that are used to treat us, to give us health care every day. ask the $110 billion in new taxes on industries like this, the pharmaceutical, the insurance industry, medical device industries is a direct passthrough in terms of what we will end up having to pay in insurance premiums. for example, this medical device tax will be assessed against thousands of products lie contact lenses, stethoscopes, hospital beds, artificial heart valves, advanced diagnostic

equipment. now, why would you impose a tax on these things that help us? you know, you could maybe see a tax against liquor or a tax against tobacco, but a tax on things like this, these advanced technologies that help us? why do we want to make them more expensive? these have been invented so that we could have more -- an extension of our lives, so our families can have better health care. we all know that when you tax something, you get less of it. in fact, the u.b.s. investment research paper recently confirmed, "if the plan passes as proposed and our estimates are correct, the initial years to be a financial challenge for medical device manufacturers as the full industry fee becomes due before patients in packed volumes." before they can even begin to pass these costs on, it could kill this particular industry. and these taxes will hit smaller firms particularly hard since some of the smaller companies

don't start out with a lot of profits. most rely entirely on domestic sales for their revenues. i note that my colleagues on the other side of the aisle, senators klobuchar, bayh, franken, and lugar from this side of the aisle recently sent a letter in which they said, "independent estimates indicate that this tax could translate into an annual income tax surcharge of between 10% and 30% on medical device manufacturers." think about that. a 10 fo iii to 10% to 30% tax oo are designing things to help us. this was a letter to the chairman of the finance committee. now, i know there are some who argue that lost jobs in the private health care sector will be made up with new jobs in the government, with health care bureaucrats here in washington. wonderful, i say.

that is not a good thing. we need jobs in the private sector. that should be our primary goal, and that certainly is what president obama was talking about yesterday when he talked about creating more jobs in the private sector. so, mr. president, in cliewrks i had i've just -- so, mr. president, in conclusion, i've just described three ways in which this legislation through its mandates and new taxes will cripple our ability to come back after this recession. all of us here in the senate, i know, want to do what we can to bring down the current very high unemployment. it's obvious that this health care bill makes things worse, not better. at every turn its new taxes and mandates puts us on the wrong course. i think it is very hard to justify support for this legislation. it threatens job creation, especially job creation for low-income workers. i just urge my colleagues when we vote on the crapo amendment here pretty soon to consider its

impact. it will enable at least people in the lower-income levels to avoid the kind of taxes that are imposed here. just one of, which for example, is the tax that the i.r.s. will enforce if you don't buy the insurance policy that the government under this bill will mandate that you buy. so if you can't afford the insurance shall the government says you got to buy it anyway, and if you don't, we'll impose a new taxes on you, enforced by the i.r.s. well, the crapo amendment would say, no, not so fast, i.r.s. we're going to protect people from that new tax. that's why it's important to support the crapo amendment. i know we've had a few votes here where very few republicans hav-- wherevery few democrats he supported republican amendments. this is one i hope all of us could support. mr. feingold: mr. president? the presiding officer: the senator from wisconsin. mr. feingold: i rise in strong

support of the amendment offered by senator dorgan. frankly, mr. president, this amendment should be a no-brainer. it saves taxpayers and consumers money by bringing down prices for prescription drugs. i don't think american consumers should have to pay the highest prices in the world for prurks particularly when those price -- for prescription drugs, particularly when those prices keep going up. brand-name drugs cost on average 35% to 55% less in other industrialized nations than they do in the united states. and the aarp release add study recently that found that the price of drugs most commonly used by seniors has risen faster than the general inflation rate every year since 2004. in it 2007, the price spiked by 8.7%. so it's no wonder that americans turn to canada to buy more affordable and entirely safe prescription drugs. americans are now importing more

than $1 billion in prescription drugs from canada alone. consumers would not go to such lengths to buy their medicines this way if they were not saving money. now the drug industry has said that drug importation can't be done safely. got to give phrma credit. they have gone to great lengths to scare the public. but the reality is that drug importation has occurred within the european union countries called parallel trade for the last 25 years. the pharmaceutical industry should know that drug importation is safe. the industry has imported drugs and sold them in the united states for decades. one-quarter of the drugs consumed by americans today are made in foreign manufacturing plants. the dorgan amendment includes a number of protections to ensure that imported drugs are safe and certainly safer than the completely unregulated system that we have today. mr. president, i don't need to remind my colleagues about the

deficit hole that we're in. federal spending is one of the top concerns i hear about from my constituents. they want to know what we're doing to get our deficit under control, and that's why i introduced legislation that -- e control spending now act -- that proposes concrete ways to bring down runaway government spending. one proposal was senator according tdorgan's drug importn legislation because it is such a commonsense and effective way to save the government tens of billions of dollars. i'm pleased that the health care reform bill we're debating already includes three other proposals in my control spending bill championed by senator bingaman and others that would slash federal spending by billions of dollars. and so with a th with the passae dorgan amendment we could make it four. we do a lot of things in congress that i'm afraid leaves our constituents scrasmg their heads. now is our chance to show them that we're listening to them,

that we understand their concern and that we want to bring down federal spending while ensuring prescription drugs they need are far more affordable. again, that real does sound like a no-brainer to me, mr. president. i thank you and i yield the floor. the presiding officer: the senator montana is recognized. mr. baucus: i ask unanimous consent to extend the period for debate only to 4:00 p.m. with the time equally divided with senators permitted to speak up ten minutes each with no amendments in order at this time. the presiding officer: is there objection? without objection, so ordered. mr. enzi: mr. president? the presiding officer: the senator from wyoming is recognized. mr. enzi: i yield myself 10 minutes. the presiding officer: without

objection. mr. enzi: mr. president, americans across this country are facing the reality of an economy that's in trouble. the unemployment rate is now 10%. according to the department of labor's broadest measure, some 17.5% of americans are without a job entirely or are unde under underemployed. the average work week is now down to 33 hours for the american worker. americans are struggling to find good jobs and because of that, they're having trouble making their mortgage payments. 14% of all mortgage loans -- meanin7.4million households -- e delinquent or in historic in the last quarter. that's the highest number since the mortgage banker survey began this in 1972. many economic indicators point toward the slow, unsteady jobless recovery and the american people know it.

in a recent survey, 82% of americans -- 82% of americans -- said that our nation's economic conditions are poor. in recent weeks president obama has convened a summit at the white house to discuss jobs and economic issues. he's given speeches to discuss proposals for job creation and economic recovery. there's even been discussion about spending additional billions of dollars on another economic stimulus bill. unfortunately, the president has not advocated for the single-quickest and simplest way to promote economic growth. if the president really wants to save jobs and grow the economy, all he needs to do is tell the majority leader and the senate democrats to scrap this $2.5 trillion reid health care reform bill and work it over step by step to get it right and to save costs. senator reid's prescription for our economic troubles is a $2.5 trillion bill full of tax

increases, higher health care costs and $5 billion in medicare cuts -- and 500 billion in medicare cuts. the reid bill contains $500 billion in new taxes, primarily how it's being paid for. there are new taxes on individuals, new taxes on small business, and new taxes on health care providers. these new taxes will raise health care costs. they'll be passed on to the individuals in the form of higher premiums. according to the congressional budget office, the reid bill will drive premiums up by 10% to 13%. i know the other side likes to relate to those pieces of the bill that talk about one section that brings it down by 7% and another one that brings it down by 7%. but they fail to notice that the bill actually raises it to 27% to begin with, so when you subtract that out, it still winds up with a 10% to 13% increase. so who gets taxed under the reid bill? if you don't have the

government-approved health insurance, you get taxed. and incidentally, we're going to till -- washington is going to tell you what the minimum requirement is, and that will be higher than most people have for insurance at the present time. the government will tell you what you need, and they'll fine you if you don't agree. now, the total amount of new taxes on uninsured americans is $8 billion. according to the congressional budget office, half of the new taxes on the uninsured will be paid by families earning less than $68,000 a year. now, if you don't have insurance, you'll get taxed. if you have insurance, you will get hit twice by new taxes in the reid bill. first, new taxes on health care providers will be passed on to consumers in the form of higher premiums. second, if the government bureaucrats decide your employer-sponsored inurns is too generous -- insurance is too general rushings you get a tax for that, too.

the reid bill includes $150 billion in new taxes on employer-sponsored health benefits. these new taxes on benefits fall disproportionately an middle-income americans. according to the joint committee on taxation, 73% of those hit with new taxes on benefits earn less than $200,000. 73%. there's a whole bunch of people in that category. the reid bill also contains new taxes on businesses that cannot afford insurance. there are some that cannot afford and to and stay in business. senator reid's health plan will mean they'll have to pay $28 million in new taxes. the same businesses that are barely making it the same businesses having to lay off workers to keep the business afloat, the same businesses cutting shifts to prevent further layoffs and they're cutting wages to keep their employees on the payroll.

with our nation's unemployment in double digits and millions more americans worried about keeping their jobs and paying their bills, it is unconceivable that any member would support new taxes on businesses that are already struggling. so small businesses that absorb the extra employees that get laid off from the big businesses and hopefully it is the small businesses that become the future big businesses. in addition to the job-killing employer taxes, the reid bill raises medicare payroll taxes by $50 billion. these new taxes will fall disproportionately on small businesses. approximately one-third of america's small businesses will be hit with this tax increase. these are the same small businesses that employ 30 million americans. i've got to say that any time you talk about taxing the rich, we're also talking about tasmg the owners of small business corporations because the money flows right through to them even though they have to put most of it back into the business in order to keep the business going. not only will small businesses

see their taxes go up under the reid bill, they will see their health insurance premiums go up as a result of new taxes on health care providers. beginning in 2010, these three and a half years before many of the health reforms go into effect, new fees will be imposed on health insurance companies. that's right now. three and a half yeeshes before the re-- three and a half years before the reforms go into effect. these have been characterized as excise taxes. they've also testified that these fees will be passed through to consumers in the form of higher premiums. if you need prescription drugs, you get taxed. beginning in 2010, new fees will be imposed on prescription drug manufacturers. similar to the health insurer fee, c.b.o. and joint tax say that it will be more expensive to buy a prescription drug. if you need a medical device, you get taxed. medical device manufacturers will be subjected to a 2.5% excise tax on sales. again, congressional budget office and joint tax have testified that this tax will

increase the cost. medical devices, just like prescription drugs, costs and health insurance -- this new tax will drive premiums up. if you have high, out-of-pocket health expenses you will get taxed. a family would no longer be able to deduct medical expenses that exceed 7.5% of their gross income. a family could only deduct expenses that exceed 10%. in plain english, this proposal limits the tax deductions a family can take for medical expenses. for example, a family of four earning $67,000 in 2013 would lose a tax deduction of $1,425. a family of four earning $92,000 in 2013 would lose a tax deduction of $2,300. instead of working toward a bipartisan solution toward our economic problem, senator reid brought a bill before us that spends $2.5 trillion over ten years, raises taxes on ph*eupbdz

class families and small businesses. i support health care reform and will continue to enact real reforms that lower the cost of health care. i cannot, however, support higher taxes that further jeopardize our economic recovery by punishing small businesses and raise health care costs for working families. i yield the floor. the presiding officer: the senator from kansas is recognized. mr. brownback: mr. president, how much time do i have allotted? i thought there was an agreement that i had a certain amount of time allotted. the presiding officer: the minority side has 36 minutes and 59 seconds, with a 10-minute time limit in that. mr. brownback: could i -- i would yield myself ten minutes to speak on the dorgan amendment. provides without objection. mr. brownback: thank you very much. mr. president, i want to speak on the dorgan amendment. the senator from north dakota has a good amendment up.

it's been around this body for a long period of time. but i have to rise in opposition to this. i'm the ranking member on the senate appropriations subcommittee on agriculture, rural development and food and drug administration. the f.d.a. is in the purview of our subcommittee, so i work on the issues of the f.d.a. also, if i might brag for a second, the university of kansas boasts one of the best pharmaceutical schools in the world, often rated number one as a pharmacy school. anybody interested in that field of study or work, that's a good place to go. but also they're very concerned about what's in the dorgan amendment. the u.s. currently has one of the safest drug supply systems in the world that allows the federal food and drug administration to monitor and regulate the manufacture and distribution of approved medicines throughout the country. the legal authority to import drugs already exist in this country. however, however, no h.h.s. secretary, democrat or republican, has been able to certify that the importation of prescription drugs from foreign

nations is safe or will lead to cost savings. none have been able to. the dorgan amendment will allow for the importation of drugs from outside our current regulatory system established and enforced by the f.d.a. without certification from the secretary of h.h.s. or the food and drug administration, the f.d.a. allowing drug importation from foreign nations could threaten public health and result in unsafe, unapproved and counterfeit drugs being placed on pharmacy shelves in the united states. the f.d.a. has been tasked with the responsibility of safeguarding this country's prescription drug supply and has executed that responsibility quite well. but, as this country and the food and drug administration struggles to discover and prevent the growing threats posed by imported foreign-produced goods as evidenced by recent failures to protect polluted products such

as infant formula, pet food and toothpaste, permitting the importation of foreign products without the complete assurance of the f.d.a. that it will not jeopardize public safety is irresponsible and threatens this nation's safety and proven drug supply. toward that end, mr. president, i ask that a letter that senator carper received from the health and human services agency, the f.d.a. director, be placed in the record after my comments. the presiding officer: without objection. mr. brownback: mr. president, this letter states in particular this -- and i just want to read from the f.d.a. chief what the commissioner of food and drugs is saying about the dorgan amendment. "we commend the sponsors for their efforts to include numerous protective measures in the bill that address the inherent risk of importing foreign products and other safety concerns relating to the distribution system of drugs within the u.s. however, as currently written, the resulting structure would be

logistically challenging to implement and resource intensive. in addition, there are significant safety concerns related to allow the importation of nonbio equivalent products and safety issues related to confusion and distribution in labeling of foreign products and the domestic products that remain to be fully addressed in the amendment. in other words, they don't think we can do this importation -- re-importation of drugs without significant safety problems. there's been an explosion of illegal drug counterfeiting around the world. in the emergence of a multibillion-dollar international black market has proven to this senate, current and past h.h.s. secretaries and the f.d.a. that weakening our prescription drug regulatory framework would only increase the risk of life-threatening, counterfeit or diluted prescription drugs entering our prescription drug supply that millions of americans rely on

and they trust. prescription drug counterfeiting has become a highly profitable criminal enterprise. it has been taken up by international organization crime syndicates, rogue nations such as north korea, syria and iran and developing nations such as china and pakistan that seek to force weak counterfeit networks. it comes with significantly less criminal penalties compared to those handed out for illegal drugs. due to these limited and minimal criminal penalties, global counterfeiting has grown into an epidemic that reaches every country around the world. the w.h.a., world health organization, estimates that tens of thousands of people are dying due to counterfeit h.i.v., diabetes, and tropical disease medicines. unfortunately, in most counterfeit cases it is not what is included in these fake drugs. it is what has been excluded

that proves to be most harmful and deadly to patients. by taking counterfeit, diluted or completely inineffective drugs many patients fail to receive the important livesaving medicines they need. it is just as dangerous for a person with high cholesterol to use a counterfeit drug that lacks the prescribed medicine as it is for a person to ingest a contaminated or even a poisonous pill. due to this global counterfeit epidemic, two secretaries of h.h. under both the clinton and bush administration have been unable to certify that the importation of prescription drugs will not pose a substantial risk to the health and safety of citizens around within the united states. and current secretary kathleen sebelius from kansas has committed to preventing a drug importation system to the united states until it can be proven that the safety standards of the imported drugs are -- quote -- "at or above american standards." and the f.d.a. doesn't believe

they can get that done at this time. now, many have argued that the parallel trade in europe has proven drug importation across nation borders that result in prescription cost savings and has not increased risk to consumers or general public health. however, these costs and safety assertions do not correctly reflect the european experience with drug importation through what's called parallel trade. a study by the london school of economics on drug importation costs concluded that safety savings from parallel imports benefit middle-men and third-party vendors that buy and resell the imported drugs and do not get passed on to the patients in the form of lower prices. they say this -- quote -- "although the overall number of parallel imports has continued to increase, health care stakeholders are realizing few of the expected savings. profits from parallel imports accrue mostly to the benefit of the third-party companies that buy and resell these medicines." furthermore, a report by the university of london school of

pharmacy on the safety of the parallel prescription drug stated this -- quote -- "the united kingdom is the most vulnerable country in europe to counterfeiting owing to the high level of 'parallel importing.'" due to parallel trade the medicines and regulatory agency in the u.k. issued ten different recalls of counterfeit drugs in the past five years. drugs recalled include prescriptions to treat schizophrenia, blood pressure, prostate cancer. most stkrurbg fact of this counterfeit infiltration is that these drugs entered the united kingdom through legitimate supply chains through parallel distribution trade according to the regulatory agency in the u.k. in other studies european commissions found the prescription drug supply chain in europe which includes the former eastern bloc counties like latvia, slovenia and bulgaria is targeted by

international counterfeiters. the trade -- quote -- "brings risk to the safety of the patients and the increase in counterfeiting medicines -- quote -- "is a very serious threat to public health and can cost lives." we don't want that happening to the united states particularly with what we've seen in recent products coming in from china not regulated under our system in things like toothpaste, pet food and the problems we have here. do you want that to happen in the drug system? no. we don't and we can't certify that we can keep these products safe. so as you can see, safety concerns and the lack of savings that may result from exposing this country to the potential risks created by the importation of drugs from outside our current safety system, these are real threats. now, it's kinder of an -- kind of an interesting study, in october of 2004, then-governor rob blagojevich of illinois

launched the r.x. program to allow residents in illinois, missouri and kansas to purchase low-cost drugs from canada. he started this program. however, by 2006 the illinois state auditor found that the program costs nearly $1 million and was used by only about 3,700 people in illinois and 267 residents of my state of kansas. mr. president, the health and human services has concerns regarding the safety importation. the food and drug administration has concerns regarding the safety of importation. and given the opportunity to purchase canadian prescription drugs, only 267 kansans took that chance. we should not disrupt the supply chain without safety assurances from this country's regulatory bodies. i yield the floor. the presiding officer: the senator's time has expired. the senator from illinois is recognized. mr. durbin: mr. president, this is the tenth day in the debate on health care reform.

i believe it's one of the most important issues we have ever debated certainly in my time on the floor of the united states senate. there have been a variety of amendments offered, and there's been a lot of work going on off the senate floor. before we could reach this point of starting this debate, committees held hearings that went on for weeks and months. they started with a base bill and entertained hundreds of amendments. the "help" committee, health, education, labor, and pensions committee, as well as the finance committee, devoted so much time to this. the first time i can recall the chairman of the senate finance committee, max baucus, coming to see me personally on this was over a year ago. so over a year has gone in to this effort to come to this moment. and i might add that the negotiations and efforts to improve the bill haven't stopped. as late as last night a large group of members of the democratic caucus in the senate were meeting to work out pretty contentious issues relating to

competition for private health insurance companies. they worked late into the night, night after night and finally came up with a consensus where differing points of view really had to make concessions and come up with the best way to move forward. that is what's gone into the base bill that is before us. and this is it. 2,074 pages put together through all of the work that i've just described. now, i understand the responsibility of the minority party in the united states senate is to disagree. but we hope that they will do it in a constructive fashion. in this situation we have invited them in from the beginning. in fact, in each of the committees, the republican senators have been active participants, offering amendments, many of which were adopted. beyond that, there were meetings off the floor. the senator from wyoming was a party to meetings that went on for, i'm told, more than 60 days

in an effort to find bipartisan middle ground. we come here today in the senate debating this bill, and there are several realities. the first reality is that after the house of representatives went through a similar exercise, only one republican representative, a congressman, republican k congressman from new orleans, louisiana, voted for health care reform. only one. in the senate to date, only one republican senator -- senator snowe of maine -- has voted for health care reform in the senate finance committee. not one single republican senator other than senator snowe has voted to move forward on health care reform. and there's a second reality. there is no republican health care reform bill. none. they have a variety of different ideas, but each one is specific. they're not comprehensive.

they don't really address the issues that this bill addresses. they have not presented a bill which makes health insurance premiums in america more affordable. this bill does. and don't take a politician's word for it. the congressional budget office looked at this bill and said it will bring down premiums for the vast majority of americans paying for health insurance today. something we definitely need because we're dealing with a situation where individuals, families, and businesses can no longer afford health insurance. there's not a bill produced on the other side of the aisle which guarantees that 94% of americans will have health insurance. this bill does. they haven't produced that bill. when this bill is enacted into law, we will have a larger percentage of our american citizens covered with health insurance than ever in our history. they have not produced a bill which changes the way health insurance is managed and -- and -- and its relationship with customers across america.

this bill does. there is a bill of rights in here that says, american consumer, you've got a right. you've got a right to have health insurance even if you have a preexisting condition. you have a right to stand up to the health insurance companies when they deny you coverage saying, we only cover you when you're well, not when you're sick. you have a right for your children to be covered under your family health insurance policy until they reach the age of 27. these are rights which we guarantee in in bill and have not been brought to the floor on the republican side because they don't have a health care reform bill. before us at the moment is an amendment by a friend of mine, senator crapo, who raises a question about, will there be taxes? will people have to pay for with what we're doing here? we have struck a good balance in terms of shared responsibility. first and foremost, understand this, if we drop this debate, an most republicans would have us do at this moment and walked away and said, we're not going to do anything, each and every

american will continue to pay over $1,000 a year in added premium costs to cover the cost of uncompensated care. in my hometown of springfield, illinois, we have some wonderful hospitals, and when poor people with no insurance show up, they're treated. they're cared for. and that hospital has to pass along the cost of that health care to the other people who are paying for their care. which means each of us is payi paying $1,000 more a year for our families in health insurance premiums to cover those uninsured. so that $1,000 tax is already there. let me tell you what this bill does. this bill says if you're making less than $80,000 a year, we will help you pay your health insurance premiums. give your tax breaks to pay those premiums. that means that a lot people who today cannot afford to pay for health insurance premiums, will

be able to. they will be able to go to the exchange and choose from options and get a helping hand when it comes to paying for health insurance. we also have special provisions in here to take care of the smaller businesses. if you have fewer than 25 employees and have a small business that represents a lot of business, mom and pop businesses, for example, we're going to give you a helping hand so that you can pay for the health insurance coverage for yourself, the owners of the business, and the people who work for you. what about those who are larger companies? well, let's be honest about it. we expect them to step up and accept this shared responsibility. you know, most of these companies don't question whether they have to pay into unemployment insurance or workers' compensation. that's part of the cost of doing business. we are saying that in this era of health care reform, with share responsibilitiy, businesses should offer good health insurance for their employees. and in most instances they do.

and they deserve our commendation for doing it. but we also understand that there are some that may not cover their employees, may have waiting periods that are unreasonable. we start moving our policy against that. so that people do have the peace of mind of knowing that when they go to work, they have good health insurance that's going to be there when they need it. it's a new look at it. but we started with a real challenge here. america is the only developed industrialized country in the world where a person can die for lack of health insurance. we're the only one. there's not another country where that happens. it's also the only country -- developed country in the world, where a person can be driven into bankruptcy because of medical bills. we kind of accept it. you know, well, so and so had an accident, went to the hospital, was there for a month, huge medical bill, they didn't have any savings or insurance and wiped them out.

it wiped them out. it doesn't happen in other countries. in developed countries it doesn't happen because they take care of people. and they understand whether using private health insurance or public health insurance, there is a social -- social obligation to make sure that we have peace of mind knowing that that will happen. there is $441 billion in tax relief in this bill for families over the next 10 years to pay their health insurance premiums. that is a tax break that will lead to more insurance coverage and more peace of mind. that is a reality. for the smaller businesses, 25 and fewer employers, there's a helping hand for them to cover their employees as well. we also provide some competition that in many places doesn't exist today. we provide that there's going to be health insurance options for people. too many small employers that i run into say, you know, it's take it or leave it deal with our health insurance company. we'll renew last year's polls ate a higher cost with less

coverage and you better take it because there's no place else to go. that's going to change here. that's part of the change. and for all of my republican friends and colleagues who have come to the floor over the last 10 days, critical of this health care reform bill, i understand, that's part of senate debate. that's part of what we're here for. but make no mistake, these same senate republicans don't have a health care reform bill. most of the amendments that have been offered have been to protect health care companies. companies that are wildly profitable. companies that, frankly, dictate in this system how much people are going to pay and whether they're going to have coverage. dutifully, now, th -- have saide have to protect the companies third and profits. my responsibility is to the 13 million people in my state of illinois and the rest of the nation to make sure that they have the same peace of mind that they all know we want, to have

quality, affordable health care. to extend the reach of health care and the peace of mind that comes with it to the largest percentage of americans in history. and the last point i want to make is the one about the deficit. we hear a lot about the deficit. this bill, this health care reform bill, will cut more money from the deficit, $130 billion over the next 10 years, than any single bill ever considered on the floor of the senate. again, not my conclusion, but the conclusion of the congressional budget office, which analyzes these bills for democrats and republicans. $130 billion reduction in the deficit over 10 years, and the next 10 years an additiona additional $650 billion. because as we start to bend the serve and bring down the increase in health care costs, it means we pay less for medicare services, less for medicaid services, less for many services that are offered through government programs. this bill is fiscally responsible. the president -- president obama

challenged us to make it such an we've done it. there has not been a bill offered by the senate republicans that reduces the deficit. not near this amount. no one has done. it it took a lot of hard work to reef this point. i would say the net result of the amendment by senator crapo, is, unfortunately, to delay this debate even further, to stop the momentum toward health care reform. i don't think that's what america wants or needs. this is a once in a political lifetime opportunity to address an issue on the mind of every american and do it in a fair and comprehensive way. certainly this bill is not perfect, as hard as we try, it never will be. but to just continue to argue there are elements they want to question without offering a comprehensive health care reform alternative, i don't really believe is a fair debate. we have put the time into this. i stand by it. i'll be proud to support it.

there are things in it that i don't agree with. many things -- most things i do. but the fact is, it is the right thing for us to do at this moment in history. we cannot miss this opportunity. i encourage my colleagues to oppose the crapo amendment. and, mr. president, how much time do i have remaining? the presiding officer: 24 minutes and 40 seconds for the democrats. mr. durbin: and how long have i spoke? the presiding officer: the senator has spoken for eight minutes. mr. durbin: mr all right. mr. president, i just want to stand in support of the amendment that's being offered by the senator from north dakota, senator dorgan. senator dorgan has talked about drug reimportation and he's raised an issue which troubles me. why is it the pharmaceutical companies in america charge americans more for their product than they charge customers in

other countries buying exactly the same product? senator dorgan had a hearing once, and the response was obvious, the pharmaceutical companies say we charge americans more because we can. and all of those other countries, like canada, when they try to sell drugs to canadians, the canadian government steps in and says, you're entitled to a profit, but don't go overboard. we'll allow you to increase your profits only so much each year. in the united states there is no such mechanism there is no such effort. we continue as a nation to pay premium prices for drugs exactly the same drugs that are sold at a fraction of the cost around the world. the aarp, which is the largest organization of seniors in america, did a study of drug prices in april showed that the price of the most commonly used drugs has risen faster than general inflation every year since 2004. this year drug prices are going

to go up another 9%, for exam. a lot of americans are saying, if i can buy the same drug in mexico or canada at the same price, why wouldn't i be allowed to do that? why wouldn't you stop me under the law? well, i don't think you should. i think we ought to give people that opportunity. what senator dorgan has done is to build in his amendment safety features so we're not dealing with counterfeit drugs and there's accountability as to the source, purity and effectiveness of the drugs bought. this amendment creates a role for the federal government with provided oversight to ensure americans access to lower prices and peace of mind knowing their drugs are safe. the bill allows u.s. licensed pharmacies and wholesalers to import f.d.a. approved me indications from europe, japan, and pass the savings on to american customers. what does it mean? 35% to 55% lower costs for some of the most widely used drugs in

america. this approach will reduce costs when people need it. particularly sick people who are dependent on drugs to stay healthy or to avoid even further illness. the c.b.o. estimates that the new policy will result enterfederal savings o of $19.4 billion over 10 years. i'll tell you why i think this is critically important. there are a lot of drugs an drug companies doing very well -- and drug companies doing very well, very profitable and they're based in the united states. i think it is unfair that they're charging people in their own country higher prices than people in other countries around the world. this reimportation is an effort to bring down some of the drug prices. these companies, incidentally, say we need the money to do research for new drugs. certainly they need to do research for new drugs. maybe they can stop and explain

to me or someone, why they spend more money on advertising than they do on research. you've seen the ads on television, heard them on the radio, and seen them in mag sphwhreens. they spend a fortune advertising, trying to lure people into using the highest priced drugs in america. these pharmaceutical companies are doing very well, their profits are sky high. sometimes the highest in america. and i think it's fair in this bill, as we try to bring down the cost of health care, that we also bring down the cost of these drugs by allowing the importation, with strict safety standards of these drugs, into the united states. i support the dorgan amendment. look forward to making more affordable prescription drugs available across the united states and i yield the floor. a senator: mr. president? the presiding officer: the senator from idaho. mr. crapo: i ask unanimous consent to speak for up to 20 minutes. the presiding officer: without objection. mr. crapo: before i begin my remarks, i'd like to yield a couple of minutes to my friend

and colleague to the senator from oklahoma, as to whether americans are presented viable and meaningful alternatives. mr. coburn: the majority whip realizes that there's an alternative bill. there are four alternative bills out there. they weren't given a hearing. they didn't have the resources, they didn't have the c.b.o. that would score them. but outside sources on a bill that would guarantee, if you have what you have now and you like it, you can keep it. has absolutely zero tax increases on american families. no increases on taxes on american business. lowers the cost of everybody's health insurance premiums. covers preexisting conditions, period. protects seniors's high quality care an choices. increased personal control over your own health care. no medicaid expansion, but, in fact, puts medicaid patients into true coverage without discrimination and allows them all of the doctors in this country to see them. protects physicians and the

patients' relationships an empowers family physicians and providers. does not empower the government. the majority whip knows that. and, yet, we heard on the floor that we've not offered anything. we offered a bill that outside evaluators save the states at least $1 trillion the first 10 years, saves the federal government $70 billion and treats everybody the same and creates access to for health care and more importantly, it incentivizes prevention and the management of chronic disease. and, finally, it attacks some of the $100 billion a year in fraud in medicare and medicaid where this bill attacks less tha than $400 million a year in medicaid and medicare. i yield back to the senator. mr. crapo: i thank my friend and colleague from oklahoma because it's frustrating sometimes to have it continuously said that there are no alternatives being

put forward when we have for years promoted major and comprehensive alternatives for the kinds of issues americans are asking us to address today. and what is it that americans are asking? i've said this many times on the floor. americans are asking us to find a pathway to lower health care premiums and costs and to increase access to better quality health care. and yet, what is it that we are being faced with in this legislation? this bill drives up the cost of health care, not down, contrary to claims that have been made on the floor repeatedly, raises taxes by hundreds of billions of dollars, cuts medicare by hundreds of billions of dollars, grows the government by by $2.5 trillion, forces the needy uninsured -- doesn't give them a pathway towards subsidized insurance or any access to insurance. instead, forces them into a failing medicaid program. imposes damaging unfunded mandates on the struggling states, leaves millions of americans still uninsured, establishes massive government controls over our health care economy.

and you wonder why we cannot get engaged in a meaningful bipartisan solution here with this kind of heavy-handed approach being insisted upon. when i talk about the fact that it raises the costs or the size of government, often the response is no, this bill doesn't raise the size of government, it doesn't increase the government. it's -- it's balanced. it -- actually, c.b.o. has issued a report that says it reduces the deficit. well, the fact is that it grows the size of government over a true ten-year period by by $2.5 trillion. now, it does provide some increased taxes -- a lot -- and it does cut medicare, and so by doing so, it does reach an equilibrium according to c.b.o. with regard to its impact on the deficit, but let's not mistake the deficit with the size of the government. this bill will grow the size of the government and the reach of the government by $2.5 trillion.

with regard to the question of whether it truly impacts the deficit also, i think most americans also have already heard that there are some budget gimmicks here. you could not ever claim that this bill doesn't ever increase the budget deficit unless you have all the taxes that i'm going to talk about in a minute and unless you had all the medicare cuts that we have been talking about for the last week and unless you had the budget gimmicks that are in the bill. the budget gimmicks are clearly depicted right here. just look at the first four years of this bill. on the spending side. very little, if any, spending. the actual implementation of the spending part of the bill doesn't happen until 2014. but all the taxes start in the first year. and all the medicare cuts come into place in the first year, and we start seeing the offset side of the bill run for a full ten years. now, it's going to be easy to say that you have balanced out spending and taxing if you don't count the spending for the first

four years. but if you look at that first true ten-year period of time, it's a growth of the government by $2.5 trillion. now, mr. president, what i'm here today to talk about is my -- my motion that's on the floor to do one very simple thing: to commit this bill back to the finance committee and have the finance committee make the bill comply with the president's pledge to the american people about taxes. and what was his pledge? repeated many, many times across this country. in the president's own words -- "i can make a firm pledge, no family making less than $250,000 will see their taxes increase. not your income taxes, not your payroll taxes, not your capital gains taxes, not any of your taxes. you will not see any of your taxes increase one single dime." that was the rhetoric. that was the pledge.

what's the reality of the bill? in its first ten years, the bill raises taxes by $495 billion. if you take that ten-year window that starts in 2014 where you're comparing spending and taxing at the same time, the total of taxes in that ten-year window is is $1.2 trillion of new taxes, a huge proportion of which falls squarely on the backs of the middle class whom president obama has defined here to be those earning less than than $250,000, and that's per family. he said under $200,000 per individual. well, what are some of these taxes that we're talking about? first, there is the excise tax on high cost premium plans. now, one might say wait a minute, that's a tax on companies, employers who provide very high quality insurance to their employees.

it's an ingenious way -- technically it's written that way, but it's an ingenious way to actually increase the cost, the tax base of the workers, not the employer. let's see the first chart. the way this works is the government will now say to an employer you cannot provide health insurance to your employees that is worth more than a certain amount. most employees who get health insurance -- and that's most employees in the country who get health insurance from their employer -- get wages and health care as a part of their total employment package. i have just picked an example here of a woman who receives receives $50,000 in wages and let's assume that $10,000 employer-provided health care benefit. the government's now going to say wait a minute, to her employer, we're going to tax you if you provide that employment benefit -- that health care benefit on such a robust nature. c.b.o. and joint tax have told us that the reaction of the vast

majority of all employers is going to be to reduce the health care benefit down below the level that gets taxed. they are not going to reduce the employee's overall benefit, however, their overall employment package. so let's just pick a number. let's say they reduce this this $10,000 down to $7,000. they'll increase the wages by by $3,000 and the employee's total compensation package stays the same, $60,000. with one difference: now that extra $3,000 is wages instead of health care, and it gets taxed. and that way the individuals in this country see their -- their health care values go down, their total compensation package stay the same, but then get also reduced as it's taxed. and our -- our joint tax and c.b.o. have told us that 84% of this $149 billion new tax is

going to be borne by those with incomes under $200,000. that's one way that this bill ingeniously gets at the pocketbook of those making less money than the 200,000 or 250,000 as a family that the president talks about. what's the next way? medical deductions. i think everybody in america who itemizes deductions knows about the line, first line that says that you can itemize your medical expenses, and to the extent they exceed 7.5%, you can deduct those medical expenses. so people who have a large proportion of their income represented by medical costs get a break in the tax code for that deduction. well, that break is now going to be smaller under this bill because the level of -- where you are able to get it is no longer going to be 7.5%, it will be 10%. and as i indicated, that 84% of

the excise tax is going to fall on people making less than than $200,000 a year, 99% of the medical deduction restriction will fall on people making less than $200,000 a year. as a matter of fact, making a lot less than $200,000 per year. and then what about the next one, the next major tax in the bill is the medicare payroll tax. now, this one has been presented to the american public as a tax on rich people, and it starts out primarily impacting people at the higher levels, but at the outset, it will already hit 345,000 americans, and it's not adjusted -- i think most people understand how the alternative minimum tax works today. it's not adjusted for inflation properly, and so over time, the payroll tax itself is going to increasingly get more and more people in that income category under $200,000. there has been some analysis on

just these three provisions in the bill. joint tax has indicated that by the year 2019, at least -- and i say at least because we're only talking about three provisions in this bill right now, and there are more -- 73 million american households -- not individuals, households, 73 million american households earning below $200,000 are going to face a tax increase. now, some have responded to this by saying wait a minute, our bill actually cuts taxes, and you're not characterizing this fairly. the tax cuts that they are talking about are primarily a a $394 billion government subsidy for purchase of health insurance, a subsidy that will be administered through the tax code. what they don't tell you is that

that $288 -- $288,000 of this so-called tax cut is nothing but a direct government payment to those who don't pay any taxes today anyway. it's not reducing their tax liability. they have no tax liability. it's a direct government subsidy, and c.b.o. says so. it is scored by c.b.o. not as tax relief. it is scored by c.b.o. as direct government spending. and to characterize that as tax relief, i believe, is inaccurate. moreover, even if it was true tax relief, is that what the president was saying, that i won't raise your taxes more than i will lower someone else's? or was he saying to the american people that he would not raise taxes on people who are making less than $200,000 a year or or $250,000 as a family? i believe it's inherently obvious what the president was saying. and to say now that we are cutting somebody else's taxes so

that we can raise yours does not comply with the president's pledge. just to give you another couple of perspectives on this in terms of numbers, when all is said and done, 7% of americans will get this so-called tax relief that is in reality direct federal spending, and the rest of americans, specifically those who don't fall in that category, will get the tax increases. out of 282 million americans with some kind of health insurance today, only 19 million of them will be helped by this subsidy. the rest are going to fall into that category of those who get to share in the burden by seeing their taxes increase. well, but let's say we give credit for all these arguments and say all right, we will let you claim that all of this spending is really tax relief. what's the true story then? even if you give that argument,

which is not valid, by 2019, there will still be at least 42 million households earning below $200,000 who will face a tax increase, and this is information from the joint committee on taxation. and, in fact, the data there is rather interesting. joint tax data indicates that by 2019, individuals earning between $50,000 and $200,000, on average, will see an increase in their taxes of $593. families earning between $75,000 and $200,000 would see on average a net tax increase of of $670. so what does my amendment do? my amendment says very simply that the bill will be committed back to the finance committee and that the provisions in the bill that violate the president's pledge should be removed. simply, make the bill comply

with the president's pledge. the president, frankly, shouldn't sign this bill unless this amendment is passed and implemented, because that's the direction that we need to go. once again, the president's pledge is that no family making less than $250,000 is going to see their taxes increased. mr. president, there is -- there is further information available about this, though. i recently sent a letter to the congressional budget office -- excuse me. was it to the joint tax or the c.b.o.? to joint tax. i recently sent a letter to joint tax asking them about whether there were other provisions in the bill other than these three. the reason i talked about these three taxes is because those three taxes have been analyzed by joint tax and it's joint tax that is telling us what they are going to do. in response to my letter saying are there more taxes in the bill

than just those you've analyzed, the answer has come back yes, and below they say is a list of the provisions that they have not previously distributed and that has statutory incidents on individuals with those who fall below the income threshold which has been defined already. what are these taxes? there's a confirmed definition of medical expenses for health savings accounts. in other words, the reduction of savings in health benefits accounts will have an impact and i believe that impact is about $1.5 billion. the increased penalty for nonqualified health savings account distributions. limitations on flexible spending arrangements. this will raise almost $15 billion. and most of this -- although we haven't got the data yet from joint tax -- most of this coming from families below the income tax thresholds, as well as the 5% excise tax on cosmetic

surgery and similar procedures and the individual mandate in the bill that will force all americans to purchase insurance or the i.r.s. will come and collect a fee from them. i don't have the chart with me here that shows what's going to happen with the i.r.s., but if you can just think in your mind for a minute the current size of the i.r.s. is about $12 billion in terms of the appropriations that we give to the i.r.s. to perform its functions. the c.b.o. says that if this bill passes, there's so much additional business for the i.r.s. in monitoring health care and the new plans and programs in this bill that there's going to have to be at least another $5 billion and maybe $10 billion in the size of the i.r.s., just so that it can implement its enforcement responsibilities under this bill. mr. president, the bottom line here is that the president of the united states, barack obama, has made a pledge. it was that pledge, among a

numbering of others, like if you like what you have you can keep it, that has caused us to see a strong confidence level by the american people but maybe it's time for congress to truly dig in and build a strong health care reform package. and yet that pledge is being squarely broken by this bill. again, mr. president, all we are asking in this bill, in this amendment is to send the bill back to the finance committee and have the finance committee make the bill conform to the president's pledge. and what that will mean to the american people is that in the first ten years of this bill, just under $500 billion of new taxes will not be imposed. and over the truly first ten-year period when the spending starts kicking in, $1.2 trillion worth of taxes will not be imposed. mr. president, there are many other issue with this bill that we have seen discussed. there's the question of whether it truly does increase the cost

of premiums in health care or not. virtually ten out of 11 studies say that it does. and the c.b.o. report says that it clearly for 30% of americans it does in major ways and for the other 60%, the impact is marginal or pretty much status quo. mr. president, as we move forward, some of these big problems with the bill need to be fixed. my amendment -- my motion focuses on taxes. we debated medicare for sometime now. we need to talk about the unfunded mandates on the states. we need to talk about the impact on the premiums. we don't want to be driving up the cost of health care. so i would urge my colleagues to let us just step down for a moment from the intensity of the debate, recommit this bill -- or commit this bill to the finance committee and let us on a bipartisan basis work out some of the solutions to these

problems and do so in a way that does not result in such a massive growth of our federal government, such a massive increase in taxes, such a massive unfunded deficit on the states, and all for no control of costs or health care premiums. with that, mr. president, i yield back the balance of the time that i've requested. the presiding officer: the senator from montana. mr. baucus: mr. president, here we go again. we keep hearing it. the other side keeps saying it. it is the scare tactics. all those democrats do, they say, is tax, tax, tax, tax, tax. that's all they saivment scare tactics. they think they'll scare people into believing something that's not true. the fact of the matter is, mr. president, this bill not

only -- not only does this bill not raise taxes on the middle class, this bill is a tax cut for the americans. this chart behind me shows that. what does that chart say? what does it show? this is taking -- this is individual taxes. we're talking about taxes on individuals in america. this chart shows that in the year 2015, there will be a net tax cut for americans of $26.8 billion. that's a tax cut. now, some -- the other side say, some of those folks aren't even paying taxes. that's true. some aren't. it is a refundable tax cut of about $27 billion. 2017, it is a net tax cut of $40 billion. 2019, a net tax cut of almost $41 billion. that's a combined effect -- i'll read the fine print four. "the combined effects of the increase in h.i. tax, and

medical expense deductions. it is the basic dksz. this is a d. -- it is the basic deductions. this is a net tax cut. for some there is a tax deduction increase but according to c.b.o. that's because those folks are going to be making more money. their wages and salaries are going to go up. i don't know if that chart is there. i don't see a chart meister behind me that can change the charts. so the chart shows that almost for every year about -- it's about a 10% increase in taxes for upper-income -- there it is there -- and about a 90% -- 80% increase in wages or income and that's basically because according to the congressional budget office, anyway, that the high premium excise tax will result in people paying actually lower premiums, 7% to 12% lower premiums as a consequence of the cadillac tax provisions. c.b.o. says that.

it's not my prediction. it is c.b.o., because it is not only passed on in the form of higher wainls and income to people and that's why people will be paying more taxes. but it is because they make more money. wages and salaries are up according to the c.b.o. this bill lowers taxes. at least that's what c.b.o. says. it's one thing to make this allegation that it increases taxes. but c.b.o. says it is a net tax cut in the amount that i just mentioned. turning now to another subject, small business ... one of the goals of health care reform is clearly to assure that small businesses have access to quality, affordable health insurance. and small business has a tough time providing health insurance. that's very true. last year only 62% of small businesses offered health insurance to their employees. compare that with about 99% of companies with 200 or more employees. big business offers health

insurance, small business says they have a hard, hard time. among the very small businesses, fewer than half offered employees health insurance. small business says the main reason they can't provide health insurance the way think want to is because premiums are so high. that's probably true. it's expensive. i have talked to many small business people. i'm quite certain that the senator from vermont, the present occupant of the chair, has run across the same comments from small business people. it is just too expensive. in the past ten years premiums have risen 82% for single workers and 93% for families employed by small businesses. as health care costs rise, small businesses are forced to make workers pay greater proportion of these expensive premiums. last year employees in small businesses provided health insurance paid more than twice what they paid in 1999. so in a period of eight years, the amount they paid -- the

employees paid -- more than doubled. the low rate of offering high cost-sharing responsibilities often limit the ability of small business to attract and retain good employees. and that's why the health care bill before us includes provisions to make quality coverage more affordable for small business and their employees. the bill includes $24 billion in tax credits that helps small business and charitable organizations purchase health insurance for their employees. $24 billion. starting in a couple of years, eligible small businesses would receive tax credits worth up to 35% of the employer's contribution to employee health insurance plans. that's 35%. and next year small businesses will receive tax credits worth up to 50% of the employer's contribution to employee health insurance plans purchased in the health insurance exchange. that is half to th of the cost o

the employer -- the employer could take half of that as a tax credit against the employee's income. to emballify for the tax credits -- to qualify for the tax credits, business would have to cover at least half of their employee costs. the value of the tax credit is based on the size of the business and the average wage paid to its employees. small business tax credit will help make health insurance affordable for many small businesses. that is clear. in 2011, 4.2 million americans will be covered by quality, affordable health insurance because of this credit. on average, small businesses across the country receive a new tax credit of around $5,000 to help them purchase insurance. and the congressional budget office estimates in a the small business credit will help lower insurance costs by 8 for 11% for employees of small businesses who receive that credit. let me say that. c.b.o. says that the small business credit will help lower insurance costs by 8% to 11% for

employees with small businesses that receive the credit. one of the reasons many small businesses are currently unable to afford health insurance is because small businesses lack the buying power that larger companies have to negotiator rates. our bill creates small business insurance exchanges shown as shop exchanges. this is legislation that several senators have suggested. it is called the "shop" act. they can pool their risk and enhance their buying power. these state exchanges will be a critical tool to help businesses with fewer than 100 employees "shop" for their employees to buy health insurance. small businesses about prosper and grow beyond 100 employees would be allowed to continue shopping in the exchanges. insurance plans sold in these exchanges will be subject to the same transparency so that small

businesses can feel confident that they are purchasing high-quality plans and will be provided quality, affordable coverage for their workers. one more point. we all talk to small business people. tiement and timed and time again -- time and time and time again they say they would like to provide insurance. but sphwhaps the insurance company comes along and says, we're going to raise your premiums, 20%, 30%, 40%. why? we found out one of your employees has a preefnlt so we're going to -- we found out one of your employees has a preexisting condition. so we're going to raise yours premiums. i've talked to a -- i remember one businessman in billings, montana, a small contractor. his heart sunk when he got that notice from the insurance company. he decided to keep the employee, a valuable employee. the employee has been working there for a good period of time. he is not going to, you know, fire that employee. so he shopped around.

he finally found another insurance company. the increase was not 30%. as i recall, it was in the nature 206%. but the point is this: small business people face this great variety in premiums. they go up this much and that much. it's because this terrible situation we have where companies can deny coverage based on conditions and health care status and so forth, and different states have different rating rules and so on. this will help small business by getting more stability and more quality. insurance plans sold, as i said, will be subject to the same transparency requirements and consumer protections that other individuals will also find available. the health care bill before us also institutes reforms in the insurance market that protects small businesses and individuals. these reforms will stop insurance companies from denying coverage based on preexisting conditions.

passing health care reform is critical to small business. without reform, many small businesses will be forced to drop their health coverage insurance because they'll no longer be able to afford the increasing premiums. that would leave many employees to fend for themselves in the individual market. the congressional budget office tells us that these reforms will make coverage more affordable for millions of small business employees. the small business tax credit will help reduce health care costs for small businesses and their employees and as a result the larger health reform proposals in this bill, there will be an increase in the percentage of small officials that offer health coverage. mr. president, i ask consent to extend the period for debate only until 4:30 with the time equally divided with senators permitted to speak up to ten minutes each with no amendments in order at this time. the presiding officer: without objection. ms. snowe: mr. president? the presiding officer: the senator from maine. ms. snowe: thank you, mr. president. i ask unanimous consent to speak up to 20 minutes.

the presiding officer: without objection. ms. snowe: thank you, mr. president. mr. president, today the senate is addressing the future of health care in our nation, both americanamericans's aamericans'. the imperative to clear that we must address rising cost costs r affordable access cannot be achieved and sustained. that is why i am joining senator dorgan, who has been a relentless champion on the issue of drug importation in proceeds this legislation so that -- the amendment to this legislation so that americans can safely and affordably access the medications they rely upon to improve health in which the industry has reminded us time and again are critical to reducing severe illnesses and hospitalization and, of course, extending life. senator dorgan has long been the senate's tireless leader. in fact, it's been more than a decade, as i recall, when he began to pursue this endeavor

and this journey. in seeking to end the inequity which resulted when americans were barred from importing less expensive medications. he has reminded us regularly of the trade inequity which has been imposed on consumers and he's also reminded us and his colleagues that drug importation conducted with proper measures provides a route to improving access to lifesaving medications. so i'm pleased to have joined him in this effort once again along with senator mccain, who's been a stalwart on this issue from the very outset and a tremendous advocate and a driving force. and, of course, the presiding officer, the senator from volume volume, senator sanders, who, of course, throughout his career has been pursuing and advocating this inequity to be remedied once and for all. we introduce this legislation -- introduced this legislation back in 2003 for the very first time. we worked on a comprehensive approach requiring -- required to address the safe, economical importation of medications.

i well recall the efforts as well, the yeomen efforts of the late senator kennedy, who, of course, himself worked relentlessly to remedy this flaw in our policy. along with senator grassley, senator stabenow and vitter, whose bipartisanship on this vital question has also been instrumental. as we advance this cause for the better part of a decade. it has been a greater undertaking than i think many would have surmised or anticipated, frankly, mr. president. there can be little doubt, frankly, of the effort that -- the need to reduce health care costs. it poses one of the greatest challenges in health care refo reform, and that's why the senate finance committee, under the leadership of chairman baucus, has worked mightily to incorporate provisions in the pending legislation to bend the cost curve. and let there be no mistake, the resistance to reforming spending has been immense. that is in part because, as so often has been said, one man's waste is another man's profit. and so while other nations pay

35% to 55% less for their prescription drugs than the united states, we have continued to pay the world's highest prices for brand drugs for the past decade, despite nearly ten years of effort to provide for the safe importations of prescription drugs. fortunately, that has not deterred a broad bipartisan call to arms on this issue. despite the industry's actions, it has blocked attempts after attempts to provide americans both access and assurances that imported drugs would be safe. indeed, this issue of both safety and affordability has drawn a bipartisan coalition which has been a model for how we can work together to address this health care problem. we created legislation which the congressional budget office previously estimated would save our nation approximately $50 billion over ten years. now the c.b.o. has not yet estimated the total savings to consumers but has projected a savings to the federal government alone of

$19.4 billion. since the federal savings was prl 20% of -- approximately 20% of total savings in the past, one can hypothesize dramatically increased consumer savings likely approaching $80 billion, mr. president. these are exactly and precisely the kinds of savings that we must advance today. one can easily see that the failure to act on this legislation since its introduction april of 2004 has needlessly carried a high cost for the american people, made all the more egregious and unacceptable given these difficult economic times, as even more americans are reducing or skipping dosages or foregoing medications altogether. and this problem isn't going to get better, mr. president, it is regrettably only going to get worse. the trend is undeniable and unabated. we're all painfully aware of the price increases in brand-name prescription drugs this year. they bear absolutely no relationship whatsoever to the overall economy. manufacturers have increased the

price of brand drugs by an average of 9% just as inflation measured by the c.p.i. actually fell by nearly 1%. and as you can look at this chart here, you can demonstrate the contrast in increases. so again, brand drugs increasing 9%. here are generics and here's the c.p.i. mr. president, it's truly i think emblematic and reflective on this chart how actually prices have been decreased by the same amount, that brand drug prices have escalated. in other words, just as we're working to expand coverage to tens of millions of more americans, we have the industry establishing a new pricing baseline that is entirely off kilter with the rest of the economy just in comparison between the c.p.i. and the cost of brand-name drugs. so it's widely unaffordable for american people, clearly unsustainable for the fewer. so how can we possibly not act on this amendment?

this is an industry that has offered $80 billion in concessions towards health care reform. approximately $8 billion over the next ten years. now, one would consider that our annual spending, while just with this single price increase of the 9%, imposed over $290 billion in drug spending, with over two-thirds of that amount representing brand drugs. so it is clear that this single price increase alone, this 9%, will yield at least twice as much as the industry has pledged to reform in the pending health care reform legislation. well, frankly, mr. president, that is the cost-shifting of the worst kind because it occurs on the back of the american taxpayer, most especially on those in the greatest need who are also the least able to afford these exorbitant prices. and there should be no mistake, these most recent increases are following the patterns we have witnessed year after year after year.

well, how do we know, mr. president? well, following the passage of the medicare modernization act, senator wyden and i requested that the g.a.o. track drug price trends, including looking back to before the bill was enacted. and what did we find? well, first, that the price of brand drugs has escalated two to three times the rate of inflation. that means that $100 in drug costs in 2004 has grown to more than $140 today. well, tell me, whose income has increased by that amount in just the last five years alone? these unabated, escalating costs for drugs are only widening the already yawning gulf of unaffordability for the american people. but that's not all, mr. president. when senator wyden and i examined the g.a.o. data, we also discovered that just as we neared the achievement of a prescription drug benefit under medicare, the rate of price increases actually rose faster. now, history also appears to be repeating itself once again, to

the everlasting detriment of all those whose health security depends on medications. one year ago, the associated press reported a startling find that for the first time in a decade, prescription drug use was down. and given the rising costs imposed on struggling american families, that should come as no surprise. it also should serve as a wake-up call, an alarm bell. we're long past the point where we should heed einstein's timeless truism that one shouldn't keep doing the same thing over and over again and expect a new result. and the fact is, we simply cannot assume that pledges of savings in the form of the industry's monetary concessions to health reform actually amount to real fundamental reforms or that drug assistance programs are a substitute for a market which brings consumers better value. they are not. it is clear that the time for enactment of this legislation is long overdue, and, frankly, more urgent than ever. as illustrated by this second chart of unfilled prescriptions.

just looking at it, you can see how the unmet need for medications has actually increased since 2003, mr. president. among working-age adults, only those with medicare coverage experienced any improvement in their ability to fill their prescriptions. all others saw a rise in their inability to obtain the necessary medications. among the uninsured, more than one in three individuals went without a required prescription. and those with chronic diseases, that number doubles. this is a travesty, mr. president, indisputably, despite manufacturers assistance programs, despite the increased use of generics, the high and escalating costs of brand-name drugs has directly -- is directly and negatively affecting the health of millions. that is why our voices today echo those of an overwhelming seven out of ten americans who have called for lifting the ban on prescription drug imofortation.

importation. now, let there be no doubt, this is a mandate for action. the president has added his voice to ours, calling for safe drug importation as one means to addressing health care costs which threaten the health of americans in pairous economic times. bottom line is when nations instituted safe, regulated trade in pharmaceuticals, they achieve results, as sweden did when it entered the european system of and saw a reduction of 12% to 19% of traded drugs. now, opponents claim importation will cause american consumers harm. and for those who did express concern about safety, no one shares the sentiment more than i do. let me be unequivocal in stating that safety is the town foundatf this legislation, mr. president. our constituents have taken action repeatedly to purchase drugs which they could afford mostly in canada -- certainly true in my state of maine, it's true in the state of vermont, the presiding officer's state. it has been demonstrated time and again that importation is

safe. we can ensure americans' safe access to imports. in europe, over 30 years of parallel trading of pharmaceuticals has demonstrated indisputable safety. in fact, a former pfizer sales executive, dr. peter ross, has stated from his firsthand experience in europe -- and i quote -- "i think it's outright derogatory to claim that americans would not be able to handle reimportations of drugs when the rest of the h educated world can do this." it's more point to a recent f.d.a. letter cautioning that drugs must be demonstrated to be safe and effective, that they must be manufactured under the highest standards, that an imported drug must be demonstrated equivalent to existing products used domestically. and that we must guard against contamine nations and counterfeit drugs. mr. president, this amendment does each of these things and much more to ensure that americans can safely have access to safe imports. under this legislation, we see

with this next chart, we would import drugs from 31 countries which meet our high regulatory standards. those are shown in blue on this chart. they are nations with meet our high standards and individuals who purchase an imported prescription drug from their local pharmacist -- pharmacies will receive these drugs from u.s. wholesalers, which import them. these wholesales would be registered, inspected, monitored by the f.d.a. this higher level of safety is a first step in establishing a higher standard for the handling of prescription drugs in the united states. our legislation also allows individuals to directly order med indications from outside the united states when using an f.d.a. registered and approved canadian pharmacy. and again, just with wholesalers handling prescription drugs, the f.d.a. will examine, register and inspect these facilities on a frequent basis. f.d.a. will assure the highest standards for such essential functions as recording medical

history, verifying prescriptions and tracking shipments. and regardless of whether the purchase is from the local pharmacist or a canadian pharmacy, we assure that a legitimate description and a qualified pharmacist are required to help assure safety. now, for those who say that consumers could unwittingly purchase an unapproved or suspect drug, our legislation assures that drugs received will also be -- will always be f.d.a. approved. if any different exists in a foreign drug, even the most trivial of distinctions, our legislation assures f.d.a. will evaluate the product and determine its acceptable. senior foes who say counterfeiting is a threat, our legislation requires the use of anticounterfeiting technologies to protect drugs. today we can thwart counterfeiting by employing technology like the one used in $20 bills. and our bill not only uses

counterfeit technologies but also a standard identifier unique to each package of a drug. moreover, this bill supports the development of new anticounterfeiting in track and trace technologies which we hope will be used to protect all drugs. for those who say the consumers won't know who has handled an imported prescription drug, our bill requires a chain of custody, otherwise known as a pedigree. it would be maintained and inspected to help ensure the integrity of imported drugs. a pedigree for medicated was mandated by law in 1988. 1988, madam chair, and has still not been implemented and this bill will change that. for the first time, in fact, this legislation will include resources to inspect all facilities handling medications so we're not just making imported drugs safer but also domestic drugs drugs, madam pre.

now, some attempt to alarm americans about the countries from which we would import drugs, citing nations such as latvia, estonia, slovakia. well, madam president, last time i checked, these are members of the europe peen union -- of the european union. and the same is true for ireland, for example, where lipitor is made. so let me get this straight. it's fine for those companies to manufacturer drugs in their plants for domestic u.s. companies and ship those drugs here where we then have the privilege of paying higher prices than anywhere else in the world? but we somehow cannot safely import drugs made in those same countries. well, madam president, exactly what kind of sense does that make? in fact, going back to this chart where the european union and other countries from which we would import up here in blue. all those countries are in blue, are areas in which this amendment will allow the importation of drugs which we see in frequent f.d.a.

inspections are in these red countries. all these countries that are designated in red, madam president, are the ones in which we have manufacturers importing ingredients are the final product in these countries, and yet there are infrequent f.d.a. inspections. the chart shows, and right now that today that drugs that are sold and consumed in the united states where there are few f.d.a. inspections. in fact, it's been estimated that approximately 40% of the active ingredients in prescription drugs consumed in the united states are actually made in india and china. and we know that oversight there is lacking. in fact, such plants may be inspected as infrequently as every 12 years. currently there are more than 3,200 foreign manufacturing plants that make medications for the united states market,

according to g.a.o. the g.a.o. also found that f.d.a., in the words of an associated press article in the matter, isn't even sure how many foreign facilities are producing for the american market. one government data base suggested 6,760. another says about 3,000. and with the explosion of drugs coming in from nations like india and china as reported in "the washington post," the f.d.a.'s budget for foreign inspection has not kept pace. as a result, the 2007 foreign drug and drug ingredient makers are inspected once every 12 years, while american-based manufacturers must be inspected at least once every two years. the article also reported that china itself has more than 700 plants. but the f.d.a. only has the resources to conduct about 20 inspections a year there. so let me just indicate on this chart again, madam president,

we, under this amendment that is pending before the senate, would allow drugs to be imported from those countries designated in blue. the countries that are designated and reflected in red are those countries where we currently manufacture the ingredients of the final product. we're not suggest that go drugs be imported from these nation. and yet our legislation will make it safer because of the resources that we have incorporated in this legislation before the senate and all of the standards that will be required for f.d.a. to inspect these facilities that are currently not inspected. we have seen the dangers in ignoring these problems. that is why the legislation would fund enhanced f.d.a. inspections to fundamentally improve the safety of drugs consumed in the united states, but that's not all. while opponents will cite current law in drug importation, the fact is the medicare modernization act, theurrent drug importation statute which

has never been implemented, there are just six safety provisions over as many pages detailed in this chart versus the 31 major provisions in our amendment. when we pass the medicare modernization act back in 2003, we included safety features because we heard from many of our colleagues they simply did not want to have drug importation. they claimed we had to have the safety certification process which we've had numerous times for the last decade to which nothing has advanced with respect to drug importation. obviously a safety inspection hasn't been made because we haven't given resources. we haven't really implemented that in good faith. yet, under the pending amendment we incorporate 31 major provisions in our legislation to address each and every issue. we systemically analyze, identify every issue that had been raised by the opponents to the drug importation legislation. every safety-related issue, every standard-related issue,

every failure that has occurred with respect to the f.d.a. inspection system and where they're importing drugs currently, where they have not inspected those facilities. we have 31 different provisions, madam president, in order to address every facet of safety-related issues. so for those who say importation isn't safe, we show that it shall be. and this legislation will set a model and a mandate for improving safety in the handling not only imported prescription drugs, but of all medications, even domestic ones. if that's not enough, let me also suggest to opponents of this legislation that they are failing to observe the greatest threat to safety threat to americans, and that is the inability to take a drug as it is prescribed undoubtedly. it exacts the toll of thousands of american lives every year. without question our measure addresses the crucial issue of

safety. i think that is indicative and reflective on this chart here today of all of the provisions that have been incorporated in the pending amendment before the united states senate, because, madam chair, this clearly will deliver the real savings as well as safety for consumers. and organizations across the board are supporting this legislation that represents more than 50 million americans because they realize extending this coverage is fundamentally critically important to the well-being of all americans. the presiding officer: the senator's time has expired. ms. snowe: thank you, madam president. mr. baucus: madam president? the presiding officer: the distinguished senator from montana. mr. baucus: madam president, i ask consent that the senator from new jersey be allowed to speak for longer than ten minutes, under the previous order which i think restricted speakers to ten minutes. i ask consent that be changed to speak for longer than ten minutes and yield 15 minutes to

the senator from new jersey. the presiding officer: without objection. the senator from new jersey. mend mend thank you, madam president. i thank the distinguished chairman of the -- mr. menendez: thank you, madam president. i thank the distinguished chairman from montana for yielding the time. that is at its core, i believe, a regressive amendment. this amendment, however well-intentioned, reminds me of a time when the lack of sufficient regulation allowed people to sell snake oil and magic elixirs. let us not relive that history. let's learn from it. i'm sure many in this chamber remember a time when the doctor wrote a prescription, we would take to the local pharmacy. and the one thing we never did was question what was in the bottle. now with this amendment, we won't be so certain.

we won't be so sure that what's in the bottle is what we need and think it is. we won't be so sure when it comes from countries all over the world -- lithuania, estonia, latvia, the chuck republic, or any one of 28 countries -- i'll speak to that. i know they're part of the european union but i'll talk about what the european union just said about their challenges with counterfeit drugs or any of the other countries who have proved to make tainted medicine, medicine, -- we won't be absolutely sure of the conditions under which it was manufactured, whether it's safe to use or where its ingredients originated. madam president, health care reform and lowering costs does

not mean we should roll the dice with the health and safety of the american people. now, i appreciate my colleagues' interest in bringing lower-cost drugs to the market. in fact, i agree with him. but we cannot risk the health and safety of the american people in order to do it. and i'm afraid this amendment would do just that. let me -- we've heard a lot about the f.d.a., the food and drug administration. yes, they are the ones who safeguard americans from having the wrong type of drugs get into our marketplace or making sure that the right type of drugs are approved and the wrong ones stay out. i've heard the stories of americans searching for affordable prescription drugs and either going online to get them or traveling sometimes. but we have to ensure the drugs they buy are not counterfeit, not tainted, not substandard, and that they are what the

doctor ordered and will work. this amendment would undo current safety protections that ensure that patients are getting prescription medications that are the same in substance, quality, and quantity that their doctor has prescribed. so let's see what the f.d.a. said. in this letter from the food and drug administration just issued the other day to one of our colleagues here in the senate, commissioner hamburg of the food and drug administration said there are four potential risks to patients, in her opinion, that have to be addressed. first, she's concerned that some imported drugs may not be safe and effective because they were not subject to a rigorous regulatory review prior to approval. second, she says the drugs -- quote -- "may not be consistently made, high-quality product because they were not manufactured in a facility that

complied with appropriate good-manufacturing procedures. third, the drugs -- quote -- "may not be substitutable with the f.d.a.-approved products because of differences in composition and manufacturing. and, fourth, the drugs simply -- quote -- "may not be what they purport to be" because inadequate safeguards in the supply chain mail out contamination or worse counterfeiting. in addition, the f.d.a. went on to say, it cited significant -- quote -- "safety concerns related to allowing the importation of nonbioequivalent products and confusion in distribution and labeling between foreign products and the domestic product. the f.d.a. is also concerned that it does not have clear authority over foreign supply chains. in other words, there's a very real risk that imported drugs

either won't make you better or, yes, could very well make you worse. one reason we never question what's in the bottle when we go to the pharmacy to fill our prescription is because the u.s. drug supply system is a closed system. that's why it's one of the safest in the world. everyone in the system is subject to the f.d.a.'s oversight, to these very standards, and to strong penalties for failure to comply with the law. f.d.a. would have to review data to determine whether or not the non-tpao*d -- the nonfood and drug administration approved drug is safe, effective and substitutable. in addition, the food and drug administration would need to review drug facilities all over the world to determine whether or not they manufacture the high-quality products consistently. madam president, it's clear that our -- keeping our drug supply

safe in a global economy in which we cannot affect the motive and willingness of others to game the system for greed and profit is a monumental task. it is not simply allowing for the importation of lower-cost medications as the proponents of this amendment would have us believe. it will require a global reach, extraordinary vigilance and a serious investment to enforce the highest standards in parts of the world that have minimal standards now. so we don't have to ask which drug is real and which is counterfeit, so we don't have to wonder if the packaging looks the same. is it approved, tamiflu or is it counterfeit tamiflu? packaging looks the same, but is the content the same? one is approved. one is counterfeit. and when the swine flu is coming

through, as everybody started trying to get ahold of tamiflu, and what do they do? they went online, a lot of them got countertamiflu, which didn't do the job. in this, the answer is no. one is counterfeit. one is real. you can't tell the difference. is this helping people save money if they pay for a counterfeit product? is this effective treatment for h1n1 flu if you've been fooled by a counterfeit bottle of tamiflu because you thought it was cheaper? no. how is this in the best interest of the american people? here's another example. lipitor. can you tell which is counterfeit or approved lipitor? they look the same. americans who purchase them are told they're the same, but how do you tell the difference? most people can't. and so they'll go about their

normal routine each morning taking the so-called lipitor, thinking they're treating their high blood pressure, but really they're walking around with the same silent killer and not taking the appropriate medication for it. another exampleice -- another example, arecept. can you tell the different between the pills in this photo? no, and that's the problem. global economy opens up global possibility conviction to counterfeiting -- possibility to counterfeiting these drugs. it opens up the possibility for these drugs to find their way from nation to nation much from southeast asia where the problem is epidemic, to one of the 32 nations listed in the amendment that are supposedly safer and

then all th ultimately into amen homes. that is a gamble we cannot afford to take. we shouldn't have to wonder what's in th in the bottle. americans suffering from alzheimer's shouldn't have to wonder if the drug they're taking is real or counterfeit by the time they figure that out buying a drug either online or abroad that is counterfeit or not of the same substance or of a different dosage, it could be too late to help reverse the damage that was promised. one final example, celebrex, used to treat arthritis and chronic pain. can you tell the difference between these bills? no. and neither would those who continue to suffer if they're scammed into buying the counterfeit version. one is approved. one is counterfeit. i fully appreciate my colleague's desire to keep the

cost of prescription drugs down. but our first task is to protect the safety of americans and to prevent counterfeit drugs from infecting the american market. the real problem here is bringing down the cost of prescription drugs as part of overall health care reform. and the real solution is expanding access to affordable drugs here in the united states. now, i've heard several of my colleagues refer to 9% increase. what they fail to do or mention is to take the deep discounts that the industry provides, particularly to government and other entities, against that increase. they don't do that. because, of course, it doesn't serve their purpose. now, in this fight to create affordable drugs here in the united states, i take a backseat to no one. but at the same time i strongly believe we cannot roll the dice with the health and safety of the american people.

this amendment is that roll of the dice. you should never put americans in the position of having to worry about whether their medicine will make them better or worse. we should never put americans in a position of wondering, is that a real pill or is that a poison pill? now, to see what happens if we allow importation, we only need to look to the european union. one of my colleagues earlier today used it as example as to why we should pass this amendment. but i listened to the words of the european union and i hear quite the opposite. earlier this week the european union commissioner in charge of this issue said and i quote -- "the number of counterfeit medicines arriving in europe is constantly growing. and the european commission is extremely worried." to quote another section of the statement. "in just two months, the european union seized 34 million

fake tablets at custom points in all member countries. this exceeded our worst fears." it went on to say -- quote -- "every fake drug is a potential massacre. even when a medicine only contains an ineffective substance, this can lead to people dying because they think they are fighting their illness with a real drug. i expect the e.u. will agree in 2010 that a drug's journey from manufacturer to sale should be scrutinized carefully." and it goes on to talk about other safeguards. so, in fact, the very essence of what some claim is the reason should be allowed importation, the european union, they say quite the contrary, they think this is a huge problem for them and that, in fact, what seems like maybe an action that would not hurt someone can actually mean the difference between life and death. i don't want american families

to see those fears come to life here. yes, counterfeit drugs may happen, but if we pass this amendment, we just open the floodgates. the european union's experience only confirms my concerns, not alleviates them as some suggest. a $75 counterfeit cancer drug that only contains half of the dosage that that person has been described and needs doesn't save americans money and certainly isn't worth the price in terms of dollars or risk to life. let us not now open up national borders to insufficiently regulated drugs from around the world. and, finally, and a different dimension, i think that safety is utmost. at a time of joblessness in this country, we are attacking the one last major research and manufacturing entity here in the united states. i don't want to offshore those jobs abroad to allow

contaminated and counterfeit prescription drugs to come into this country. the one that has been at the forefront of the health care reform effort has put $80 billion of its own money in for reform, i want to see more partners like that in this process. so let us reject this amendment. let's keep our drug supply one of the safest in the world. and with that, madam president, i yield the floor. a senator: madam president from the senator from upon tan -- mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: i ask that the time equally divided and senators permitted to speak up to 10 minutes each with no amendments in order. the presiding officer: without objection. mr. baucus: i ask for the absence of a quorum and that the time be equally charged to both

sides. the presiding officer: without objection. the clerk will call the roll. quorum call:

quorum call: the presiding officer: the senator from north dakota. mr. dorgan: madam president, i ask the quorum call be vacated. the presiding officer: without objection. mr. dorgan: madam president, i have listened this afternoon to some of the opposition to the legislation. the amendment that we have offered trying to deal with the increasing price of prescription drugs and the -- those who are opposed to it really apparently are oblivious to the question of the dramatic runup in prices for prescription drugs. they talk about counterfeiting and their worry about

counterfeiting. i want to talk about that a little bit because if you're ward about counterfeiting -- and by the way, there is a counterfeiting issue with respect to prescription drugs in this country and several of my colleagues have described that issue. if you're worried about that, then you have to, it seems to me, support the amendment that i and senator mccain and others have offered here that provides the only basis for getting to things like pedigree on prescription drugs, batch lots, tracers, and so on. the only mechanism to do that is in this amendment which will make the domestic drug supply safer, allow us to track back drugs to their origin, and will certainly allow us to import the f.d.a.-approved drugs when they are sold in other countries for the fraction of our price. madam president, let me just describe what brings us to the floor of the senate, and i would say to those that are -- that oppose this amendment, if one wants to be oblivious to this, i

guess fine, but the consumers will certainly knots. want to go buy some nexium? well, guess what? nexium is going to cost you $424 in this country, but if you buy it in britain, it's $41, buy it in spain, it's $36, buy it in canada, $65. germany, $37. once again, the american consumer gets to pay $424 for an equivalent amount. ten times the cost of what it costs in great britain. fair? not to me, it's not. it's not fair to me that the american consumer is charged the highest prices in the world. plavix, you can see what's happening here. $133, $59 in britain, $58 in spain. the american consumer gets to pay $133 for the equivalent amount. lipitor, the most popular

cholesterol-lowering drug. for an equivalent amount of lipitor, we get to pay -- an american consumer pays $125. in great britain, they pay $40. in spain, they pay $32. in germany, they pay $48. again, the american consumer is told no, you get to pay $125. i have described over and over again the two bottles of lipitor, empty bottles, made in ireland by an american corporation and distributed all across the world. the most popular cholesterol-lowering drug. same pill put in the same bottle made by the same company, f.d.a.-approved. the only difference is this one has a blue label, this one has a red label, this one went to canada, this one went to the united states. and the united states consumer got to pay nearly triple the price. fair? not where i come from, it's not fair. and by the way, in the past

year, my colleague from maine who spoke moments ago talked about a nearly 10% increase in price for brand name prescription drugs just this year. this shows what's happening. arthritis drug called enbrel. if you were taking that, this year you got a 12% increase. singulair for asthma, this year a 12% increase. boniva for osteoporosis, this year you got an 18% increase for your drug costs. and the list goes on. plavix, an anticoagulant, 8% up this year. in fact, i have a chart here that shows what has happened year after year after year. the price of brand name prescription drugs in the united states is up way above the rate of inflation in every single year. in fact, during this year, the rate of inflation has dropped down here and the price of prescription drugs has gone up

9.3% this year. now, my -- several of my colleagues have -- at least a couple of my colleagues have come to the floor and talked about the issue of counterfeit drugs. i'm concerned about counterfeit drugs as well. in fact, there were proposals here in this country, in the congress that would have done what we should have done long ago with respect to the -- to insuring a safe drug supply. attaching pedigrees to drugs, batch lots so you can trace them all the way back to their origin and trace them all the way through the chain of custody. that's never been done and it should be done and it's in our amendment. it's the only way you're going to have a safe drug supply, totally safe drug supply. a couple of my colleagues have talked about a couple of circumstances where there have been counterfeit drugs in this country. that's true. that's true. those were domestic drugs, drugs inside this country. and by the way, how does some of

that happen when you have not only counterfeit drugs but contaminated drugs? 40% of the active ingredients in u.s. prescription drugs come from india and china. think of that. 40% of the active ingredients of all the prescription drugs consumed in our country comes from india or china. and i described earlier today a "wall street journal" investigatory report which shows the circumstances with the active ingredient for heparin, the production of heparin in a -- in a building in china. this, by the way, shows the development of pig intestines for the production of heparin. you will see -- "wall street journal" articles, in the expose, here is a man in this building in china that is producing heparin that is stirring a rusty old pot with what appears to be a twig from a

tree. in clearly unsanitary conditions. and that becomes ingredients for america's prescription drug supply, 40% of our active ingredients come from circumstances in which there is virtually no inspection or very few inspections of those kind of places where those prescription drugs are developed. and by the way, there was a drug that was produced by a pharmaceutical company, a very reputable one. there was a wonderful book written called "dangerous doses" by katherine eban. she traced this drug to a 16-year-old boy named timothy afghanan whose health was

dramatically affected by what has happened here. this drug, by the way, found its way all the way through these places, including -- it is expected, including a strip joint in miami, a cooler in the back of a strip joint in miami, in the trucks of automobiles, distributed through all sorts of strange and unusual places and gets to a 16-year-old boy with devastating results, devastating results because this drug had 1/20 of the strength that was supposed to have been given to this young boy for his disease. now, does anybody have the capability to understand where all this happened, how it got tracked? no, a journalist did the investigative work to find this out. fortunately for us, we now have a track on this one drug that affected this young boy in a

devastating way. that's not reimportation. that's the domestic drug supply. how can this happen? because we don't have batch lots and pedigrees and tracers and the capability to find out where is the drug produced and where does it go from that production to the final user in every single circumstance. we have that in our amendment. it is the only way it will happen in this country if we pass this amendment. now, it is interesting to me that there was a man named dr. peter rost. dr. rost was the former vice president of marketing for pfizer corporation. and by the way, dr. rost also worked in europe in the parallel trading area for 20-some years. they do this in europe routinely. they actually have parallel trading where you can purchase drugs one country to another, no problem. the biggest -- here's what he says. the biggest argument against

reimporttation is safety. what everyone has conveniently forgotten to tell you is that in europe, reimportation has been in place for 20 years. so they all say oh, this is going to be unsafe, you can't do it. europe has been doing it 20 years. don't tell me we don't have the capability to do that. if europe can do it, we can do it. now, why would we do it? because it's -- it's unfair to the american people to be paying double, triple, or quadruple or ten times the cost of prescription drugs that is being paid for by people in the rest of the world. that's unfair. it doesn't make any sense to me. so we offer an amendment. it is one of the few amendments here in the united states senate in recent days and weeks that is bipartisan. most of the things that have been offered here aren't bipartisan. this is an amendment dorgan-snowe. we offer it with broad support. the late ted kennedy, bless his soul, sat right over there.

he was a cosponsor of our amendment. john mccain, senator john mccain, a cosponsor of our amendment. senator grassley, senator stabenow. madam president, let me ask consent for five additional minutes. the presiding officer: without objection. mr. dorgan: this is broadly bipartisan, and it's one of the few bipartisan amendments -- and my expectation is that we will have a vote on the crapo amendment. he offered his last evening, and i offered mine last evening, and my expectation is that we'll have a vote on the crapo amendment and then have a vote on this amendment and move on. i would hope that we'll have the votes on this because it is the only thing in any health care proposal in the house or the senate that starts to put the brakes on the escalating prices of prescription drugs. it is the only thing. without this, we will pass health care reform if, in fact, it passes, and if someone says to you what have you done to try

to put the brakes on the fact that prescription drugs are increasing at 9% and 10%, what have you done about that? and the answer is going to be well, we didn't do anything about that, just couldn't do that. the fact is a whole lot of people in this country use prescription drugs regularly to control their cholesterol, control their bloop -- their blood pressure and otherwise manage diseases, and it keeps them out of the hospital. the fact is many of these prescription drugs are very important in the lives of people. and so the question for us is if we're allowing these drugs to be priced out of the reach of people, what does that say about the value of the drugs? i mean, we need to have fair pricing for the american people. we must insist on fair pricing for prescription drugs for the american people. it's that simple. and this -- this notion of there being any kind of a safety issue

is a total canard by those who want to ignore the very provisions of the bill that establish those rigorous -- the most rigorous regime of safety that has ever been established for the domestic drug supply and for the reimportation of prescription drugs. that's just a fact. so my hope is that in very short order, we will have an opportunity to have the members of the united states senate cast their votes on this and at long, long last senator snowe and i, having been at this i think now for eight or ten years, will have at the right time -- that's health care, when you're considering health care, when is the more appropriate or more appropriate time to consider the pricing of prescription drugs, at the right time and the right place we will have been able to get this legislation passed. we offer a bill now as an amendment. 30 senators having cosponsored it, republicans and democrats, conservatives and liberals and moderates having sponsored it, and it's my expectation that we will have this vote and at long,

long last be successful in doing something for the american people. the question is does the pharmaceutical industry have a lot of clout? the answer is they sure do, sure do. i -- as i said many times, i have no beef against that industry. i want them to succeed, i want them to earn profits. i think their pricing strategy is unfair to the american consumer. do they have a lot of clout? yeah, they do. but it's my hope that when it comes time for a vote, the american people and the interest of the american consumers will have as much clout in this chamber, just based on the facts, the facts that suggest the american people ought to be treated fairly. this amendment is all about freedom, giving the american people the freedom to do what we have given everybody else to do, and that is participate in the global marketplace, and when the medicine they need that is f.d.a.-approved medicine is available somewhere else for half price or for an 80% reduction, why on earth should they not be able to acquire that lower priced drug that is f.d.a.

approved? the answer is they should have the freedom to do that, and the only way that freedom will exist is if we pass this amendment. that's just a fact. madam president, i yield the floor. the presiding officer: the senator from montana. mr. baucus: madam president, i yield the time remaining on our side to the senator from maryland. the presiding officer: the senator from maryland is recognized. four minutes and 40 seconds. mr. baucus: mr. president, i ask, notwithstanding the prior agreement, the senator be allowed to speak for how many minutes? 10? 10 minutes. the presiding officer: is there objection? without objection. mr. cardin: and i would ask unanimous consent, madam -- [inaudible] mr. baucus baucus: he would liko speak for 15 minutes following the senator from maryland. i ask consent that be allowed. the presiding officer: without objection. the senator from maryland. mr. cardin: madam president, i ask unanimous consent i would be able to speak as if in morning business. the presiding officer: without objection. mr. cardin: madam president, we

live in a world that is being poisoned by greenhouse gases of our own making. if we do not act, we face irreversible, catastrophic climate change. my grandchildren face a world where there will be not enough food, water or fuel, a world that is less diverse, less beautiful, less secure. as i speak today, we are witnessing a critical moment in our fight against global warmi warming, both at home and abroad. this past monday, the environmental protection agency acted by releasing its final determination that greenhouse gases threaten the public health and welfare of the american people. this was an action required by law and ordered by the supreme court. this finding will require e.p.a. to regulate greenhouse gas emissions under the clean air act. monday's endangerment finding is a critical step in our country's effort to stop global warming, which not only poses a threat to

public health and welfare but to our national security. i am proud of the strong, science-based actions taken by this administration to live up to its clean air obligations to protect our health. but i strongly believe that the best way for our country to solve the problem of greenhouse gas emissions is through comprehensive legislation enacted in the congress of the united states. legislation that invests in clean energy and new high-tech infrastructure will bring us to a long-sought goal of energy independence, good jobs for our citizens, and a healthy planet for our children and grandchildren. we are now closer to that kind of legislation than we have ever been. the house has passed a bill that puts a limit on pollution in our air. it dedicates funding to develop new domestic sources of clean energy. it invests in new infrastructure that is less dependent on foreign fuels, creates american

jobs -- and we really need those jobs. here in the senate, we have improved on our colleagues' wo work. senate legislation makes additional investments in clean transportation. it provides additional oversight and accountability and support for developing countries. it ensures that we do not add one penny to our national deficit. this legislation is consistent with the budget of our country to try to help reduce the deficit and yet make us energy independent, create jobs, and be sensitive to our environment. because climate change is a global problem, we need a global absolutely. this past monday was also an important day in the international effort. the international community began a two-week meeting in copenhagen, denmark, to work on an international agreement to address climate change. the international community has set the right objectives to make the meeting a success, a

political agreement that promises both immediate action and contains the structure for a future formal treaty. the agreement reached in copenhagen should include the following points: specific, near-term greenhouse gas emission reduction targets, a critical part. the support the developed nations will provide to the developing world to adopt to a changing industrial economy and changing climate. we have a responsibility to help the developing world. the core elements that will make up the final treaty and a time line for reaching that agreement within the next year. we can't put this off. it's critical that we act timely. the administration has taken civil very important actions over the past few weeks to help us secure a global agreement in copenhagen. e.p.a.'s endangerment finding sends an important signal to the world about the united states commitment to take decisive action. similarly, the president's announcement that the united states will commit to an

emission reduction in the range of 17% below 2005 levels by 2020 and his pledge to contribute the united states fair share of $10 billion a year in financial support for the developing world by 2012 demonstrates that we are prepared to be serious partners in the fight against climate change. that he the type of action we want to see not only in the united states but in other countries who are major emitters. many of my colleagues, however, have legitimate concerns that if the united states enacts strong carbon standards, carbon imports will have an unfair advantage in our market. we need to make sure that we accomplish our goals internationally and also have a level playing field to. address this fear, i believe it's critical that our international negotiators include in copenhagen strong verification and compliance procedures that will make it clear that every state has a responsibility to take action to reduce greenhouse gasses.

i've seen too many international agreements that include the highest ambitions for labor, environment, human rights protections, fail to achieve those goals in the absence of consequences for violations of those principles. the groundwork for achieving a final international agreement in copenhagen must ensure that the major emitting nations take on clearly defined emission reduction targets, adopt standardized systems to measure, report and verify actions and commitments, and it must provide for consequences if countries fail to meet these commitments. inclusion of these principles in the copenhagen agreement allow us to pursue these critical components in any final agreement and sends an important signal that all countries, all party countries are committed to real emission reductions. i am proud that the senate foreign relations committee climate change bill, introduced by senator kerry last week, includes language i authored

that makes clear our expectations that any international agreement should include strong verification and compliance mechanisms along with emission reduction targets and a strong commitment to provide assistance to the developing world. i will be watching the negotiators and hope that it will produce the kind of agreement i have discussed here today. but regardless of what happens -- what copenhagen brings, i will continue to advocate for domestic legislation that invests in clean domestic energy and frees us from an -- frees us from energy policies that undermine our national security and our economy by being dependent upon imported oil. i will advocate for legislation that invests in the industries of tomorrow to stem the loss of clean energy jobs, jobs that stem from american invention and ideas to countries overseas. i will advocate for legislation that provides significant investment in clean fuels and public transit so that we seize an opportunity to build the infrastructure of tomorrow and

change the way we move people and goods around this country. right now, the transportation sector represents 30% of our greenhouse gas emissions and 70% of our oil use. if we could only double the number of transit riders every day, we could reduce our dependence on foreign oil by 4 40%. that's equivalent to the amount of oil we import every year from saudi arabia. that kind of legislation's good for our country and good for maryland, but we must remember, even after copenhagen, any deal we reach, any papers we sign are still but the foundation. the work must continue in earnest with follow-up dedicated to truly changing the way we work and live and move around this earth. madam president, with that, i yield the floor. mr. roberts: madam president?

the presiding officer: the senator from kansas. mr. roberts: madam president, i understand i'm recognized for 15 minutes; is that correct? the presiding officer: the senator is correct. mr. roberts: mr. president, i understand that the distinguished senator from michigan would like to attend the very important democratic corches a brand-new health care bill and i understand that and i shall try to expedite my remar remarks. only with the suggestion to the president that when you're late in the senate, you're early. and they're not going to say anything important without you. and i would like to yield at this time to the distinguished senator from georgia, who i understand has a terribly important message he would like to insert in the record at this point. mr. chambliss: i thank my friend from kansas. the presiding officer: without objection. mr. chambliss: madam president, i was going to come over and speak this afternoon on the issue of the significant amount of taxes that are going to be levied on the american people by the bill we have under consideration, and in light of the fact that there is this pending conference that's going to take place, i will submit my

statement for the record, and i ask unanimous consent to do so. the presiding officer: without objection. mr. chambliss: and i thank the senator from kansas. mr. roberts: madam president, president obama has repeated to me two pledges to the american people and we've heard it and heard it before and will probably heard it again about health care reform. and number one, the first is that if you like the health care you have, you can keep it. we know the bill before us does actually break this pledge because all but two in the majority voted to preserve the nearly $500 billion in cuts to medicare which includes $120 billion cuts to medicare advantage. the -- this vote -- the nonpartisan -- excuse me. the nonpartisan congressional budget office, or c.b.o., has confirmed that these cuts to medicare advantage means that approximately half of the medicare advantage benefits will be cut for the nearly 11 million seniors -- one in four dwhiesh are enrolled -- one in four -- who are enrolled

in this program. this vote confirms whether americans will be able to keep the benefits they have and like and that answer unfortunately is no. so now let's look at the president's section pledge, that he will not raise taxes on families earning $250,000 or individuals earning $200,000. a number of my colleagues have pointed to comments made last year in dover, new hampshire, by then-candidate obama who said -- and i quote -- "i can make a firm pledge" -- and we've heard this before -- "no family making less than $250,000 will see your taxes increase. not your income taxes, not your payroll taxes, not your capital gains taxes, not any of your taxes." i think he said one thin dime at the end of that. yet time and again in this bill, it seems to me that that pledge is -- is just simply broken. this bill calls for nearly $500 billion in new taxes, penalties, and fees that hit virtually every american, including middle-class families making

less than $250,000 and individuals earning less than $200,000. even though the majority has tried to disguise these taxes as various fees and present them as being paid for by targeted health care industries -- emphasize the word "targeted" -- health care industries, the reality is that this bill taxes the average american coming and going. it taxes you if you have health insurance. it taxes you if you don't have health insurance. it taxes you if you use medical devices such as a hearing aid or a pacemaker. it taxes you if you save on your own to pay for your health care expenses. and it effectively increases taxes for individuals and families with catastrophic medical expenses. americans should understand that the higher taxes called for in this bill will come straight out of their pockets with the middle class bearing much of this tax burden. let me just give you a few examples of the new taxes proposed and who will pay for them. the bill imposes a 40% excise

tax on health insurance providers that offer high-cost health insurance plans. this provision is the largest tax hike in the bill, raises almost $150 billion, and will be paid for primarily by individuals. not the health insurance provider but by individuals through income -- through, pardon me, through increased income and payroll taxes. by the time this bill is fully implemented, 84% of this tax on high-cost plans will be paid by americans who earn less than $200,000. taxpayers the president promised would not pay additional taxes. second, the bill imposes new taxes on health insurance providers and medical device manufacturers. both the nonpartisan congressional budget office and joint committee on taxation have said that these taxes will be passed on to consumers in the form of higher insurance premiums. the new $60 billion tax on

health insurance providers alone could raise premiums by as much as 2% according to some analyses and that increase could come as early as next year. not only that, the $19.3 billion in new taxes on medical devices could increase costs for up to 80,000 medical products, heart stints, blood pressure monitors, eyeglasses, pacemakers, hearing aids, advanced diagnostic equipment. such a tax would stifle and will stifle innovation and reduce the ability for manufacturers to develop new lifesaving devices and technologies. so make no mistake, madam president, the cost of this tax will be passed on to and paid for by anyone who uses a medical device, including those middle-class taxpayers the president has pledged will not experience any tax increase. if you need a pacemaker or a stint, you'll pay more for it because of these new