aide in the senate. i can remember president johnson, a democrat; everett dirksen, the republican leader, dealing with the housing construction in 1968. a very controversial bill. how did they deal with it? the democratic leader had the bill written in the office of the democratic leader with staffers marching in and out. people looked to washington and said the republicans and the democratic think it is important. in the end they voted for cloture and in the end they got the bill. mr. mcconnell: my friend from tennessee is entirely correct. right before we got here in 1964 and 1956, the democrats -- 1965, the democrats had an overwhelming majority. the voting rights bill of 1965 passed on an overwhelming bipartisan basis. the leader of the republicans, everett dirken was involved in

that. the republicans supported it on a percentage basis -- the presiding officer: minority time has expired. mr. mcconnell: i ask consent for one more minute. the presiding officer: without objection, so ordered. mr. mcconnell: an even greater percentage of republicans ended up supporting the civil rights bill of 1964 and 1965 than democrats, but it was a bipartisan landscape for our country, a landmark, important. and it was widely accepted by the american people because of the broad bipartisan support that it enjoyed. that is what has been lacking here from the beginning. mr. mccain: mr. president, i ask unanimous consent that a list of the physician organization that oppose -- organizations that oppose this act, over -- representing over 1/2 million physicians be in order. the presiding officer: without objection, so ordered. a senator: mr. president? the presiding officer: the

senator from montana. mr. baucus: mr. president, i must say some of the debate on the other side of the aisle is a little surreal. they say they want to move ahead. and then they refuse to enter into any reasonable time agreement to consider necessary appropriations measure. i find it very impressive. i'm very impressed how the minority can maintain both if they want to move more quickly and not move at all. surreal. mr. president, i want to also explain, despite what the claims on the other vise, that we have tempted mightily together on the other side of the aisle to get health care reform passed. they claim it is one party rule, but nothing could be farther

from the truth. let me explain why when we began this effort over a year ago, we had many, many hearings, it was last year that i had 10 hearings in the health care finance reform to educate ourselves. because we knew that health care reform was going to be a big issue in the year 2009. so in 2008 we had many finance committee hearings on all different aspects of health care. how does our system work? how do the parts fit together? how does this all work? we're there to educate ourselves we didn't have a political ax to grind, we called in the experts, how does it work? how do the different parts of our system work together? then we issued a white paper. it was november of last year. it was the call to action, we called it, an 80-page, 90-page paper, statement of health care options, delivery system reforms, various ways to get

health care coverage, various ways with health with the insurance market reform. lots of different provisions. and i might say, casting no modesty to the wind, that white paper, that "call to action" in november of 2008, is probably the basis -- the spring board from which most of the ideas we have been debating in the house and senate and both sides of the aisle come from. they basically come from there. i must say it is all been -- has been totally transparent. it has all been on the internet. it has been open for everybody. republicans and democrats participated fully. first was the library of congress all-day session. both sides fully -- that was over -- over a year ago. and -- and since then, that is -- that is in 2009 of this year, we've had countless number in the finance committee.

countless number of we call roundtables. countless number of walkthroughs. countless number of hearings. and all the various aspects of health care reform. bipartisan. fully open. and also i instituted something else here, mr. chairman. and that is we got to the point we finally get to markup. put the markup bill up on the internet again. so everybody sees everything. we also made sure that all amendments were up on the amendment and fully debated by both sides. totally open. totally transparent. and i prided myself on doing that. in fact, one very well-known health journalist, who works for a very major paper, walked up to me and said, max, is this the way of doing things, being so transparent, workin working so h together. do you think this is a model for future? i don't know. but it impressed him how we

tried to work together. and did work together with people on both sides of the aisle. so this is -- i cannot think of a more comprehensive, mores transparent, more bipartisan effort than this. so what happened? well, the "help" committee had their version passed and so we in the finance committee worked on our ours. -- on ours. and to move the ball, i shifted it to another group, we called it the group of six. three republicans, three democrats, to try to get a provision together to get to the full committee. we had countless number of committees -- i mean hearings. i forgot how many. i think 30, 40 meetings. close to 100 hours. republicans and democrats, to and fro. guess what? it was very, very, very constructive. i wish the american public could watch these proceedings and watch the proceedings.

i highly compliment my friend from wyoming, senator enzi, i highly compliment my friend from -- from maine, senator snowe. and i highly compliment everybody who is there. they asked very, very good questions. senator grassley is a ranking member of the finance committee. same on the democratic side. in an effort to find a good, solid health care reform bill. well, we kept working bipartisan. working together. for days and days, hours and hours. and then, fortunately, mr. president, it got to the point where i'm just calling it as i see it. i can't -- i -- one of my feelings is i'm too honest about things. and it's -- the republicans started to walk away. they pulled away from the table. they had to leave. i ask you why? why did that happen? and the answer is, to be totally fair an above board, is -- and above board, is because their

leadership asked them to. their leadership asked them to become disengaged from the process. i know that to be a fact. why did their leadership ask republicans to leave and become disengaged from the process? to be totally candid, they wanted to score political points by just attacking this bill. they were not here to help -- help be constructive to find bipartisan solution. they were for a while, then when the rubber started to meet the road and it came time to try to make some decisions, they left an began to attack -- and began to attack. i think that one of the -- a big, unfortunate circumstance of all of this, we're going to pass health care reform. it's going to pass. it's going to do wonders for the american people. we're going to -- we're going to dramatically reform the health insurance market. people are going to have health insurance they do not now have we're going to help put in place delivery system reforms. that's just a fancy term for

saying, changing the way we reimburse for hospitals and doctors in a very positive way so we're focusing more on quality and less on quantity. this bill is going to pass. it will be a very, very good bill when it does pass and people understand it. it is unfortunate that the other side pursued a strategy of just saying no. just saying no. and attack, attack, attack. and that's basically what we've heard here in the last several weeks. instead of coming up with a comprehensive alternative. instead of coming up with a comprehensive alternative health care reform package. and then it would have been just wonderful if we had an honest and goodness solid debate on the pros an cons of each -- and cons of each side. the merits of each side. a constructive dialogue, pursuit, inquiry, focus on which portions of this should be put

in the bill and which should not. but that did not happen. we did not have this constructive alternative provision presented to us. we had no provision presented to us. to us, i mean the american public, so we can debate here. but, rather, they just said no. we worked as hard as we could to meet a bipartisan -- to be bipartisan and to be honest and candid about it the other side walked away. they walked away. and i think that's very unfortunate that that happened. mr. president, i have 10 unanimous consent requests for committees to meet during today's session of the senate. they have the approval of the majority and minority leaders. i ask consent that these requests be agreed to and these requests be printed in the record. the presiding officer: without objection, so ordered. mr. baucus: mr. president, i'll yield five minutes to the senator from massachusetts, senator kirk. mr. kirk: mr. mr. president? the presiding officer: the senator from massachusetts is recognized. mr. kirk: thank you very much.

before i say anything else, i want to once again commend the senator from montana for his leadership on this historic piece of legislation. it will have an impact on people more widely and broadly than our social security system. and this will be as important a domestic piece of legislation as that. and every american who looks forward to golden years, knows what social security means. i thought it would be instructive since the senator from montana had quite correctly mentioned how this legislation will have an impact on people's lives. i've only been in the senate a short period of time. but i can't tell you the numbers of constituents who have commune a kid with -- communicated with me about their situation in the commonwealth of massachusetts. where, as -- mr. president, in 2006 massachusetts enacted health care reform. many of the aspects of that

legislation are contained in the bill that we're debating. and just for the record, recently the "boston globe" published a story indicating that more than 96% of the state's adult taxpayers had health insurance in 2008. this is close to universal coverage. i'm sure that before too long we'll be able to say we hit the 100% mark. this isn't providing affordable insurance to people who otherwise would never have had it. and when the senate from -- from the senator from montana talked about how this bill would impact people's lives, i'm going to tell you a story that was told to me by a family who had a situation, i'll call them daniel and brenda, that is their name. they had been living without health insurance for years. and -- and brenda said she could barely remember whenever they -- when they had last gone to the

doctor because they didn't have health insurance. but she learned about a health care for all on the -- on the help line as an assistance in massachusetts from a close friend. and soon after she contacted it, her husband was diagnosed with a serious heart condition. with the indispensable assistance of the help line, her family was able to enroll in coverage they could afford. brenda's husband daniel could feel constant fatigue. they never imagined that some day they would need a strong supporting device inserted in his heart. brenda said that they truly appreciated all of the assistance given to them through the help line. there's more. brenda and daniel recently welcomed a new addition to their family. unfortunately, the son who was born was born with respiratory problems and had to stay in

intensive care unit for seven days immediately after their birth. brenda told us she had a hard time leaving the hospital without her new-born son in her arms. but she could also take comfort of being surrounded by the top medical professionals who were dedicated to the caring of her son. and here's what she wrote, "health care for all has been such a gift to our lives. first, my husband had no idea of the seriousness of his health issue. if it wasn't for our eligibility with the state's new health care reform program, we probably would have found out about this heart disease much too late. and right after came the unexpected surprise of having my son in neonatal care for a week. both these situations were hard to go through emotionally," she

wrote," we couldn't imagine how hard it could be financially speaking, that's why we're just so amazed to be massachusetts residents an count on the -- and count on the tremendous support we have been receiving from the help line counselors." mr. president, this is just one example of countless families i've heard from in massachuset massachusetts. it it clearly shows how important it is to pass national health care reform to enable all americans to have the quality, affordable health care that brenda, daniel, and their son was able to have. so i just wanted to bring to the attention of our colleagues in the senate a real life story of what health care reform can mean and what will be great relief both for financial and health security to american families when we enact this legislation.

mr. president, i ask unanimous consent that the "boston globe" article i mentioned be entered into the congressional record, and, mr. president, i yield the floor. the presiding officer: without objection, it is so ordered. mr. casey: mr. president? the presiding officer: the senator from pennsylvania is recognized. mr. casey: thank you, mr. president. mr. president, i rise this afternoon to speak of two subjects as part of our health care debate. the first is what happens to our children. we have had an opportunity in the last couple of weeks to have a full and will continue to have a full debate about so many aspects of this legislation. and when it comes to the question of what happens to our children, -- and i speak of in

this case poor children and special needs children -- i have said from the beginning of this debate, even before the debate began many, many months ago that the standard ought to be four words -- no child worse off. very simple standard, but i think it's a standard that we can meet and i believe it's a standard that we should meet for the most vulnerable children in america, those who happen to be poor or suffer from or are burdened by special needs, both the impact on that child, that individual life, but also the impact on his or her family. the good news is that over the last couple of years, we have gotten it right with regard to children's health insurance, a program that i'm proud to say had a good bit of its foundation and its origins in pennsylvania, became a national effort in 1997

when president clinton signed the legislation, and we have had , frankly, a lot of bipartisan support for this program over many years. less so bipartisan support when it was re-authorized this past year, president obama signed it into law. here's what it means. the children's health insurance program known by the acronym chip, the chip program has provided millions of children with health insurance coverage that they would never have absent that program. we're at a point now we don't know the exact number as we speak today but in the range of seven million or more children covered. in the next couple of years, we'll have 14 million american children covered. that is an enormous achievement, but more important than any kind of legislative achievement, it will mean that 14 million children won't have to worry or their families won't have to worry about whether they get the kind of health care. the first year of a child's

life, the experts tell us they should at least get to the doctor six times for a so-called well child visit. the idea that a children's health insurance program in america ensures that that child, among many benefits, dental benefits, immunization, preventative care, but the fact -- i always point to at least one for an example. that six times in the first year of that child's life will get to see a doctor because they are in the chip program has enormous impact, for that one life, for that one family, but i would argue, and i think the evidence is irrefutable, it will have a positive impact on all of our lives because of the impact of millions of children getting that kind of help in the early years of their life. so we know this program works. the children's health insurance program works, and that is an understatement. it works real well. what we're worried about,

though, what i'm worried about is that there have been people in washington who have hoped or have advocated for, i should say, putting the children's health insurance program in the new insurance exchange. now, the exchange is going to be a very positive development for our health care system and for adults, but i would argue strongly and vigorously that it's not good for kids. so we're going to be debating that maybe in a couple of years, but we want to make sure that as we debate that question that we have as much evidence to show that -- and put forth the reasons why the children's health insurance program should not -- should not be part of the exchange. just in terms of why we say that, the research on this question is indisputable.

the c.b.o., the congressional budget office director doug elmendorf -- and we know, we have heard a lot about c.b.o. they make determinations about this bill and about costs. c.b.o. has said that children will have better benefits and more cost savings in chip than they will in the exchange. just yesterday, an organization that many people here know, first focus, released a white paper which compared children's health insurance coverage versus coverage those children would get in the exchange. here's some of the results of that -- of that research paper. number one, the question of children's coverage from 2009-2013. if health reform were to repeal chip in 2013, states would not invest in improving coverage for children when those very efforts will be dismantled just a few years later. it stands to reason, why would a state go forward and strengthen

a program that they know is going to change as a matter of federal policy a couple of years later? the increased coverage of four million children that is expected from passing children's health insurance legislation earlier this year would be largely lost. that whole effort. it took years, years and two presidential vetoes before president obama became president to get -- to continue the chip program and expand it. number two, first focus, another one of their conclusions. one of the -- the other conclusion. children in most state children's health insurance plans receive coverage for all approved, as i said before, vaccinations, dental care, well baby visits, well child visits. this level of benefits stand in contrast to private plans like those in the exchange. what's good for an adult may not be good for a child. children are not small adults as so many advocates have said over

and over again. but the level benefits that children get in chip stands in contrast to the provisions in private plans like those in the exchange which often impose limits that are particularly harmed for the low-income children and children with special needs. that's conclusion number two by first focus. conclusion number three is the following: an actualial -- an actuarially should shows that children move from chip to the exchange, that those children would dramatically -- increase dramatically out-of-pocket costs for those kids. out-of-pocket costs for a family living at 225% of the federal poverty level, the out-of-pocket costs would increase by 1100%.

not $1,100. 1100% if the senate were to join the house in repealing children's health insurance as a program. another reason why it's a bad idea. we want to make sure that this program is strong, that we know works, and we also don't want to exponentially radically increase out-of-pocket costs. conclusion number four, premiums. because children's health insurance keeps premiums and other out-of-pocket costs for children at low levels, the cost of health insurance exchange plans will be many times higher than that, even for just covering children. an increase in premiums will lead to a number of children currently enrolled in chip to lose coverage, lose coverage according to the congressional budget office. number five reason to do the right thing here. access to pediatric providers. children's health insurance plans specifically focus on the

unique health care needs of children, which is not the case in the proposed exchanges. the recent children's health insurance re-authorization. and for those who watch these senate debates, we use words like re-authorization. my simple way of saying it, that is we do it again. we take an existing program, evaluate it, see if it's working and keep doing it. that's what re-authorization is all about. but we did that earlier in the year, thank goodness, for children's health insurance, but their recent effort to continue chip included improvements to pediatric-specific quality measures that may get lost in the conversion of chip as a stand-alone program put in the exchange. we don't want to do that for kids. we want to make sure that every pediatric-specific quality measure that we have in place now all these years later is maintained. we don't want to injure that.

we don't want to cut that back. finally, in terms of another on the list of reasons, guaranteed care. in the exchange plans, some children currently eligible for the children's health insurance program may be barred, may be barred from receiving subsidies for coverage due to the cost of employer-sponsored plans. once again, what is good for an adult may not be good for our kids. we have got to watch this. moreover, the families that are eligible for subsidies and coverage for the exchange plans may find coverage so unaffordable that they are left without insurance entirely. so we don't want to send a family into the exchange who are trying to get insurance for themselves and their kids and find out that they can't cover their kids because it costs too much. we have an existing stand-aloan children's health insurance program that we know works. this amendment that -- that i filed for this debate on health care, the children's health

insurance amendment to guarantee that we keep it strong, strengthen it and continue it, this children's health insurance program has the support of over 500, 500 national and state organizations focused on children's health, health policy generally, social workers, children's mental health advocates, school educators, health plans in particular, faith groups across the country and more. these 500 national and state organizations speak volumes about why this amendment is so important. we must strengthen and ensure the continuity of chip in this health care reform bill. so that's what our amendment is all about. i want to submit for the record, mr. president, a letter addressed to me on december 9 from a series, all those hundreds, more than 500

organizations, and i'll submit this -- this letter for the record if that meets with your approval. the presiding officer: is there objection? it is so ordered. mr. casey: thank you very much, mr. president. i want to make an inquiry in terms of how much time i have left. the presiding officer: three and a half minutes, senator. mr. casey: okay. i'll move quickly. the second part of my remarks focuses on pregnant and parenting teens and women. we have an amendment that focuses on a group of pregnant women in america that we're not doing enough about. neither party, in my judgment, is doing enough about them, enough about help for those women. and i'm going to come back to this maybe later today, but it's vitally important that we as -- whether we're democrats, republicans, or independents, but as americans, that we give integrity and meaning to the sentiment that's often expressed

that we care about pregnant women, that we care about a teen mother who decides to bear a child, that we're going to help her through that if she makes that decision. if a woman on a college campus becomes pregnant and decides to have that child, we want to give her all the help we can. if a woman is a victim of domestic violence or other sexual violence or stalking and through all of the horrific nightmare of that -- of that violence, that she determines she is going to go through with the pregnancy and have a child, that we help her in the midst of that darkness, that we give her some light in that darkness. what we don't want to have is women who are deciding to bear a child who feel all alone. we have to walk that path -- who have to walk that path all by themselves. so that's what this amendment is about, and i will return to it later today. with that, mr. president, i will yield the floor.

mrs. hutchison: mr. president? the presiding officer: the senator from texas is recognized. mrs. hutchison: mr. president, i ask unanimous consent that we be able to go into a colloquy for the next half an hour. the presiding officer: without objection. mrs. hutchison: thank you. mr. president, i rise today to talk about the taxes that are in this bill and taxes that are imposed in three weeks. not three weeks from -- six months from now, not three weeks from 2014, three weeks from january 1 of 2010. three weeks from now, january 1, 2010, we are going to see the taxes in this bill start.

now, i know people are saying, but wait a minute, this bill doesn't take effect until 2014. that's what we've been talking about, it's what we've been hearing, but, no, the tax part starts in three weeks, january of 2010. i have partnered with senator thune, who has been working on this problem, senator grassley, senator hatch, and many others who are going to be speaking today. and i see my colleagues from florida, nebraska, wyoming, as well as my colleague, senator crapo from idaho, all of whom -- and senator crapo, of course, is waiting for an amendment on -- a vote on his amendment which would stp the taxes o stop the e who makes $200,000 or less. so we're talking about the taxes because it's such a huge issue.

but here is what is going to happen with the taxes in this bill that start in three weeks. americans will pay more in insurance premiums. americans will pay more in prescription drugs. and americans will pay more for medical equipment. let's walk through those taxes. in a few weeks, in january of 2010, $22 billion in taxes on prescription drug manufacturers. $19 billion in taxes on medical device manufacturers, and $60 billion in taxes on insurance companies. that's around a hundred billion dollars that starts in three weeks. and then in 2013, the taxes on high-benefit plans take effect. that's $150 billion in taxes. so every union member that has a really good plan that gives them the benefits that they have negotiated for over the years,

those taxes come in at 40% of the premiums. that starts in 2013, but you're still saying, well, wait a minute, i thought the bill started in 2014. that's right, but the taxes start in three weeks and they keep right on going. and in 2013, the high-benefit plans start giving a 40% excise tax. mr. president, when the $100 billion in taxes senator three weeks on drug manufacturers, medical device manufacturers and insurance companies, what happens? premiums go up immediately. prescription drug prices go up immediately. the medical devices, the hearing aids, the things that -- that people need for their medical treatments go up immediately. so we've been talking about

reform, health care reform, the need for health care reform, the need to make history, and yet the reform that we're going to see go into effect right away is huge tax increases. so i'm here with many of my colleagues that -- who are so concerned about this for their constituents, and i would just like to ask the senator from wyoming -- the senator from wyoming is one of two physicians in the united states senate and he has been so active in this area. and i would just say, when -- when the taxes go up on our insurance premiums, our prescription drugs, our medical equipment, i would just ask the senator from wyoming, as a physician, what do you think is going to happen to the costs of health care? mr. barrasso: well, i have great -- the presiding officer: the senator from wyoming is recognized. mr. barrasso: thank you very much, mr. president. i have great concerns about the cost of health care for american

families, and we see it with our seniors certainly as they are seeing medicare cuts is what we've heard from the floor here, $464 billion in medicare cuts, but also the taxes that are going up that are going to impact on all people in this country. you know, i remember a promise that the president made and he said, his plan won't raise your taxes one penny. he went on to say, if, you know, they are not -- your income taxes, payroll taxes, capital gains taxes, any of your taxes. but we're seeing here that taxes are going up and in a way that is basically, you hate to say it, but it's a gimmick, a gimmick in this bill. a gimmick where they're going to collect taxes for ten years but only give benefits for six. and it's the last six years. so even though my -- as my colleague from texas said, they're going to start collecting taxes -- today's the 10th, on the 31st of this

month, 21 days from now they'll start collecting taxes, but the services won't be given for four years. that's how they get the number under a trillion dollars. and yet it's at a time when the president makes his statement, well, this won't add a penny -- a dime to the deficit. 80% of the american people don't believe it because they know what's in front of them. they know how they have to live their own life and they know what it's like. so i'd ask the senator from texas, is this what you're seeing as well? mrs. hutchison: the senator from wyoming brings up the point, because the president inside his address to the joint session of congress that this bill had to come in at a cost of no more than $900 billion. and so the c.b.a. -- c.b.o. scored the bill at $847 billion, but the senator from wyoming has brought up the point that's because they started scoring the bill in 2010 but the costs in

the bill don't start until 2014. so if you take the ten years from 2010 to 2013 -- or 2010 to 2019, it probably comes in at $847 billion. but if you start when the costs start at 2014 and go to 2023, the cost is $2.5 trillion. i would just ask the senator from nebraska if his constituents from nebraska ar are -- are hearing this, $2.5 trillion cost, half of it is come from medicare cuts -- not half but about a quarter of it from medicare cuts, about a quarter it was in new taxes that start next week. what are the citizens of nebraska saying about this? mr. johanns: well, they're -- the citizens -- mr. president? the citizens of nebraska are

absolutely on to this gimmick. they've got it all figured out. they know it's a gimmick. here's -- here's what i would tell the senator from texas. i had an opportunity, as you know, to be their governor for six years. every year i had to walk in front of the unicameral, our one-house system, and give a state of the state address and lay out a budget plan. and, you know, had i walked into that chamber with a budget plan with these kinds of gimmicks, they would have been rolling in the aisles laughing at me. i mean, literally. they would have been rolling in the aisles. and then the people of nebraska -- i would always do a state fly-around where i'd go community after community talking about my budget vision, talking about my legislative package, et cetera. well, the people of nebraska would have run me out of the state had i tried to balance the

state budget based upon this kind of gimmicky approach. and, senator, you have absolutely hit the nail on the head. what you have here of i here isa situation where -- those who wrote this bill -- as we all know, it was written behind closed doors. nobody knew what this bill was until just a few weeks ago. but those who wrote this bill said oh, my goodness, we've got -- the president has said we've got to bring this bill in under $900 billion -- that's what he said -- how are we going to get that accomplished? and so they used gimmicks. they put the revenue -- they uploaded the bill, front-end loaded the bill on the revenues so that starts right away. but then the benefits of the bill don't start for three or four years. and so, whoa, magic. magic. we've made the bill come in

under $900 billion. but let me just offer this thought. who loses on this? who loses on this crazy accounting gimmick? well, you know who loses? the constituents that we represent in the united states, not just nebraska, because they're going to pay the taxes. they're not going to see the benefits. it's like buying a car and paying on it for four years but not getting the car for four years. they're going to pay on it. and then sadly and most concerning to me is that this gimmickry is going to get passed on to the next generation. because when it doesn't work, somebody has to pick up the bill. and the full cost of this bill, we've come to recognize, is $2.5 trillion. and this bill just doesn't fit

together. it doesn't pass the smell test, as we say back home in nebraska. my hope is that sanity will revisit what we're doing here and people will say, time out, we can't ask the american people to go along with this. we've got to call a turnout andd we've got to get this right. mrs. hutchison: i thank the senator from nebraska and, i think his view having been a former govern certificate govery important here because of what we've heard. we haven't seen any new proposals but we've heard there's going to be an expansion of medicare, an expansion of medicaid. medicaid in particular is going to be very costly to states because they have a requirement, a matching requirement for medicaid. and many governors are concerned about that and i know the

governor from nebraska and his background realizes that that's one of the biggest issues in a state budget. and i know that the senator from florida also has experience with being in a governor's office, being chief of staff for a governor. and he has been very active, especially because the population of florida has man many -- a very high rate of senior citizens, and the cuts in medicare in the bill before us are huge. so he's on the floor. and i'm just wondering when you're looking at the cuts in medicare and you're looking at the huge taxes, how that's going to impact the state of florida and how you think we're going to have to deal with that. mr. lemieux: well, i thank the senator from texas. mr. president? this is budget gimmickry, and like the senator from nebraska -- i didn't serve as governor, but as the chief of staff who had to work on trying

to balance a budget because our constitution in florida requires that, you know, we'd sit around and we'd try to figure out how much revenues we had and then how much we could spend. and if there weren't enough revenues, we either had to cut spending or find a new source of revenue. there weren't any other choices. we couldn't engage in this budget gimmickry. and i like, if i may borrow from my friend from nebraska, the analogy of the paying for a car for four years before you get to drive it. i mean, this is really what we need to tell the american peop people. imagine you're going to buy a substantial purchase, a house or a car, and they show you the house and they say, here's what your mortgage payment's going to be and you're going to live in the house for ten years, start paying today but you can't move in until 2014. that's what this bill does. so in order to make this quote, unquote, "budget neutral," we steal a half of a trillion dollars from medicare -- health care for seniors where seniors have paid in -- we raise taxes,

which is going to increase, not decrease, the cost of insurance. when we tax pharmaceutical companies, when we tax the providers of medical devices, what happens? they pass those costs right along to the citizens. so not only are we stealing from medicare, not only are we raising taxes, which is going to get passed on to citizens, now we're going to tell the states we're going to increase medicaid. and we're hearing this secret deal that's been put together behind closed doors -- you know, now -- at least we're getting some friends that are in the dark because now a lot of democrats apparently don't know what's going on either and they're scrambling around trying to figure out what the deal is. but the deal apparently is going to put more of a burden on the states. and i want the american people to understand -- and i know that my friend from nebraska knows this, being a former governor -- is that when you increase medicaid, the states pay the vast majority of that and they're going to, because they balance their budgets, they're going to have to cut something

else. so they're going to have to cut teachers or they're going to have to cut law enforcement. so we steal from seniors, we steal from the states, we raise taxes, we don't cut the cost of health care for most americans. you you know, i'm new to this chamber. perhaps my friend from idaho can help me understand this. but this doesn't make a lot of sense of how we should proceed with health care reform. mr. crapo: no it doesn't and i appreciate my comments -- the comments from my colleague and all of the colleagues on the floor today. to commit this bill from the finance committee that the president pledged would not be in there the president pledged that no one who makes $250,000 as a family or $200,000 as an individual will pay any taxes under this bill. and, yet, in the very first 10 years there's almos almost $500 billion of those

taxes, a huge portion of which falls on people who are in that category. and as has been indicated, the real implementation of the bill on the spending side doesn't happen until 2014. if you count the amount of taxes that start when the spending starts, it's about $1.2 trillion of new taxes. and, really, the only thing that's transparent here, because this was crafted behind closed doors, the only thing that is transparent is the gimmick. the president said, saids senator from texas pointed out, he would not let a bill come across his desk with his signature if it is more than $900 billion. you say, why do we have to have almost $1 trillion worth of spending. it turns out this cost around $1 trillion or$2 .5 trillion. how did they make it meet th the $900 billion test? they said, look, let's delay the

implementation long enough that the number comes out to be under $900 billion. that happened to be the year 2014. and so if you don't count the first four years and only count six of the 10, then in this budget window we're work in, you can get your number. it's just remarkable. before i -- before i ask the senator from south dakota about his perspective, because i know he's working with the senator from texas on an amendment to try to correct this gimmick, i'd just like to respond to one quick point that i know our opposition on the other side has continued to make, and that is they actually say that there are no tax increases in the bill. how do they say that? well, here's the way they say it. there are subsidies in the bill that are provided to people with low income who don't have adequate access to insurance. those subsidies total about $400 billion in the bill in the first 10 years, which is really only six. and they count those subsidies

as a tax cut. the technical term given to them is -- is a refundable tax credit. although three fourth fourth, $300 billion don't go to taxpayers. the people who receive them do not have a tax liability. but then they offset those subsidies against the taxes that the rest of america will pay and say, therefore, there are no factions built. i think that's another -- no taxes in the bill. i think that's another form of gimmickry. i'd like to ask the senator from south dakota about what your perspective is on the types of gimmicks we're seeing here and whether the people should insist that things should be removed from the bill. mr. thune: i would say to my friend from idaho, that i support his amendment. i hope we get a chance to vote on it. i know they're scrambling to try to find an alternative to try to put up so they can give their side political cover. they know -- the reason they try so hard is they know it raises

tax. to say with a straight face this doesn't raise taxes, the american people get this. i think they know the gig is up. there are huge tax increases in this will. as the senator from idaho pointed out, when they say that the refundable tax credits will go back in the form of premiums an sub i dids and there aren't going to be that many people who i pay, 73% of those who will get the premium subsidies are people who don't have an income tax liability already. so, therefore, it's hard to say that you're going to reduce taxes on somebody who doesn't have an income tax liability. more importantly than that, there are still 42 million americans with incomes under $200,000 a year, according to the joint tax committee who are going to see their taxes go up under this. so you've got literally millions and millions of americans under $200,000 a year, and as you mentioned, the president's promise was he wouldn't raise taxes on anybody overdz -- or under $250,000 a year.

this flatly contradicts that. flatly violates that pledge. and i can't fathom anybody coming here with a straight face saying, oh, yeah, it doesn't raise taxes. of course it raises taxes. what the senator from texas intends to on our amendment, and on your amendment and i hope we have chance to vote on this. but we offered an amendment that we think makes sense or a motion, i should say, because it alliance or synchornizes the dates of all of. this what has happened here is in a very, i would say, deceptive way, they have understated the cost of the brim. my colleagues on the floor right now have allude to this. they tried to get it under $1 trillion. in that attempt to get it under $1 trillion, they had to come up with some budgetary gimmicks. to illustrate that with a bar chart, you can see in the first 10 years, starting today and going to 2019, the spending in the early years doesn't show up much.

most of the spending gets put off until january 1 of 2014. if you look at the first 10-year period, the spending under the bill is less than when the bill is fully implmentd. when the bill is fully implemented, you look at 2014 to 2019, it ex cloadz, fro from $000 billion, to$2 .5 trillion when it is fully implmentd. the reason they're able to do this is because of the smoke-and-mirrors way of delaying the tax increase or enacting the tax increases immediately and delaying the spending much and so the american people -- spending. and so the american people are going to spend $71 billion in tax increases in their pockets, out of the american taxpayers' pocket before they ever see a benefit under this bill. so what the senator from texas, senator hutchison, and i are offering as a motion, that would

delay the benefits, that would be a fair way to go about making public policy. what they have done in an effort to obscure the cost of this, the overall cost of this is to say that 22 days from now we're going to raise your taxes. january 1 of this year is when most of these taxes, taxes on prescription drugs, on medical devices, on health plans, all of the taxes on the bill begin to take effect on january 1 of this year. for the first four years, people will pay taxes out of their pockets. i might add, because of the taxes that are going to gone these device manufacturers, prescription drugs, health plans, will be passed on in the form of higher premiums. there will be tax increases an premium increases before they see a dollar of benefit. it is 1,483 days until the benefits under this bill kick in. that, mr. president, is unfair. it's unfair to the american taxpayer. it's unfair to the american people. and it's unfair, i think, to try and obscure and mask the total

cost of this bill and say, well, we're only spending $1 trillion on this when we know full well when it's fully implemented, the total cost of that is $2.5 trillion. so i appreciate the discussions that being held here in pointing out the -- the smoke-and-mirrors sort of underhanded way they're trying to shield the cost of this. but also to support the senator from idaho with his amendment that would recommit this bill and get these tax increases out of here because the one thing that the small businesses in our economy are saying right now is we want to invest. we want to create jobs. but you can't raise taxes on small businesses when you want to create jobs. and that's what this bill does. the north carolina federation of independent -- the national federation of independent businesses, the chamber of commerce, all of the major business organizations have opposed this. the national independent federation of business said yesterday that we don't support policies that increase the cost of doing business and raise

taxes. that's what this bill does. our amendment -- our motion is very simple. it delays the tax increases until such time as the benefits begin. mrs. hutchison: i'm very pleased that the senator from south dakota talked about what we're trying to do. because it's very simple. it's very simple. the hutchison-thune motion to recommit says, if we do nothing else -- if we do nothing else in this bill, we have to be fair and transparent with the american people. and that is we don't start the taxes. we don't start the increases in premiums, increases in prescription drug benefits, increases in medical devices until at least there's an implementation of the program that we hear is going to be offered to the american people. we haven't seen it, but we're told that there's going to be a program that americans can sign

up for, but they're going to be paying higher taxes and premiums and costs in health care for four years before they ever see it. and all we're saying is, let's send this bill back to committee an fix that. it does not -- and fix that. it does not -- as the senator from nebraska said earlier, it doesn't pass the smell test. it doesn't pass the smell test in nebraska, or wyoming, or florida, or idaho, or south dakota or texas, to tax people for four years, to raise their costs until they basically say, give me an alternative. and the alternative is, guess what? a big government takeover of our health care system. that's like saying i'm from the federal government, and i'm here to help you. we've heard that before. i don't think the american people will in any way believe

that this bill is fair or honest with them if we start the taxes 22 day from now as the senator from south dakota has pointed out. but they don't see a program. they're going to go online and say, oh, my premiums are going up. my prescription drugs are going up. my goodness, where is the program that they've been talking about? oh, they're going to go online. but, hey, there's no program. now how can we go home? i would ask any of the senators who would like to -- to add their perspective on this, how are you going to go home and tell your constituents that your taxes start in 22 days. maybe -- maybe in four years, roughly, maybe you're going to see a program and we're from the federal government. we're here to help you. a senator: you can't go home and say that with a straight face. the people at home.

and many rural areas in our state, the people see through all of this. mr. barrasso: two articles next to each other in "the new york times". one talks about the details of the secret agreement that they're working on behind closed doors. and it says "details are scanty." and right next it says, "for rural, times are harder," this is for people who will see taxes go up and cuts in medicare. i want to read the first paragraph. this is from lingell, wiping wyoming, a community in my state. it talks about norma clark, 80. it says that she slipped on the ice near the horse coral and broke her hip. i'm an orthopedic surgeon. alone took her three hours -- alone it took her three hours to drag herself the 40 years back to the house in snow and mud after she tied her legs together

with a rope to stablize the injury this is a person on medicare. and they're going to cu cut $464 billion from medicare. and they're going to use gimmicks that are going to harm our people. and i have a former governor, a chief of staff from a governor's office. you know in the rural parts of your community, governor, and now senator of nebraska, you have hard-working people who expect honesty from a government an they're not getting it in this bill which is going to tax for 10 years an only give services for six. mr. johanns: that is such a compelling story. and i want to add something to that. when you think that the policy could not get more crazy and insane, you hear about this idea that you're going to expand medicare, which is due to be insolvent in 2017. but the tragedy -- the tragedy of that in relating it to the story you just told us is this, that will hammer our rural

hospitals. why? because they can't stay open on medicare reimbursement rates. they can't stay open on medicaid reimbursement rates. so this poor woman who dragged herself to try to get some care all of a sudden could be faced with a possibility that the hospital she relies on will not stay open under this health care bill. and i've been to those hospitals. i've seen the struggles that they are going through with medicaid reimbursement and medicare reimbursement. and every hospital administrator tells me the same thing, we would close our doors if we had to live on that. so what's their solution here? expand medicaid and medicare. you've got to be kidding me? who are they listening to? you know what, take this bill out to the rural areas of nebraska, you'll get an earful. mrs. hutchison: how much time is left on our side? the presiding officer: seven seconds.

one, two, one, zero. time has expired. mrs. hutchison: that was not on our side. let me give the last five seconds to the senator from south dakota. mr. thune: i yield my five seconds. i didn't have time to distribute it equally here. so it wouldn't be fair. a senator: mr. president? the presiding officer: the senator from florida is recognized. mr. nelson: i ask unanimous consent that the time for debate only be extended until 2:00 p.m. with the time equally divided with senators permitted to speak up to 10 minutes each with no amendments in order during this time. the presiding officer: without objection, it is so ordered. mrs. hutchison: mr. president, reserving the right to object, i would just ask the senator from florida is it ten minutes then and going back and forth? it's not 30 minutes allocated per side? is that correct? mr. nelson: it is back and forth. mrs. hutchison: thank you, mr. president. the presiding officer: without objection, it is so ordered.

the senator from missouri is recognized. mr. bond: mr. president, i ask to be advised when i have used eight of my ten minutes. the presiding officer: without objection, so ordered. mr. bopped: thank. mr. bond: mr. president, small businesses are the backbone of our economy. they make up 99.7% of all employer firms. they pay 44% of the total u.s. private payroll. they have generated 64%, a majority of the net new jobs over the past 15 years. they create more of than half of the nonfarm gross domestic product. they hire 40% of all high tech workers. small businesses drive this economy. they are also the sector most in need of real health reform that will reduce costs and make it easier to buy insurance. mr. bond: it's estimated that 26 million uninsured small business owners, employees, and

their dependents, that's a majority of the uninsured, they continue to struggle to be unable to afford health care. two examples: jim henderson, president of dynamic sales in st. louis has made every adjustment in the book to continue to provide health insurance to his employees. he covered plot -- both employees and their families back in the 1980's, but now he's at a point where he can only afford to provide for his employees. he pays 70%. his employees 30%. jim is one of the very few small businesses right now who have weathered the storm despite the economy. he wants reform that lowers costs and helps individuals better spend their health care dollars. unfortunately, the democratic health care bills that we have seen so far -- and i guess we haven't seen all of them -- won't help jim continue to provide his employees health care. kathy and some vise own true value hardware in vice president biden's hometown of wilmington,

delaware. they employ 28 people, most of whom they consider family. they cover hundred% of the costs for the employees and half for their families, but they have seen huge increases in premiums over the years with a 36% increase just this year after an employee got sick. each year they are forced to shop for health insurance, but they continue to have limited choices due to an uncompetitive market. unfortunately, the democrat bills won't fix the problem or help kathy and tom continue to provide their employees health care. mr. president, if we really want to get out of this recession, if we really want to address the problem of affordable and accessible health insurance, then the majority party needs to take a hard look at health care reform. number one, we need to allow small businesses to go together and purchase health care, to purchase health care across state lines so they have true competition and so they can lower costs. we need medical malpractice reform that would cut cut $120 billion to $200 billion

out of the costs in health care. however, when we look closely, the bills we see before this do nothing to address real health care needs, and in fact by imposing more taxes and taxes which the c.b.o. said will be passed from health care companies down to those who are paying the private bills, not only will it make the health care less affordable for these small businesses, it will force many of them to drop whatever coverage they have now. tax equity is extremely important. an employee of a large corporation or a union member who gets health care premiums paid for by their employer or by their union doesn't have to record them as income. small businesses, their employees, farmers, and individual purchasers need the same benefit that the employees of large corporations and union members get. now, instead of proposing

commonsense health care solutions for small businesses, the bills that we've seen coming out of the smoke-filled rooms run by the majority leader continue to heap costly new burdens on small businesses trying to keep their doors open. more and more, it seems small businesses are under attack. that's what they're telling us. one of the universities that visited me this past week is trying to do something to help small businesses, and i said what's the attitude? and they say the attitude of small businesses is they are under attack by what's being done in congress and what's being proposed by the administration. the 2010 budget calls for tax increases on those earning earning $250,000 or more. now, for small businesses that are taxed at their personal rate, proprietorships, partnerships, and sub s corporations, these tax increases hit the returns of

those small businesses and they are taxed at the punitive rate. higher energy taxes on businesses in the cap-and-trade plan will put many small businesses in my part of the country out of work. new taxes and new mandates in the health care bill will be passed on. randy egston of lenivton, missouri, says: "the new taxes would eliminate rockville half of my profits. it would force me to let employees go, refrain from hiring new employees and preeivet me from reinvesting in my business. the mandates would be very harmful and make it much more costly for me to operate my business." this bill, the last bill that we had seen requires a costly costly $28 billion new mandate on businesses that do not offer health care. who pays that mandate? anybody looking for a job. if you tell businesses they have to spend big money on a mandate,

they cannot spend it on hiring new worker. the mandates do nothing to reduce insurance costs. because they are focused on full-time workers, the mandates give companies an incentive to classify more of their workers as part time. gene schwarz with k.n.s. wire products in missouri says: "we are in a recession and i'm in manufacturing. the legislation would be nothing but detrimental to us. our work force is already down 25% from last year. if this bill goes through in its current form, the new taxes and mandates will force me to make further cuts. also, this bill will increase my costs by further raising my already sky high insurance premiums." this bill also includes more paperwork, costly for a small business. section 9006 requires that every time a business vendor sells a service or property to another business exceeding $600, the receiving business must report the transaction to the i.r.s.

that's an enormous new costly paperwork burden that will hit almost every business, regardless of how small. these mandates and regulations disproportionately affect small business and come at a high cost. according to the s.b.a.'s own website, very small firms with fewer than 20 employees annually spend 45% more per employee than larger firms to comply with federal regulations. these very small firms spend four and a half times as much per employee to comply with environmental regulations and 67% more per employee on tax compliance than their larger counterparts. the bill clearly fails to bring down the cost of health care for small business. it fails to bring down the cost of health care at all. but it's especially hard on small businesses that can't afford coverage under the current law. small business owners from my

state have come to me for two decades looking for more affordable ways to make health insurance available. they want to be able to provide insurance for their people. that's why i have long been a champion of small business health care reform. mr. president, at this point i would ask that the remainder of my written remarks be included in the record. the presiding officer: without objection, so ordered. mr. bond: and i have a couple of other comments that i -- i wish to add. we have now learned that there is a new proposal coming out of the back rooms, the smoke-filled rooms. every time something new is thrown up on the wall, we stand around with a great deal of interest to see whether it sticks. when you look at this one, i don't believe it sticks. i think it stinks. if you will read the -- "the washington post" lead editorial today, its headline -- "medicare

sausage. the emerging buy-in proposal could have costly unintended consequences." and i ask unanimous consent that this be added into the record after my remarks. at the end of it, it says -- "the irony of this late-breaking medicare proposal is that it could be a bigger step towards a single-payer system than the milquetoast public option plans rejected by senate moderates as too disruptive of the private market." now, to say that it moves toward public option -- or public takeover is confirmed by one of the outspoken backers of the public option, one most interested in getting public control, governmental control of all health care. new york helicopter anthony weiner, who is quoted in

"politico" today hailed the expansion of medicare as an unvarnished triumph for democrats like himself who have been pushing for a single-payer-run health care system. "never mind the camel's nose. we've got his head and his neck in the tent." now, mr. president, i think that's clear. trying to expand medicare will almost assuredly drive all the private plans out of the market. why? medicare pays 80% of the costs of hospitals and less for doctors, and they have to make up the rest of their costs by charging private care patients, private covered patients more money. and it will raise the costs so that private employee -- that private health care can no longer -- can no longer succeed. mr. president, i thank the chair and i yield the floor. mr. burris: mr. president?

the presiding officer: the senator from illinois is recognized. mr. burris: thank you, mr. president. over the past several months, mr. president, i've come to the floor of this body many times to speak about the urgent need for comprehensive health care reform. i have said that our bill must accomplish three goals in order to be effective. it must bring competition to the insurance market. competition to the insurance market. it must provide significant cost savings to the ordinary americans. and it must restore accountability to the industry that has run roughshod over the american public for far too long. so, mr. president, i would like to focus this last point with my remarks today. we need real accountability in the insurance market. after almost 100 years of debate about health care reform, this

senate stands on the verge of making history. there are many good elements in the legislation that is before us today, but without accountability, any reform measure would be toothless and inconsequential. if we don't give the american people a chance to hold their insurance providers accountable, quality care will continue to elude certain segments of our population. mr. president, we can't stand for this any longer. we must prevent insurance companies from discriminating against people by charging their higher rates or denying coverage because of certain conditions. now, everyone knows that it's hard for ?iewd -- for uninsured patients to get quality medical care, but under the current law in the case of catastrophic injury or illness, anyone admitted to the emergency room should receive equal treatment to save their lives. shockingly, mr. president,

harvard researchers have found that this is not the case. they examined 690,000 individual cases over four years and found that ?iewd -- uninsured patients are nearly twice as likely to die in the hospital as patients with similar injuries who do have insurance. and even after these results were adjusted to account for age, race, gender and the severity of the injuries, they found that the uninsured were still 80% more likely to die than those with health coverage, including medicaid. and, mr. president, i just had a delegation in my office of physicians, and i listened to their comments in reference to wanting us to make sure we pass

a health care reform bill this session. and one of those physicians began to relate to me a story of his brother who was employed but was without health insurance. at 41 years old, he died of cancer because he waited too long to try to get treatment because he was uninsured and no one would treat him, and that took his life at a young, tender age of 41. so, mr. president, this new evidence is conclusive and it is truly disturbing. the poor and the uninsured suffer disproportionately under our current system. and in the most advanced country on earth, there is no excuse for this stunning inequality. big corporations know that there is a lot of money to be made out

of the poor, and they don't hesitate to rake in large profits and -- large profits and their expenses. these companies exploit large technicalities not to cover people who are sick. they use gaping holes in the system to refuse treatment for those with certain conditions. that's because they do not see patients as real people who need help. they see them as numbers in the corporate ledger. they see risk and expenses and lower dividends for their shareholders. so, mr. president, that's why we need to prioritize patient over profits. that's why we need to extend coverage to more people and make these companies accountable for the first time in decades. if we pass insurance reform with a strong public option, it would be illegal to deny coverage

because of the preexisting conditions. for the first time in many years, ordinary americans would be able to shop around if they're paying too much or they're not being treated fairly. costs would come down, coverage would improve. mr. president, lives would be saved. colleagues, let us pledge ourselves to this cause. let us make sure that every american can get treatment they need in the emergency room regardless of their income need or their insurance coverage that they have. we must not fall short in this regard and we must not settle for anything less. thank you, mr. president. mr. grassley: mr. president? the presiding officer: the senator from iowa is recognized.

my friends on the other side of the aisle have consistently stated that this 2,074-page reid bill, according to the joint committee on taxation, is a net tax cut, and i want to put emphasis throughout my remarks on the word "net." yesterday a chart was used to illustrate this point. this chart had multiple bars with dollar figures. for example, in 2019, the chart showed a $40.8 billion net tax cut. my democratic friends said that this number came from the joint committee on taxation, a very responsible, intellectually honest group. unfortunately, the chart my friends were using was not entirely clear on how they came

up with this net tax cut for americans. so it was natural for most of the fellow senators and the country at large to wonder how my democratic friends got this number. they said, show me the data. well, to clear up any confusion. here -- right here -- is the joint committee on taxation table that the democrats relied on to claim that the reid bill results in a net tax cut. here it is, mr. president. you can see the negative 40 -- the negative $40,786 as an example. that's the figure that was used.

as the chart indicates, these dollar amounts are in the millions. so $40,786,000,000. the joint committee on taxation says it this way. this means negative -- the negative mark there -- negative $40.8 billion. now, my friends on the other side unfortunately did not explain what was going on here. it appears my friend simply made an assertion that they hoped many of us and those of us in the media would believe, but i can't let my democratic friends get off the hook this easy. why? because the entire story is not being told. so let me take a moment to explain. first, in simplest terms, where

you see negative numbers on this chaforchart, the joint committen taxation is telling us that there is some type of tax benefit going to the taxpayers. so this group and these groups here, or wherever there's a negative here, those are -- those are tax benefits to the benefit of the taxpayers. for example,, families making $50,000 to $75,000 -- $50,000 to $75,000 have, a negative $10,4 $10,489 -- $10,498 in their column. this means the joint committee on taxation is telling us that this income category is

receiving $10.4 billion in tax benefits. now, i hope you'll listen closely. when we see a negative number on this chart, joint committee on taxation tells us that there is a tax benefit. so, conversely, where we see a positive number, joint committee on taxation is telling us that these taxpayers are seeing a tax increase. i've actually enlarged those numbers. the number of tax returns and the dollar amounts where there is a positive number for individuals and families. again, these positive numbers indicate tax increase. so my friends have said that all

tax returns on this chart are receiving a net tax cut. if this were so, why aren't there negative numbers next to all of the dollar amounts list listed? because not everyone on this chart is receiving a tax cut, despite what my friends have said. quite to the contrary. a group of taxpayers are clearly seeing a tax increase and this group of taxpayers in middle income are seeing tax increases. i didn't come down to the floor to say that my friends on the other side of the aisle are wrong. after all, you can see here the negative $40,786,000,000 figure

that they used right there is out in the open, but what i am doing is clarifying that my democratic friends cannot spread this $40.8 billion tax cut across all the affected taxpayers on this chart. and then say that all have received a tax cut. well, you want to know why? because this chart, produced by the nonpartisan joint committee on taxation, shows that taxes go up for individuals making more than $50,000 and families making more than $75,000. it's right here in the yellow, as you can see. the numbers obviously don't lie and of course i say that the nonpartisan joint committee on taxation -- i think most everybody agrees that they're very intellectually honest.

so let me give you my read on what the joint committee on taxation is saying here as evidenced by the figures on the chart. first, there is a group of low-&middle-income taxpayers -- low- and middle-income taxpayers who clearly benefit under the 2,074-page bill that's before the senate. they benefit from the government subsidy of health insurance. this group, however, is relatively small. there is another much larger group of middle-income taxpayers who are seeing their taxes go up due to one or a combination of the following tax increases: the high-cost plan tax increase, which actual ily is a brand-new tax; the medical deduction expense limitation, which used to be 7.5%. now before you can deduct, you've got to have 10% of your

income be medical expenses or you don't deduct anything. so that's a tax increase. and then a medicare payroll tax increase, where everybody's going to pay -- well, everybody over certain incomes -- going to pay an additional half a percentage point. or if you're self-employed, pay one percentage more of payroll tax. in general, this group is not benefiting from the government subsidy. after all, how can a taxpayer see a tax cut if they're not even eligible for the subsidy. also, there is an additional group of taxpayers who would be affected by other tax increase provisions in the reid bill that the joint committee on taxation could not distribute in the way that people are distributed on this chart. these undistributed tax increases include, among others,

the cap on federal savings -- or fiscal savings accounts -- flexible savings accounts. then there's a tax on cosmetic surgery. my friend from idaho, the author of the amendment that's before us, mr. crapo, recently received a letter from the joint committee on taxation stating that this additional group exists and many in this group will make less than $250,000. and, hence, have a tax increase that's not accounted for here and also a tax increase if they're under $250,000, it's a violation of the president's promise in the last campaign that nobody under that figure would get a tax increase, just people over $250,000. so you see, mr. president, my democratic friends cannot, one, say that all taxpayers receive a tax cut.

i've proven that here. and, number two, say that middle-income americans will not see a tax increase under the reid bill. i yield the floor. the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, some of the chart that's been on the other side of the aisle have taken us down some detours. essentially they try to distract us from what -- from some of the main points of this legislation. so i might take a few moments to discuss one of the key features of the bill and that's insurance market reform. the bill would change the way that insurance companies do

business in america. sometimes i think that this reform is part of the reason why some on the other side are fighting this bill so hard. our bill will end the practice, widespread today, of insurance companies denying coverage altogether or charging someone an exorbitant amount of money if they have some preexisting condition, something in their health history which is an issue. and our bill would make the change -- make those changes right away. that is, they start in effect in 2010. that is, the prohibition against companies denying coverage based on preexisting condition or health care status and on down the list would take effect right away in 2010. we all have countless number of examples, either directly or

through friends or relatives or small insurance companies who either denied insurance coverage or have to pay much greater increase in premiums because of a preexisting condition, whatever it may be, of somebody. and it's just wrong. flat, outright, 100% wrong. and this bill stops that. stops those practices by insurance companies. i think it's important that we not get sidetracked by some other very important matters, but also keep central in our -- and focused here on what this legislation does. that is, it reforms the health insurance industry. what else does our bill do with respect to reform in the health insurance industry? it prohibits lifetime limits on people who get sick. right now insurance companies limit how much a person gets sick, lifetime limits, annual

limits. no matter how sick you are, the insurance company says, sorry. we're putting a limit. that's not right. sometimes people have conditions that require a lot more attention. more hospitalization. more attention by doctors. our legislation would prohibit lifetime limits on payments to people who get sick. our bill prohibits annual limits, what insurance companies impose on their policyholders. this reform would apply in the group market and individual market. what does that mean? it means it applies to everybody, whether you're an individual or work for a company. and this would take effect six months after enactment. that's pretty important, mr. president. a lot of people have insurance policies with limits where the insurance company only pays so much so an individual or -- during the person's lifetime in any year. it's just not right because some

conditions require a significant -- a significant increase in payments. or coverage for the person. our bill requires any insurance plan that provides -- our bill would require any insurance plan that provides dependent coverage for children to continue to make that coverage available until the child turns age 26. we know that's a problem too today. often in a state when a child turns 21 and 22, that person can't find health insurance. and in today's market, that -- that is, in today's economic recession, unemployment is so hard, it's hard for kids to find health insurance. we say that your family coverage covers your child until the child turns age 26. and this reform would take effect six months after enactment. in addition, when the exchanges are up and running, our bill

prohibits insurance companies from discriminating against consumers because of health status generally. sometimes the insurance industry says, well, it's not a preexisting condition, but you've not been very healthy lately, so we're not going to give you health insurance. no longer can health insurance companies refuse a policy because a person gets sick. renewals, if you pay your premiums, the insurance company has to renew your coverage. when our exchanges are up and running, the legislation before us today would limit the ability of insurance companies to charge people much more just because of their age. that's what they do today, mr. president. sometimes, depending upon the state, insurance company's able to charge somebody much more for the same coverage just because of that person's age. right now it's not at all unusual for insurance companies to charge more than five times as much just because a person is, say, age 55.

our bill would prohibit insurance companies charging more than three times as much because of age. they -- some states there's no limit. no limit whatsoever. in my state of montana, we're no limit. some states have five. we're saying down to three. when the exchanges are up and running, our bill would prohibit insurance companies from charging women more than men. think of that. some insurance companies charge women more than men. that's not right. this is a widespread practice among insurance companies that is charging women more than men is just plain wrong. our legislation would stop that. health insurance reform also means real insurance market reform. it means real change in the way that insurance companies do business. no longer will insurance companies be able to build their business on cherry picking, only the healthiest and the youngest. that's what they do today. especially for individuals. to some degree in smaller organizations. no longer would they be able to

insure only those who don't need insurance. we bring real reform, mr. president. it would make insurance much more fair and that's literally a matter of life and death. as a recent harvard study reported, people without insurance are 40% more likely to die prematurely than people with private insurance. just think of that. people without insurance are 40% more likely to die prematurely than people with private insurance. tens of thousands of americans die each and every year because they do not have insurance. is that america, mr. president? that doesn't sound like the united states of america we're all so proud of where we allow tens of thousands of americans to die each and every year simply because we have not set up a way, a system, for them to have health insurance. and that is something that we end, we stop in this bill. mr. president, i suggest the

absence of a quorum and ask consent that the time be charged equally against both sides. the presiding officer: without objection, so ordered. the clerk will call the roll. quorum call:

mr. grassley: mr. president? the presiding officer: the senator from iowa's recognized. the senate's in a quorum call. mr. grassley: i ask that the quorum call be suspended. the presiding officer: without objection, so ordered. mr. grassley: i've said for the last two days i was going to speak on senator dorgan's amendment, a bipartisan amendment, to allow the importation of drugs into the united states. i haven't done it until now, so i'm glad to speak in support of this bipartisan amendment. to add provisions of the pharmaceutical market access and drug safety act to this bill. that legislation is a result of a collaborative effort by senator dorgan, senator snowe, senator mccain, and this

senator, to finally make drug importation legal in this country. now i have -- i have for a long time been a proponent of drug reimportation. in 2000, 2002, and 2003, i supported an amendment permitting the importation of prescription drugs into the united states from one country, canada. this one -- this -- this amendment we're working on now is much broader than just canada. in 2004, the late senator kennedy and i worked together on a bill that would authorize drug importation, but it did not survive the partisan politics of this chamber. i then introduced my own comprehensive drug importation bill in 2004. that was s. 2307, the reliable entry for medicines at every day discounts through the importation with effective

safeguard act -- remedies act is what the acronym finally spells out. in 2005, i combined my bill with a proposal sponsored by senators dorgan and snowe. in 2007, we reintroduced a legislation with the hope to lower prescription drugs for all americans. and that is what we are still wog thank senator dorganor his leadership. this time around i -- i should be confident that this effort will finally pass. historically democrats claim to be champions of holding the big pharmaceutical companies accountable. and now we have a democratic super majority in the congress and a democratic president who supported drug importation in the past. i'm not as confident as maybe i

should be, that is, because the white house has participated in some backroom negotiations since the last time this legislation was brought before the senate and then senator obama supported it. behind closed doors the democratic white house found new friends in the pharmaceutical industry. last summer the head of the pharmaceutical labying group bragged -- lobbying group bragged that drug manufacturers negotiated a rock solid dealed, that's their words, with the present administration. an article in "the new york times" detailed the administration's deal with big drug companies. and this quote comes from "the new york times". "for seeing new profits from the expansion of health coverage, big drug companies are spending as much as $150 million on advertisements to support the president's plan." end of quote. but in 2008 when president obama

was campaigning for the position he now holds, he promised that -- quote -- "we'll take on drug and insurance companies, hold them responsible for the prices they charge and the harm they cause." and, certain, i will -- and certainly, the president knows that a great way to hold drug companies accountable is to allow drug importation. in fact, in 2004 when he was a candidate to be a member of this chamber, he challenged his opponents to support drug importation. he said at that time, and i quote -- "i urge my opponent to stop writing with a drug manufacturer --" i used the wrong word. i will start over again. "i urge my opponent to stop siding with the drug manufacturers and put aside his opposition to the reimportation of lower priced prescription drugs. but unfortunately it has been

reported that during the back room negotiations at the white house, the big pharmaceutical companies have convinced the president to drop his strong support for drug importation. "the new york times" reports -- quote -- on july 7, meaning this year, rahm emanuel, president obama's chief of staff assured at least five pharmaceutical companies during a white house meeting that there would be no provision in the final health care package to allow the reimportation of cheaper drugs." end quote. i thought that we were going to hold drug companies accountable. i thought health care reform is supposed to drive down the cost of health care, including the costs of prescription drugs for all americans. the dorgan amendment is a commonsense bipartisan approach to achieve both of these goals.

drug importation achieves these goals without imposing arbitrary fees and without flexing the muscle of the federal government. i have always considered this a free trade issue. now, i know most people see it as a health issue, and it is a health issue, but i come from it from the point of view that only a couple items americans can't buy in this country from anyplace in the world that they want to buy them. one class is pharmaceutical drugs. the other class is cuban -- the presiding officer: the senator's time has expired. mr. grassley: i ask for four additional minutes and that to come off the next block of time for my side. the presiding officer: without objection. mr. grassley: so i see this as a free trade issue. imports create competition and keep domestic destroy more responsive to consumers. in the united states, we import everything consumers want, so i ask again why not

pharmaceuticals? that's why it's a trade issue for me as much as a health care issue. consumers in the united states pay far more for prescription drugs than those in other countries. if americans could legally and safely access prescription drugs outside the united states, then drug companies will be forced to re-evaluate their pricing strategies. they would no longer be able to gouge american consumers by making them pay more than their fair share for research and development. now, it is true that pharmaceutical companies do not like the idea of opening america up to a global marketplace. they want to keep the united states closed to other markets in order to charge higher prices here. based on the reports that i just read, it seems that the white house has already sided with the drug manufacturers and promised them the ability to continue to gouge american consumers

otherwise known as the status quo. the debate is not over. with the dorgan amendment, prescription drug companies will be forced to be competitive and establish fair prices in america. the drug companies will try to find loopholes in order to protect their bottom line. the dorgan amendment would make such action illegal. it would not allow manufacturers to discriminate against registered exporters or importers. it would prohibit drug companies from engaging in any actions to restrict, prohibit, and delay importation. the dorgan amendment would give the federal trade commission the authority to prevent this kind of abuse. it develops an effective and safe system that gives americans access to lower prices. our effort goes to great lengths to ensure the safety of imported drugs. the dorgan amendment requires that all imported drugs be approved by the f.d.a. it puts in place a stringent set of safety requirements that must

be met before americans can import drugs from that country. the amendment requires all exporting pharmacies and importing wholesalers to be registered with the f.d.a. and inspected. it gives the authority for the f.d.a. to inspect the entire distribution chain for imported drugs, and it sets very stringent penalties for violations of the safety requirements in this bill, including criminal penalties and up to ten years imprisonment. we need to make sure americans have even greater, more affordable access to innovative drugs by further opening the doors to competition in the global pharmaceutical industry. if my colleagues on both sides of the aisle are serious about benning down the cost curve of health care inflation and doing it in that direction, the right direction, then they will support the dorgan amendment, a bipartisan amendment. i yield the floor.

the presiding officer: the senator from ohio is recognized. mr. brown: thank you, mr. president. i would echo the comments of the senior senator from iowa. he is exactly right about the dorgan amendment. and there are a lot of reasons as he pointed out that the doarg amendment makes sense for the american people. makes sense for taxpayers because we pay way too much for prescription drugs as taxpayers. government programs, whether it's tricare, whether it's medicare, whether it's medicaid, whether it's -- it's the federal employee benefit health plan, which makes sense for small business and large business alike who are paying too much for prescription drugs, and it makes sense for seniors and all americans who are paying too high a price for prescription drugs out of their pockets. it also makes sense in terms -- it makes -- it makes sense in terms of sort of internationally what we do on the buying and selling of prescription drugs. i mean, i hear -- i've heard so many times -- and i was part of

these discussions in the house where we had the same amendment, we would pass it, and then it would die in the senate or things would happen in conference committees, whatever, where the drug companies really did exert their influence over this -- over -- over the congress and with the president during the bush years. but one of the arguments they always make is it's a question of safety that these drugs coming from -- coming from canada or these drugs coming from france aren't safe, that they -- as if they don't have a food and drug administration as efficient and effective as ours in terms of protecting the public. but what sort of shoots a hole in that argument is -- is how many american drug companies over and over and over in increasing numbers, how many american drug companies are importing ingredients especially from china. we had a hearing -- senator kennedy a year and a half or so ago asked me to chair an oversight hearing with the

health, education, labor pension committee on this issue of what's happening when these american drug companies are increasing their outsourcing of jobs to -- particularly to china. it was in response to what happened in toledo, ohio, among other places, where a number of americans died because of contaminated heparin. heparin is a blood thinner drug that's a very important drug to keep people healthier and live longer and live better, but some of the ingredients for heparin were made in china. and the drug company is not able to trace back, if you will, the supply chain where they are getting their ingredients, so they know they get them from china. they know that when an american drug company, pfizer or another outsources their production to china, they may know where the plant is that puts all these ingredients together, but they don't know -- they can't trace back or at least they won't tell us or can't tell us where they trace back all their ingredients.

so they may get this ingredient from wuhan and this ingredient from shanghai and that ingredient from a rural outpost in hunan province, but they can't tell us exactly where they come from. so no wonder these drugs aren't as fatal -- as safe as they should be. so if they were really interested in drug safety, it wouldn't be that they would stop us from drug importation, because we know if we buy it from france or canada or germany, they have got a food and drug administration agency, an f.d.a. equivalent that keeps our drugs safe. they know that. it's all about protecting their profits. there is simply no doubt about that. and it -- it -- their profits get to be bigger because they make some of these drugs in china, so let's not have it both ways. let's not say we can't import drugs safely into this country when they are exporting jobs as so many other industries are doing, exporting jobs to china, exporting jobs to little villages who put these

agreements -- these manufacturer manufacturer -- create, manufacture these ingredients. they end up in america's medicine cabinets. let's not talk out of both sides of their mouths as the drug industry is doing. a couple other comments, mr. president, about the underlying bill, how important this is that we move on this. there are -- there are 400 people -- more than 400 people every day in defiance, ohio, and zanesville and st. clairesville and all over my state, 400 people every single day that lose their insurance. every day my friends on the other side of the aisle delay. every day they offer amendments and then won't let us vote on them and stand up and object to even voting on things. every day they try to filibuster. every day they put up another hurdle. it's 400 more people in my state that lose their insurance. it's about, mr. president, it's about a thousand people every -- every week, a thousand people in this country every week that are -- that die because they don't have health insurance.

900 people every week in this country die because they don't have health insurance. a woman with breast cancer without insurance is 40% more likely to die than a woman with breast cancer with insurance. and i heard president bush in ohio say several months, maybe a couple of years ago, say that every american gets health care, they can go to the emergency room. well, a woman suffering from breast cancer that didn't get a mammogram because she couldn't afford it, didn't get the kinds of tests that she should have because she didn't have a doctor that she could afford to pay and because she didn't have insurance, the emergency room doesn't do those kinds of things. and even if she got sick, the emergency room wouldn't take care of her until she is almost dead. then she can go into the emergency room and they will take care of her the last few days or last few weeks of her life. this kind of delay, mr. president, hearing these kind of delaying actions, these kinds of delaying tactics, these kind of we can't pass this,

chicken little, the sky is falling. every day we have republicans coming down here saying the sky is falling, and it's simply not. i want this bill to be bipartisan, mr. president. i stood -- i'm a member of the health, education, labor, pension committee as my senator mr. roberts from kansas is in the chamber. we accepted during that markup in june and july, we passed 160 republican amendments. some of them were major, some of them were not so major, but this bill had a bipartisan flavor to it. it's only on the big questions, the role of medicare, the role of the public option, some of the bigger questions where there are philosophical differences. the same reasons that back in the 160's when medicare passed, it was passed almost only by democrats because republicans didn't agree there should be a major role in government in our health care system. so it really is a philosophical difference. it's not so much partisan as that. even though there are many good republican ideas in this bill, in the big questions there is that difference. so, mr. president, i -- i just think it's so important that

when i hear this many ohions every day lose their insurance, this many americans every week die because they don't have insurance that it's so important to pass this legislation. mr. president, i ask -- i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. mr. roberts: mr. president? the presiding officer: the senator from kansas is recognized. mr. roberts: i ask unanimous consent that the quorum call be rescinded. the presiding officer: is there objection? objection is heard. mr. roberts: parliamentary inquiry, mr. president. the presiding officer: the senator is advised that the senate is in a quorum call. mr. roberts: let me try it again. i thought it was worked out. i ask unanimous consent for the second time that the quorum call be rescinded so that i may be -- the presiding officer: is there objection? mr. robert: that i may proceed for 15 minutes. the presiding officer: objection

is heard. mr. roberts: partisan objection or -- i would ask of the acting presiding officer. quorum call:

quorum call:

the presiding officer: the senior senator from connecticut is recognized. mr. dodd: i'd ask consent that the call of the quorum be rescinded. the presiding officer: without objection, so ordered. mr. dodd: mr. president, i'd ask unanimous consent that over the next 30 minutes that time be equally divided 15 minutes for the majority, 15 minutes for the minority for debate purposes only. the presiding officer: is there objection? so ordered. [inaudible] the presiding officer: is there objection? without objection, so ordered.

mr. robert: mr. president? the presiding officer: the senator from can scan recognized. mr. roberts -- the senator from kansas is recognized. mr. roberts: well, i thank the president. i rise today to talk about health care in general and the latest proposal to come out in the form of a so-called compromise, if there's no objection. amazing.

third time was the charm. you know, we talk a lot about being bipartisan here and i don't think that works too well on either side if a member can't at least seek recognition and express their views on what is going on. be that as it may, i do want to talk about the latest proposal to come out from what some of us have determined the majority leader's behind-closed-doors efforts or the compromise on the government-run health insurance plan. now, i'll admit very readily that i do not know all of the details of this plan, hope to in the very near future, but i think most of my friends across the aisle are in the same boat and we are all getting our information from "the post" and "the times" and the rest of the catch-up media, and perhaps from the elevator operators, i don't know.

but this is the compromise, as i understand it. the majority leader will drop the government plan in exchange for two major policies. first, a national insurance plan run by nonprofit insurance companies and supervised by the office of personnel management. and, second, a massive expansion of medicare to tens of millions of people aged 55 and over. well, putting aside the first policy, which, frankly, i don't understand how it could possibly work, i cannot believe anyone is seriously considering expanding medicare as a compromise to the government-run or so-called public option. if doesn't take a genius, mr. president, to see a huge expansion to medicare is, as one single-payer advocate in the house dubbed it -- quote -- "the mother of all public plans." further quoting, "an unvarnished and complete victory for advocates of single-payer health

care and socialized medicine." that's a quote. this is not a compromise to the public option. it's worse. maybe we need to remind ourselves why moving targets -- pardon me, why moving towards a more government control of our health care system is such a bad idea. i think we need to look no further than our current government-run insurance plans -- that's medicare and medicaid -- for examples. government-run insurance plans currently control nearly half of the market with the government's power. they have the ability to set payment levels for doctors -- and they do -- and hospitals -- and they do -- and home health care agencies -- and they do -- and even hospices and all other health care providers not based on the actual cost that those providers incur when treating patients but instead based on whatever arbitrary spending target the budget crunching bean counters -- that's my word, and i'm sorry for that, but that's the way i feel about it -- what

they determine the government can afford. to paraphrase one observer, these types of global government budgets transform patients from sources of revenue over which providers compete to attract and serve, into sources of cost for the government to avoid shunt off and treat off as cheaply as possible. now, that's not right. this has clearly been the result of the medicare program, often heralded as the best of all the government's health care programs. so to review, medicare -- just for a moment. this has clearly been the result of the medicare program often herald as the best of all the -- heralded as the best of all the government health care programs. let's review it. medicare has been on an ever-shrinking path toward bankruptcy for years.

the latest reports from the medicare trustees say the hospital insurance trust fund will not be actuarially sound within the next eight years. the program has $38 trillion in unfunded liabilities. and how has the government responded? by severely underpaying medicare providers and denying medicare patient claims. medicare only pays doctors around 80% of the costs, hospitals, 70% and perhaps even lower. so privately insured americans pay a hidden tax -- this is something we really ought to talk about a lot more but we don't -- of nearly $90 billion a year to make up for these underpayments because the cost-shifting goes on in the hospitals and in case of the doctors. but even that hasn't been enough to keep some -- some providers in business and able to afford

medicare's patients. medicaid is even worse. medicare is also a huge denier of claims. i think many of my colleagues would be surprised to hear that medicare denies claims more often than most private insurance companies. in fact, in 2008, medicare had the highest percentage and the highest number of denied claims in the country. now, think about that when you hear some senators demonize private insurance companies for denying claims. medicare is even worse. this bill already exacerbates these medicare problems by cutting almost a half a trillion dollars from this already woefully unfunded program. now we're considering adding even more people? this is a sinking ship with no lifeboats and we're adding more folks to the deck. by underpaying health care providers and denying claims, medicare already rations health

care. expanding medicare to tens of millions of new people, add envisioned by this compromise that we hear about, will take government rationing to a whole new level. because, as the government takes over more of the health care system and becomes responsible for more of the increasing costs of that system, the only way it will be able to afford this commitment is to ration health care. and as i've said countless times before, this bill gives the government all the tools it requires to ration care. from the comparative effectiveness research, the infamous c.e.r., to the independent medicare advisory board, which will now set medicare reimbursements -- not the congress but the advisory board -- to the new powers granted to the centers for medicare and medicaid services, c.m.s. i can assure you, every provider

knows who and what c.m.s. is. and the u.s. preventive services task force. there's four of them, the four folks who have the ability to ration care by almost executive order unless the congress would come in and overturn it with a -- with a supermajority. this bill puts the rationing infrastructure into place. the u.s. preventive services task force recent change to its guidelines pertaining to mammograms was a perfect illustration of how your health care will be rationed under this bill. for those who don't know -- and you should know -- the task force recently reversed its long-standing advice that women should start getting regular mammograms to detect breast cancer at age 40. now, why is this important? because under this bill, the recommendations of this task force will carry the weight of law for both government-run --

i.e., medicare -- and private insurance. also private insurance. if the task force recommends a particular treatment for a particular set of patients, then medicare and private insurers must cof it. if it -- must cover it. if it doesn't, they don't. now, what do you think will happen to treatments and tests that don't get the task force's recommendation? they simply will not be covered. and that's how the government will hold down health care cos costs, by rationing access to treatments and tests like mammograms. some government-controlled health care systems, like the one that exists in the united kingdom, are much more explicit about rationing. the rationing in this bill, quite frankly, is not as honest. since americans would never stand for the government explicitly rationing their health care treatment by treatment by treatment, the authors of this bill had to come up with a pseudo scientific

justification for rationing, and that justification is the main feature of this bill, comparative effectiveness research, or c.e.r. now, very generally, c.e.r. is the comparisons -- it's very simple -- it's the comparison of two or more treatment options to see which one is better. sounds great and it is a good concept, right? except when you realize that c.e.r. is not being conducted for the purpose of improving patient care but for the purpose of saving the government money instead. now, identify rea, i've read thf the bill, and i remember my amendment, and the distinguished chairman of the "help" committee was very helpful, said he would study it over the night and then when he important business and he had somebody else stand in and that was the end of that, because i had the word "prohibit." and we got into a great debate on what -- what "prohibit" means. and i -- i thought it was pretty clear but, unfortunately, that was dropped from the bill, or the "help" committee bill. we tried that again i in financ,

didn't work. we'd like to try it again if we have time in regards to senator kyl and myself. this bill establishes a c.e.r. institute to conduct this research for the purpose of justifying government rationing of health care. c.e.r. will be the golden ring of rationing or the tablet brought down from the old testament from c.m.s. to give instructions to the health care delivery system. so what we have here is a recipe for disaster. a bill that already significantly weakens the woefully underfunded medicare program, lays the foundation for a rationing infrastructure, plus a compromise that apparently will pour millions of more people into the program. now in the no holds barred search for a proposal that can attract 60 votes, i just don't understand how any senator could support this idea. this -- this is not just a

trojan horse, another step toward the single payer system. again, as one house member of the leadership observed, this gets not only the camel's nose under the tent, but his whole neck and head too. it's just another step toward socialized medicine, strong words, harsh words, i intend them to be. and increased rationing of health care. now the american hospital association, the american medical association, and the federation of american hospitals are finally taking the -- finally taking notice of the advice they're receiving from the state and local hospital associations and doctors and they finally have seen light and come out in opposition to this deal at least. i urge my friends across the aisle to resist this latest misguided attempt at deal making. the consequences are just too

dangerous. you know, there's an awful lot of kactus in this -- cactus in this health care world, i just don't think that we have to sit on each and every one of them. before i yield back my time, i truly want to thank the distinguished senator from connecticut and thank him for his comity in allowing me to make these debate comments and also thank the acting presiding officer in his effort to be bipartisan. and i think we will have a sad day in this body if one side or the other gets into a situation where we do not even allow people to make remarks on not only the pending bills, but on the general issue of health care. thank you, sir. a senator: if my colleague would yield, mr. president. the presiding officer: the senator from connecticut. mr. dodd: when you get older, it is hard enough to remember what happened yesterday, never mind what happened a couple of months

ago. the debate at that time was over the words construed to contribute. it's hard to have the word construed when you raise various practices. as i recall the compromise offered by my friend and colleague from kansas was to strike the word construe so nothing would be prohibit the. i'm not quite sure why we shouldn't accept language that eliminates the word construe. that went on for a day that language back and forth. maybe we'll get our staff together and talk about that. i think -- i hope you're wrong about this thing. i think it's good to have best practices, but if a doctor thinks it is absolutely essential for that patient, you shouldn't be prohibited. the words were over the words to construe. i wanted to respond to him on that point.

a senator: i would agree with the senator. if we get to the specifics of the bill, i think it says shall not in regards to cost containment on medicare a and b. mr. roberts: but the rest of it is encouraged. c.e.r. is the -- what is it? a 30,000 feet overview of the blueprint of how we allot health care dollars in this country. i might mention to the gentleman -- pardon me, the senator and gentleman, that i had a chart on what c.e.r. recommended and it had a figure of a hutc hump whad how much we would devote to different age groups. if you're 60, and the average age of the senate is 62, you're if you're 70, you better get out of luck. that drops off severely. something fixed before this bill passes. so that's my point. and i thank the senator for his comments. i yield back my time.

mr. dodd: i want to thank senator roberts. his amendment in the "help" committee to protect patients by preventing rationing of health care. that's in the senate bill. and that was language that we adopted, i say to my friend from vermont, it was the roberts amendment that was adopted in our markup that prohibits any ration of health care in our bill. so i thank him for that addition. i yield the floor. mr. sanders: mr. president? the presiding officer: the senator from vermont is recognized. mr. sanders: thank you, mr. president. you know, when the republicans controlled the white house, the senate, and the house, they had the opportunity to do something about the health care disaster in america. from 2000 to 2008 some seven million americans lost their health insurance. where were the republicans? during that same period health care costs soared in america. small business people found themselves unable to provide

health care to their workers. where were our republican friends? i'm delighted that down -- that they're down here on the floor now every single day criticizing an effort to try to improve the situation much but it might have been a little bit better eight years ago bringing forth their ideas, but they weren't. now, having said that, let me suggest, mr. president, that the midst of this health care crisis, where 46 million americans have no health insurance, in which health care costs are soaring, and, as the president indicates, will double in eight years if we do nothing, at a time when 45,000 americans this year will die because they don't get to a doctor when they should, when close to one million americans are going to go bank frup from medically reld bills, we need health care reform. that is something that i and i know many other members in

congress have been fighting for for years. and, more than anything, i want to see us pass strong health care reform. but i must express a disagreement with some of my colleagues on the democratic side who think we're on a two-yard line. we're almost there. i don't think so. i think there are a number of problems that remain in this legislation that have got to be resolved that i just want to touch on a few of them. mr. president, one of the good parts of this legislation is finally we're going to add some 30 million americans to insurance health care. that is a good thing. about half of those people are going to be added to an expanded medicaid, a huge expansion of medicaid. but here is my concern, right now our primary health care system is extremely weak. everybody knows. we don't have enough primary health care doctors. we know that medicaid today is on wobbly legs as it trys to

take care of the people who access that program. i am not quite sure how you add 15 million more people to medicaid if you don't have a primary health care infrastructure to accommodate their needs. in this regard i have fought they hard for authorization language in the senate to greatly expand community health centers and the national health service corps, which will train and make sure we have the primary health care doctors, dent siss, and -- dentists and nurses that we need. that we desperately need. in the house bill there is language introduced by representative clyburn, supported by the ctic leadership -- democratic leadership, that would provide $14 billion over a five-year period to expand community health centers, enable tens of millions more to access health care, and make sure we have the primary health care

doctors and dentists that we need. mr. president, it would be a cruel hoax to tell people that they now have health insurance, medicaid or another program, but not create a situation by which they can get into the doctor's office. and i fear that may happen. so, mr. president, i am going to fight as hard as i can to make sure that we have the primary health care infrastructure that we need. and that means here in the senate adopting the language that currently exists in the house bill, dz 14-dz billion over a -- $14 billion over a five-year period. money, according to a variety of studies, will pay for itself as we keep people out of the emergency room and as we keep people from getting sick are than they otherwise should and ending up in a hospital. this makes a lot of sense. community health centers have had wide bipartisan support. we've got to support the house language. now, mr. president, on another issue, i found it interesting,

my friend from kansas, a moment ago was denouncing the united kingdom's health care system, denouncing medicare single payer. i have been confused by fri mends -- by my friends, the republicans says, we love medicare. we, republicans, who year after year after year wanted to privatize medicare, this week they love medicare. well, if they love it so much, why don't they join us in trying to expand medicare and address some of the problems in medicare? let's work together. last week we were criticized. but now, well, i guess the tune has changed a little bit. get your act together, my republican friends. either continue the line you've had for many years about detesting medicare, because, it is,ing in fact, a single-payer,

government program, that's what it is. it is a single-payer government health care program. you've been on the floor of the house defending it all week long until a couple of days ago. i support medicare. what i believe and what i'm fighting for is a medicare for all single-payer program. because at the end of the day i disagree with many on this side of the aisle. i think at the end of the day the only way you're going to provide comprehensive, universe -- universal health care to all is with a medicare single-payer system, which ends hundreds of billions of bureaucracy and waste engendered by the private insurance companies. one of my concerns as we hurdle down to the finish line here, i don't know who will be able to offer amendments. i have an amendment that speaks to what millions of americans want, including the physicians for national health care program.

17,000 doctors, mostly primary health care doctors, but not exclusively, they want to see this country have a medicare for all single payer system. i understand that i'm not going to get very many republicans supporting that amendment. i'm not going to get any republicans to support that amendment. i understand that i will get few democrats to support that amendment. in days to come we will have a medicare single payer system. i want that debate on the floor of the senate. i offered the amendment. i want the right to have that debate. i don't need 20 hours, i don't need five days. i would love to discuss with my republican friends that issue, democrats, that's an amendment that has a right to be offered and should be offered. i understand that that amendment will not pass. i can tell you what could pass and could have the republicans' support and that is the provision i have been working on which at least nays our federalist system where each state learns from other states

at least give states the option if the governor wants, in the legislature wants to go forward with a single-payer model. maybe it works, maybe it doesn't work. if one state, vermont, california, pennsylvania, states that have strong single-payer movements, once they does it and does it well, other states around the country will say we want the same thing. it's the cost-effective way to provide comprehensive health care to all of our people. mr. president, i want to touch on another issue where i think my colleagues here in the senate are wrong and my colleagues -- my former colleagues in the house are right. and, mr. president, this is an issue that you have worked with me on. we just held a press conference this morning. and that is to understand that this legislation is going to cost between $800 billion and $1 trillion. how do you get the money? well, the senate bill contains a

tax on health insurance benefits. i think that's wrong. i think that that is regressive. it's called a tax on cadillac plans. let me tell you, give the soaring cost of health care in america today, what maybe a cadillac plan today is going to be a junk car plan in five years from now. millions of americans are going to be forced to pay taxes on their health care benefits or else their employer is going to come back on those benefits and they're going to have to pay for them out of their own pocket. that is wrong. it is a regressive and unfortunate and unfair way to raise the revenue that we need. our friends in the house did the right thing. they said that millionaires should be asked to pay a little bit more in taxes to make sure that we expand health care coverage in this country. and i support what our friends in the senate -- in the house did and disagree with what is in the senate bill. there will be a poll coming out

later this afternoon in which 70% of the american people, as i understand it, disagree with the tax on health care benefits. they understand that is a tax on the middle class. let's be clear. we are in a terrible recession now. working families are struggling. it is wrong for us to propose a tax on health care benefits which in a few years will be impacting millions of middle-class workers. we should follow what the house has done and say to people at the top millionaires who have received huge tax breaks under president bush, they have got to pay a little bit more in taxes so that we can provide health care to all of our people. mr. president, there is a lot in the bill in the senate that makes a lot of sense to me, and i want to congratulate senator dodd and senator baucus and all those people and their staffs who have worked so very, very

hard on this. we got 31 million more people who are going to get insurance. there is insurance company reform dealing with pre-existing conditions. we made some progress on disease prevention. we have made some progress in this bill. a lot of good things in it. but i want to be very clear i do not think we are at the 2-yard line. i think a lot of work has to be done to improve this bill. we need to, as i mentioned a moment ago, major, major improvements in primary health care. i think we need to change how we fund many parts of the expansion of insurance, do away with the tax on health care benefits. i think we have got to give states the option, the flexibility to go forward with a single-payer system if that is what they want to do. and i also hope very much that this afternoon we will vote and pass the reimportation prescription drug legislation championed by senator dorgan. it is an absurdity in this

country that we remain the country that pays by far the highest prices in the world for prescription drugs. when i was in the house, i was the first member of congress, as i understand it, to take americans over the canadian border, and back then, ten, 15 years ago, women were able to purchase the breast cancer drug attacks for 1/10 the price that they were forced to pay in the united states. i know the drug companies are very powerful. i know they have a lot of influence in this institution, but i hope that we can do the right thing and provide affordable medicine for all americans for -- through reimportation, and i hope that we can pass that bill. so, mr. president, i did want to say that i have some very serious concerns about this legislation, and i hope that they will be addressed in the coming days and weeks. i very much want to be able to vote for this bill, but i am not there now, not by any means. mr. president, thank you very

much, and with that, i would yield the floor. i would suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

mr. reid: mr. president? the presiding officer: the majority leader is recognized. mr. reid: i ask con scene the call of the quorum be terminated. the presiding officer: without objection, so ordered. mr. read: i now move to proceed to conference report to accompany h.r. 3288. i ask also for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. mr. mcconnell: mr. president? the presiding officer: the

republican leader is recognized. mr. mcconnell: i ask consent that i be allowed to proceed just for a moment here prior to the vote. the presiding officer: is there objection? so ordered. mr. mcconnell: mr. president, i want to say to my good friend, the majority leader, we have been anxious to have health care votes since tuesday and we've had the crapo amendment pending since tuesday. you have said repeatedly -- and i agree with you -- that this is -- the health care issue is extraordinarily important and that we should be dealing with it and debating it, so it is my hope that somehow through our discussions, both on and off the floor, we can get back to a process of facilitating the offering of amendments on both sides of the aisle at the earliest possible time when we can get back to the health care bill. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i'm happy to respond through the chair to my distinguished colleague. i think it's pretty evident to

everyone here, not only on what's happened here on the senate floor but the statements that have been made, publicly and privately, and certainly i'm not going to discuss any of the private conversations i've had, but the -- based on the rush limbaugh and glen beck, which is on all the news today, they're upset at senator mcconnell because he's not opposing the health care bill enough, that reasonable process on this -- there are no efforts made to improve this bill, only to kill this bill. and i -- i think that this debate has really come to a point that i've rarely seen in the senate -- in fact, i've never seen it -- to have my friends on the other side of the aisle come to the floor and in some way try to embarrass or

denigrate me by virtue of the fact that -- in fact, trying to embarrass me. but they should understand, any events i had scheduled this weekend have been canceled. events i had last weekend had been canceled. four or five of them. so i'm -- to say the least, i -- i would never, ever intentionally come to the floor and try to talk to somebody about having had a fund-raiser and that's why they're trying to get out of here. the reason that i laid out to the senate what i thought was a reasonable schedule -- procedurally, we're where we a are. the rules of the senate are such that once cloture's invoked, that's what you stay with. and i thought it would be appropriate because we've worked pretty hard here to have a day or two off.

anything that was reasonable, i'd be happy to deal with everyone, but there was no reasonable way to stay that. everything that was done to divert attention and stall has been done. and that's too bad because it's important legislation. today 14,000 americans will lose their health insurance. between now and 3:30, a number of people will die as a result of having no health insurance. so we're engaged in important stuff. as pundits have said, some of the most important legislation that's ever tbon this body. so i'm going to proceed, follow the rules of the senate. and i am sorry that we haven't been able to work with the republicans in a constructive fashion on this health care bill, but it's obvious we haven't. mr. mcconnell: mr. president? the presiding officer: the

republican leader. mr. mcconnell: i just ask unanimous consent to be able to respond briefly. the presiding officer: is there objection? so ordered. mr. mcconnell: i would reiterate to my good friend from nevada, all i said was, the crapo amendment has been pending since tuesday. we would like to vote on amendments. and there have been -- there had been some difficulty apparently in coming up with a side-by-side to the crapo amendment of i understand that. but i am perplexed that it would take two days to come up with a side-by side. this has been stated by my good friend the majority leader, is the most important issue, some have said, in history, been equated with a variety of monumentally important pieces of legislation in american history. all we're asking is the opportunity to offer amendments and get votes. and i said it in the most respectful way and meant it in the most respectful way. i think it is pretty hard to

argue with a straight face that we're not trying to proceed to amend and have votes on this bill. that's what we desire to do. the majority leader certainly has the right to move to the conference report, and he's now done that, or we're about to vote on doing that. all i suggested was, we'd like to get back on the health care bill as soon as we can, resume the debate process on what has been described as an issue of historic importance, and let -- let senators vote, which is what we do here in this body. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: i say to my friend from kentucky that i'll -- we -- i have an event i'm going to now. we'll see if we can work something out. the presiding officer: the clerk will call the roll.

vote:

a vote:

vote:

the presiding officer: are there any senators who wish tpo vote or to change their vote? on this vote the ayes are 56. the nays are 43. the motion to proceed is agreed to. without objection.

the clerk will call the roll. quorum call: the presiding officer: the senator from arizona is recognized. could i please have order in the chamber, please. the senator from arizona is recognized. mr. mccain: madam president, it is my understanding we are

now on the fiscal year 2010 consolidated appropriations act. the presiding officer: the senate is in a quorum call. mr. mccain: i ask unanimous consent that further proceedings under the quorum call be suspended. the presiding officer: without objection. mr. mccain: mr. president, i'll have a lot to say about this 3,000-page omnibus appropriations bill, but i would point out to my colleagues that it is loaded with 9,000 -- excuse me 4,452 earmarks totaling $207 billion. six bills totaling $450 billion, 1,351 pages long, 409 pages of earmarks, spending on domestic programs has increased by 14%. veteran spending has increased by 5%. that shows the priorities around here. let me repeat that.

domestic spending programs increased by 14%, military construction and veterans has increased by only 5%. here we go again, just a matter of months ago in march, the senate passed a mondays russ -- monsterus a appropriations bill loaded up with earmarks. at that time those of us who complained about the ridiculous amount of race were ignored. the director of management and budget, peter orszag said -- quote --"this is last year's business. we just want to move on." a truly remarkable statement coming from the man put in charge of the budget. in march there was a -- senator reid said -- quote --"we have a lot of issues we need to get to after we fund the government. something we should have done last year. but could not the because of the

difficulty we had working with president bush. so what's the excuse this time? where will the blame be placed now? is the majority leader having difficulty working with president obama? we've had all year to work on 12 annual spending bills and we only enacted five of them through the regular order and one of those five was passed and sent to the president before the new fiscal year began. we should be embarrass bid this process. -- embarrassed by this process. here we go again, faced with a 1,350 page omnibus appropriations conference report which contains six bills, spen spends $450 billion and 4,752 earmarks totaling $3.7 billion. meanwhile people are out of jobs, out of their homes. unemployment in my state is 17% and we're going to pend money on things like $2,700,000 -- get

this, 2,700,000 for supporting surgical operations in outer space at university of nebraska medical center, omaha, nebraska. $30,000 for woodstock festival youth initiative, $13.9 million for fisheries. the $200,000 to renovate and construct the laredo musical theater. the american dollars shouldn't be used for seating and sound proofing materials. $800,000 for jazz at the lincoln center. $3.4 million for a rural bus program in hawaii. you'll note that hawaii pops up all the time here.

$1.6 million to build a tram between the huntsville botanical garden and the flight center in alabama. $750,000 for design and fab gaition of exhibits to be placed in the world food prize hall of lauretes in iowa. i'm not making these up. i'm not making these up. and this was the same party and president that promised to scrub each one of these appropriation bills and get rid of the unnecessary ones. so we'll be talking a lot about this -- about that in this bill. six bills, not one, six bills totaling $450 billion, 409 pages of earmarks, 4,752 earmarks totaling $3.7 billion, and spending on domestic programs has increased by 14%.

milcon and veteran spending has increased by 5%. now, i just met recently with the governor of my state. we are suffering under incredible economic difficulties. they're have the greatest financial crisis in the history of my state. couldn't they use some of thi this $3.7 billion in earmarks to pay for some of the essential services that they're having to be cut back not only in my state, all over america? no, the beat goes on. it's business as usual here in washington. and do not be surprised at the anger of the american people over this kind of -- this way of doing business. bills of 1,351 pages long filled with earmarks and pork that is -- that's got nothing to do with the betterment of our nation. so we'll be talking a lot more about many of these pork barrel amendments that are on, but it's

really awful. $200,000 for design and construction of the garapan public market in the northern marianas islands. we'll hear more about it. a senator: will the senator yield for a question? mr. mccain: i'll be glad to. a senator: did you senator mention that the year over year spending is 12%. does the senator from arizona know what the c.p.i. was? mr. mccain: c.p.i. was win .3%, -- as it 1.3%, not to mention that people not staying in their homes and the hardest economic conditions in history. spending on domestic programs has increased by 14%. what bring that's down to 12% is that they spent only increased veterans -- veterans spending by 5%. but oprah houses -- opera

houses, rural bus programs, music programs. $300,000 for music programs at carnegie call. do you think that carnegie hall needs $300,000 for music programs? mr. thune: will the senator yield for another question? do these -- do these numbers that you're talking to, this 12% increase in spending on the seven appropriations bills in the previous year at a time when families across the country are being asked to tighten their belts, small businesses are tightening their belts, we have order unemployment. do these records include the almost $1 trillion spent in the stimulus bill? mr. mccain: the stimulus bill has nothing to do with that, i would say to my colleague. we all know that. this is an entirely new six appropriations bills totally nearly $450 billion. which, by the way, the majority leader wanted to pass by unanimous consent. remarkable. mr. thune: i'd say to my

colleague and friend from arizona that 12% year over year increase and -- and five bills that have already passed had increases that were -- were in the teens in terms of the year over year increases too. i don't know how when you pass a trillion dollar stimulus bill, much of which was distributed to federal agencies that will get the 12% year over year, 12%, 14% increases in spending, how to justify that to the taxpayer or hard-working americans struggling to make ends meet and having to balance their family budgets. states are struggling to balance their budgets. but here in washington it seems like it is spend, spend, spend. mr. mccain: i would respond to my friend it has to be in the context of a revision over 10 years recently by the office of management and budget fro from $10 trillion to $12 trillion. and the deficit this year i

is $1.4 trillion. and i'm not sure what it is next year. but they couldn't have known that in the appropriations committee when they passed spending measures such as this. the point is in the face of massive, unprecedented deficits, unfunded liabilities in social security an medicare -- and medicare, where we're asking americans all over to tighten their belts. in my state essential services are being cut because they don't have enough money. this is the same business as usual that we've seen for years. and so i saw a poll yesterday, it was in hotline, or one of those, that the approval rating of members of congress is below that of used car salesmen. i just have not met those who expressed their approval. so we should not be surprised at -- at some very interesting things that may take place in the elections coming up this november. but it's really -- it's really

unfortunate. that's all. mr. thune: senator, one final point i'd mike is that all of the -- i'd make is that all of the spenting that you mentioned, all of the money in the stimulus money was borrowed money, it will be paid for by our children and grandchildren. the $1.4 trillion that you mentioned last year that constituted the federal deficit means that out of every dollar that the federal government spent last year, 43 cents was borrowed. i mean -- mr. mccain: you know who they borrowed it against? our kids and grandkids. they're the ones that will have to pay for it. i don't think i will. it's our kids and grandkids. this is a colossal act of generational theft that we committed. believe it or not, the american people have figured it out. mr. thune: there's no question. and one thing that's really bothersome if you're -- you know, most generations of americans, your generation, obviously, worked hard, sacrificed so the next generation could have a better

life. we're borrowing from the next generation because we haven't been able to live within our means. that turns on its head one of great ethics of america that have served this country so well for generations. washington, d.c., has not learned the lesson that when you borrow money, it's got to be paid back and this you can't spend more than you take in. 43 cents out of every dollar last year was borrowed. all will be put on the bills of our children and grandchildren. mr. mccain: the gentleman is correct. madam president, i yield the floor. and i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: test.

mr. grassley: mr. president? the presiding officer: the senator from iowa is recognized. mr. grassley: i ask the calling of the quorum be suspended. the presiding officer: without objection, so ordered. the clerk will report the kenilworth. the clerk: conference report to accompany h.r. 3288, the committee of conference on the

disagreeing votes of the two houses on the amendment of the senate to the bill h.r. 3288, making appropriations for the departments of transportation and so forth and for other purposes, having met, have agreed that the house recede from its disagreement to the amendment of the senate and agree to the same with an amendment, and the senate agree to the same, signed by a majority of the conferees on the part of both houses. mr. grassley: madam president. the presiding officer: the senator from iowa. mr. grassley: i know we have moved to the omnibus appropriation bill to continue government and the time is running out for the current authorization bill, and this brings us back to the authorization of spending, but it also takes us away from health care reform, and on this side of the aisle, we have been waiting for a long period of time to vote on some amendments that are now before the senate, like the crapo amendment that would stall the tax increases in

this bill until 20 -- no. the crapo bill would send the bill back to committee to take out the tax increases that are in it, and then we have also got the dorgan amendment. now, i can understand why maybe the majority maybe do not want to vote on republican amendments, but i sure don't understand why they would object to voting on senator dorgan's amendment, a democratic amendment, because there has always been more democrats than republicans for the dorgan amendment, and quite frankly i'm in a position where i agree with that amendment, i'm a cosponsor of it, and i think we would have a great deal of bipartisan support for the dorgan amendment. but now we're just automatically away from the health care debate

and those amendments, so i'm wondering why we had to right now do this appropriation bill, and i -- i think that there is growing realization that maybe public reaction, negative reaction to the legislation before us -- remember, that 2,074-page bill that's before us -- that the public is getting wise to what's in that bill and there is objection to it and maybe now the majority party would like to have a little respite from that debate. so i thought i would come back to not the substance of the health care reform bill debate but to a lot of organizations that oppose it and why they oppose it just to keep the public's attention that we on this side of the aisle feel that the health care issue is very, very important.

as i travel around iowa, i hear a lot of concern about how to control government spending. people are worried about all the bailouts, the banks and the automakers, the automakers like general motors being nationalized. they're worried about the rising rate of unemployment, 10% now. they don't see how we'll ever dig ourselves out of a deficit hole that we're in, a deficit that has been increased by 1.3 -- by $1.3 trillion since president obama's inauguration. and as senator mccain just pointed out, the bill that has now come before the senate to fully fund the federal government, that bill has 12.5% increases in it, and from that standpoint, it seems to me that we are getting away from a commonsense principle that we ought to use around here on spending, and that spending

shouldn't eat up any more than the economic growth of the tax base that's coming in to the federal treasury to support that spending. and quite obviously, you can't have 12.5% increases in appropriations this year over last year, and last year was 9% over the previous year. you just can't sustain that. common sense dictates against it. but what rules here in washington is just a lot of nonsense. confused.nstituents are they're confused why in the face of all these fiscal problems some in congress are proposing now a $500 billion in tax increases. tax increases are very bad for the economy. it's more difficult to get out of the recession as you increase expenditures. they don't understand why some are proposing the largest medicaid expansion since the program's creation. and they want to know why they are proposing $500 billion on

medicare cuts to create an entirely new entitlement program that this country can't afford. nowhere are these worries and this confusion more evident than among business leaders of america, because business is where jobs are created. you know, government does not produce well. government consumes well. so if you want to expand the economy, you do it through the private sector. that's where the resources of government comes from. that's where the resources that sustain our people come from. so whether it's a small business owner on main street or a c.e.o. on wall street, the message is clear: stop spending, get the economy back on track and get people back to work. unfortunately, the pending health reform bill will not address any of these goals. in fact, it may just do the

opposite. don't take my word for it. let's take a look at what the groups that represent american businesses are saying. let's start with the chamber of commerce representing three million american businesses. in a press release distributed november 19 one day after the release of the senate bill, the chamber called the senate bill -- quote -- unquote, missed opportunity to enact meaningful reform. end of their title. let me go to a specific quote -- "this bill still contains a government-run plan and an onerous employer mandate. it taxes working americans, slashes medicare, spends over a trillion dollars, and after all this, c.b.o. tells us 24 million americans will still not have health insurance."

end of quote. that doesn't sound like the kind of reform that is going to help get the chamber members back on track hiring more workers so we can get this unemployment down. it sounds like they will end up being forced to pay higher taxes and cut jobs. i'm not an economist, but that certainly doesn't sound like a formula for getting this country out of the recession. in fact, the chamber's press release says -- "the chamber believes the path to a healthier economy is to cut taxes, not to raise them by $500 billion." end of quote. they go on to ask a question that i still can't find an answer for: why is there still no meaningful medical liability reform? is currying favor with the trial lawyers worth passing up up $50 billion in c.b.o.-verified savings?" end of quote.

i think it's pretty clear that the chamber of commerce doesn't think that this $2.5 trillion bill will cure what ails the u.s. economy, but let's see what some other business groups have to say. the national association of manufacturers put out a press release the same day as the chamber of commerce, november 19. the manufacturers association is the nation's largest industrial trade association. their members build the machines that keep america running so they should know a little bit about how to get our economy running again, and unfortunately they see senator reid's bill as a step in the wrong direction. like the chamber and pretty much like every other business group, the national association of manufacturers has announced that they cannot support the pending bill. i find it hard to believe that some senators that claim to be pro business can support a bill that is opposed by almost the

entire business community, or am i missing something? how can some democrats that claim to want to get people back to work support a bill that economies from the far right to the far left say that it will reduce wages and increase unemployment? it's just -- it just doesn't seem to make sense. like other business groups, the national association of manufacturers is in favor of reform. manufacturers realize that we need health reform but with lower costs, increased access, and improved quality. but according to their press release, they cannot support the bill that will -- they cannot support a bill that will, quote -- and this is their quote -- "add massive financial burdens to businesses that are already struggling in this recession." end of quote. they go on to express deep concern about huge tax increases

that will hurt small business manufacturers, and they're worried that both the so-called public option and the massive medicaid expansion will just end up shifting more costs and higher premiums to private businesses. the national association of manufacturers ends their press release by saying, quote -- "oppose the majority leader's bill and urge senators to do the same as it raises costs and ultimately will destroy jobs." end of quote. and again, i find myself asking how someone can claim to be pro business but support a bill that is so strongly opposed by the business community. let's take a look at what small businesses have to say. maybe that's where the answer is. and you've got to remember that small businesses create 70% of the net new jobs in america. in fact, it was christina roemer, the president's top economic advisor, who said in a recent webcast that health care

reform will -- quote -- "benefit small business, not burden it." end of quote. unfortunately, the national federation of independent businesses, the voice of small businesses, doesn't seem to agree. after the release of senator reid's bill, the national federation of independent businesses said this -- quote -- "this kind of reform is not what we need to encourage small business to thrive. we oppose the patient protection and affordable care act due to the amount of new taxes, the creation of new mandates, and the establishment of new entitlement programs." end of quote. like the chamber, the national association of manufacturers, small businesses want and need reform. probably more so than even chamber members in the national association of manufacturers, but it doesn't sound like the pending bill actually addresses the problems with small business.

in fact, it sounds like the pending bill simply creates a whoaft of new problems, problems at a time when this country is coming back from the brink of the greatest economic downturn since the depression. the national federation of independent businesses goes on to say -- quote -- "there is no doubt all these burdens will be paid for on the backs of small businesses." end quote. over the coming weeks, i'm sure some senators are going to come down here and talk about all the benefits for small businesses that are in this bill, with you in the interests of honest debate, i hope they will at least mention in their remarks that despite all the so-called benefits, this bill is still opposed by the voices of america's small businesses. it is still opposed by the national federation of independent businesses. i could go on and list about

half a dozen other business groups that oppose this bill. the associated builders and contractors, the independent electrical contractors, the international franchise association, the national association of wholesalers, the small business and entrepreneurial -- and entrepreneurship council, and the international food service distribution association. all of these groups recognize the devastating impact this bill will have on our economy. we're facing the highest unemployment rate in 26 years. we have already seen the national debt heat wave by by $1.3 trillion since inauguration, or per household, household, $11,535. the pending bill misses the mark on businesses -- on business' top priority, and that is lowering costs. don't take my word for it. the congressional budget office

says that the reid bill bans -- bends the federal spending curve further upward by a net of of $160 billion between 2010-2019. for these reasons, the pending bill is opposed then by these organizations that i've quoted: the national association, the chamber of of commerce and the national association of independent business, as well as almost every other business group based in washington, d.c. or maybe, for all i know, they're based in other parts of the country but they still follow legislation here in this city, in the congress. the business community has spoken and their message is lou and clear. for senators that want to bend the growth curve down -- and that's what we all set out to do but we don't have a bill before us that does it -- this bill is

not the answer. for those senators that want to get people back to work, this bill is not the answer. and for those senators that want to get this country's economy back on track, this bill is not the answer. if you support american businesses and american businesses is what provides the income into the federal treasury, whether it's corporate tax or whether it's income tax, it seems to me if you have pride in american businesses and the jobs they create, you cannot support this bill. i yield the floor. the presiding officer: the senator from washington is recognized. mrs. murray: thank you, madam president. madam president, i rise this afternoon to speak about the transportation and housing title of the bill that is now before the senate. this is a bill that has broad

bipartisan support because it addresses the very real housing and transportation needs of american families across the nation. you know, there's a lot to be proud of in this conference report and i'm really pleased with what we have been able to accomplish working with my colleague from across the aisle, senator bond, chairman olver on the house side and congressman lathem and all of their staffs. this bill makes needed investments in our transportation infrastructure. it creates critical jobs while also supporting housing and services for our nation's most vulnerable. and it ensures that two critical federal agencies, departments that communities across this country depend on, have the resources they need to keep our commuters safe and to keep communities moving and prospering. the bill that is now before us touches the lives of americans in ways they can appreciate each day, and because we are talking about transportation projects and housing assistance, we are also talking about jobs and stemming a housing crisis that

has contributed to our current economic troubles. so whether it's the parent that commutes every day and needs safe roads or new public transportation options so they can spend more time with their families, or it's a business who depends on solid infrastructure to move goods and attract customers, whether it's a young fan who's searching for a safe and affordable community to raise their children in, or the recently laid-off worker who needs help to keep his or her family in their home. this bill, the omnibus bill that's now before us, has a real impact on americans who are struggling in these troubling economic times. our bill takes a balanced approach that addresses the most critical needs we face in both transportation and housing while remaining financially responsible and staying within the constraints of the budget resolution. madam president, i'm especially pleased that the bill provides over $10.3 billion to support

and expand public transit, which continues to see record growth in ridership. the bill also includes $600 million for the competitive multimodal surface transportation grant program, which supports projects making a significant impact on communities and regions in addition to the over $41.8 billion included for our nation's roads and bridges which will support good-paying construction jobs and lead to safer and more reliable infrastructure. these transportation investments are critical to supporting our nation's economy and creating good-paying jobs. in addition to these important investments in transportation, the bill represents a firm commitment to providing critical housing and supportive services to families who are most impacted by the economic crisis. this bill includes increased funding for the section 8 program which provides housing for low-income families across the country.

in addition, the bill increases housing programs for some of our nation's most undiseived populations, like the elderly and the disabled and native american communities. madam president, senator bond and i are particularly proud that this bill includes $75 million for vouchers for the joint h.u.d.-veterans affairs supporting housing prap. program. that program is going to provide an additional 10,000 homeless veterans and their families housing and supportive services, so we should all be very proud of the inclusion of that in this bill. i'm also pleased the bill includes more than $150 million for housing counseling programs to help our families avoid scams and stay in their home instead of facing foreclosure. our bill provides assistance to those who need it most and it directs resources in a responsible and fiscally prudent way of the it addresse.

it addresses the needs of families and businesses in every region of the country, families who are looking for the federal government to step up and provide solutions to everything from congestion solutions, transportation safety, foreclosure assistance and affordable housing. madam president, this bill helps our commuters, it helps homeowners, it helps the most vulnerable in society. and most importantly, it will create jobs and supports the continued recovery of our national economy. i hope that we can get past the differences that we have and move quickly to send this bill to the president's desk. madam president, before i close, i do want to thank all of our senate staff who worked extremely hard over this past year to move this bill forward, through our subcommittee, through full committee, through the floor of the united states senate, flew conference committee and now -- through conference committee and now here on its final stop before it reaches the president's desks. they have spent many, many evenings, weekends, nights and beyond in putting the details

together. i want to thank matt mccardle, ellen jaymark, travis slumpkin, grant lamon, michael banee, dedra goodman and alex keenan. and i especially want to thank megan mccarthy and rachel milberg for their outstanding efforts to help us get this bill to the floor today. so, madam president, these bills come. we are the ones who stand before everyone and take credit for them but it is our staffs and many, many people who help us get here and i truly want to thank staffs on both sides of the aisle for getting us here today. and, again, i urge our colleagues to get past our differences and move this bill quickly to the president's desk. thank you, madam president. and i yield the floor. mr. crapo: madam president? the presiding officer: the senator from idaho. mr. crapo: thank you, madam president. madam president, i want to speak on both the omnibus appropriations bill to which we've just moved as well as to return and make some comments on the health care legislation from which we just retreated. first of all, with regard to the

omnibus appropriations bill, i'm very concerned about the fact that as my amendment -- or my motion is pending on the health care bill dealing with one of the more important issues in the bill -- namely, the president's pledge to make sure that no one in america who makes less than $250,000 as a couple or $200,000 as an individual, will be required to pay for the unbelievably high cost of this bill. and while we were facing this amendment, the majority has decide that they will shift from the bill. i understand that's a tough vote to take because the bill contains so many -- hundreds of billions of dollars of new tax increases that the american people squarely in the middle class will be called upon to share. but we should not have shifted from the health care debate to move to the omnibus appropriations bill. not only because of the importance of the issues we're dealing with on the health care legislation but because of the omnibus appropriations bill itself. this congress cannot control its

appetite for spending. the appropriations bill, which we see before us now, is called an omnibus bill because it packages together seven of the individual appropriations bills that this congress has been working on which have -- and we're still now just studying them to find out what the detail is, but from the information i've received, the average rate of growth in spending in this bill overall, over those seven bills, is somewhere between 12% and 14% growth in federal spending. this congress has generated a $1.4 trillion deficit in less than 12 months, and now for next year, we want to see federal government grow by another 14%, 12% to 14%, and that doesn't count the new stimulus package spending that is being talked about and it doesn't count the spending that almost $2.5 trillion of new spending that's contemplated in the health care legislation and any

number of other pieces of legislation that are waiting in the queue to come before the congress. at some point, fiscal restraint has to return and come to washington, d.c. we haven't seen it here for far too long. madam president, i know that it's very tempting to just say, hey, we can pile the debt on our children and our grandchildren and spend what we want to spend today. there are those who say that the only way we can have a strong economy is to spend ourselves into prosperity, and yet it is not the government that creates jobs. the formation of capital, it is the investment by small businesses and entrepreneurs and new ideas and new products and the expansion of business in the united states that will allow us to sustain a strong, healthy growth in our economy. if we continue to rely on borrowing money from the future in order to spend ourselves into

prosperity, we will continue to see our national debt mount to points where it cannot be sustained. we are already at a $12 trillion national debt, a national debt that is projected to double over the next ten years to $24 trillion. and i object to moving off the health care bill, where we had such critical amendments and motions pending, and i object to moving to a bill that will now increase the growth of the federal government by 12% to 14% in the seven areas where it is focused. let me shift for just a moment, madam president, and talk for a bit more about the health care bill. the motion that i had brought, which is the pending motion before the senate -- or was before we shifted off the health care bill -- was a simple motion that would have required the bill to be recommitted to the finance committee with instructions to the finance committee to take out those parts of the bill that impose a tax increase on people in the

united states who earn less than $250,000 as a couple or $200,000 as individuals. restraightforward, exactly what the president -- very straightforward, exactly what the president pledged on multiple occasions to the american people he would do. yet we have shown that there are almost $500 billion of taxes in the first ten years of this bi bill, and if you look at the real first ten years after the spending wha has kicked in, the 2014-2023 time period, it's almost $1.2 trillion of new taxes, a huge portion of which fall on the middle class. and the response? the response has been, well, actually this bill has a tax cut -- is a net tax cut. how can that be? the only way it can be claimed to be a tax cut is if you take all the subsidies in this bill -- about $400 billion worth of them -- are used to provide people at lower-income

categories who don't have at quit access to insurance with a subsidy toward the purchase of insurance, and if you call that a tax cut. it's actually in the bill called a renewable tax credit even though $300 billion of the $400 billion goes to individuals who do not pay taxes, who do not have a tax liability, and is scored by the congressional budget office as spending, not tax relief. and even if you were willing to count that money as tax relief, then you would have a situation in which 7% of the americans would be receiving these government subsidies while the remainder would be paying the price, paying the taxes. to put some numbers on that, out of282 million americans who have insurance in america today -- or will have in 2019, only

19 million of them would receive this tax credit that is being talked about. and, remember, the vast majority of them get what's called a tax credit but it is a government subsidy going to those who have not generated a tax liability. and 157 million of that 282 million would be people who get health insurance through their employer and will not be eligible for that health insurance. and after you do all the numbers and just take out the taxpayers who make less than $250,000 per year couple or $200,000 as individuals, the bottom line is, after all of those who are subsidized are taken out, there are still 42 million americans in the middle class, as defined by the president, who will pay hundreds of billions of dollars in taxes. my amendment would simply

require that those taxes be taken out of the bill, that the president's pledge be honored in the bill and that the bill then be made -- put into a posture to return to the floor for further debate. madam president, one other item i'd like to talk about. one of the things that is often said about the opponents of my amendment is that this bill actually drives down the spending curve. well, when they say that, i wonder what curve they're talking about. are they talking about the size of government? no. the size of government under this bill goes up by $2.5 trillion. are they talking about the cost of health care? no. the c.b.o. study indicated very clearly that, at best, americans will not see the cost of their health care go down, and for those in the most needy categories, the 17% of americans who are in the individual

market, their health insurance will actually go up by 10% to 13%. are they talking about the federal deficit? actually, c.b.o. says that the deficit will go down. that's not the size of the government, but that's the size of the debt or the spending each year. but how does it go down? it goes down only if you use the budget gimmicks that i'll outline in just a minute, or if you include all the taxes, the hundreds of billions of dollars of taxes that are in the bill, and if you count the medicare cuts that are in the bill. you take out any one of those, the nearly $500 billion of medicare cuts, the hundreds of -- nearly $500 billion of taxes, or the budget gimmicks, and this bill does not drive the deficit curve down. now, what are the budget gimmicks? and i'll close with this. madam president, what are the budget gimmicks i'm talking about? there are a number of them. the biggest is that the proponents of the bill just

don't count the first four years of spending. if you look at the 10-year spending cycle -- of the first ten dwreers of the first part of this bill, the taxes go into effect on the first day the bill is law. on january 1 of next year. the spending doesn't start until the year 2014. so we have ten years of taxes, ten years of the medicare cuts, and six years of the spending, and that's how they're able to say, well, it balances out. if they started the spending and the taxing on the same day and didn't give themselves a four-year run of tax collection until they start the actual implementation of the spending part of the bill, it would drive the deficit down also. so, madam president, all we need to do in this senate is slow down, refer the bill back to committee, have them fix the provisions on taxes, and then work on some of the common ground that we know we have that

will help bend the spending curve down and will help improve the situation for americans across this country who are calling for us to control the skyrocketing costs of health care. madam president, it's my hope that as the senate goes through the next few weeks of debate on this legislation, as well as the other legislation that we bring before us, that we'll remember our children and our grandchildren and all americans today who are calling for the kind of true health care reform that will truly address the kind of fiscal responsibility and the kind of cost containment that we should be seeking in these chambers. and with that, i'd yield back my time. mr. burr: madam president? the presiding officer: the senator from north carolina. mr. burr: madam president, i rise to reiterate exactly what my colleague just said, that

transparency with the american people on the cost of this plan is absolutely essential. fiduciary a going to tax the american people, then tell -- if you're going to tax the american people, then tell them what you're going to tax them. but don't use smoke and mirrors only for people to find down the road they've been sold a pick in a poke. i want to talk about not what's been introduced but what's been reported in the press as to where we may go on this bill. as many know, the bill that's under consideration that's supposed to reform health care was a bill crafted in a back office in the capitol where very few people participated and those that did participate were only democrats. it wasn't until it was rolled out on the senate floor that many of us had an opportunity to read 2,074 pages, and if the american people are like i am, we're still working our way through section by section trying to figure out exactly

what it says and, more importantly, exactly what it means and, even more important than that, how does it affect me, how does it affect my family. you see, health care is a very personal issue for everybody in this country, and it's important that we display the honesty that they expect u from us, if in fat we're going to reform health care, then let's reform. it. if we're going to do what we've done over the past several weeks which is have a debate over coverage expansion, then let's be honest with the american people. who's going to pay for it? we know from how the c.b.o. has looked at the bill and how it was designed by the majority leader that we're going to steal $464 billion from medicare. that's fact. nobody disagrees with that. $464 billion will be stolen from medicare, which the medicare trustees say will be insolvent in 2017. a mere eight years from now.

not sure that that's fiscal responsibility, but it's in the bill. now, in the last 24 hours, the press reports that the majority leader has sent a new proposal to c.b.o., the congressional budget office, because he's seeking to find out what that new proposal will cost. if the reports are correct, he's decided to drop the public option and to craft a new coverage plan for some segment of the american people. again, by news accounts only, that would be an expansion of coverage for individuals in this country 55-64. now, i don't know if that's the entirety of the group. that's 24 million to 30 million people. if it were opened up to any segment, it would be like a magnet to those who probably had some type of health condition,

because if you don't have a health condition, the likelihood is in the open marketplace, through your employer, if you're employed, you can find a reasonably priced plan. so automatically the way we've designed it, we're going to attract the sickest of that population. now, in the process of doing that, i think what we have to pause for a moment and realize is that we've got over 40 million seniors and disabled already in medicare. it's system that doesn't reimburse 100% of the services provided for them. in other words, for medicare we reimburse a doctor and a hospital less than it costs them to deliver the service, and nationally we've accepted that, because in that system when a senior goes in under medicare and gets a service, what's not

reimbursed is they'v they then r to the people in the -- is then shifted over to the people in the private sector side. doctors and hospitals have been successful at managing their payer mix. a lot of doctors have "x" amount of medicare and "x" amount of private pay. when you put them together, they stay in business. i think it is safe to say when you change the doctor's payer mix or the hospital's payer mix, you could take a provider and move them from slightly profitable, enabling them to practice, over to losing money based upon how the payer mix reimburses them. so my point here is, as you take people out of private pay, which is coverage by their employer or under a health care plan, payment out of pocket, or purchase of health insurance where that health insurance pays at 100-plus percent of the cost

of a service provided, we're basically putting 24 million possibly new additional covered lives into medicare under medicare reimbursements. we thre through that automaticay change the payer mix of every potential provider in america. we put in jeopardy the doctor, we put in jeopardy the hospital, we put in jeopardy anybody who provides a service under medicare. now, what's a doctor going to do? well, the doctor can look at it and say, i can absorb the reduction and the change in the payer mix. the doctor may look at it and say, i can't add anymore medicare beneficiaries. so i'm sorry i saw you before when you were on private insurance, but i can't continue to see you because now i don't get reimbursed sufficiently, so you're going to have to go find another doctor. well, now all of a sudden we've gotten into the core pledges of

the president where he said, if you like your plan, you get to keep it. if you like your doctor, you get to continue with it. bus w we're putting the burden - because we're putting the burden on the hospital or the physician to make a determination as to how they monitor an control the payer mix. by one simple change, by increasing the opportunity for people to participate in a program that up till in time has been sacred and might also add is a program that every participant has paid their lifetime to be enrolled in. you see, medicare is a trust fund. i think we forgot that when we arbitrarily said we could take $464 billion and steal it out of medicare and use it to fund this new entitlement. this isn't our money to steal. this is the beneficiary's money that they have paid taxes on to fund their medicare benefit their entire life. i'm not sure where we believe we have the right to go in and move

that money from one account to another, where in essence moving it from one account and using it for somebody totally different. it's unfair to those that had planned a lifetime for it. but let me go back to the payer mix. as you increase the rolls of medicare beneficiaries, you affect the viability of every outleoutlet of medical service: hospitals, doctors. this could also affect pharmacists. and it's important that we realize, we've already increased in this bill the number of individuals who will be covered under medicaid. the original majority leader's bill mandates that every state will now raise their limit on medicaid participation from 100% of poverty to 1313% of poverty.

-- 133% of poverty. medicaid reimburses at about 72 cents of every dollar of service provided. when you do that, you've now enrolled between 11 million and 15 million new covered lives under medicaid. so every provider in the system is already looking at what's been proposed until the press accounts of the last 24 hours and said, i'm going to have 11 million to 15 million more people that i'm being reimbursed at 72 cents of every dollar provided. it's hard to stay in business when it costs you $1 to deliver a service and you get 72 cents back at payment. so they're already sitting here trying to figure out how they're going to adjust their payer mix to meet the demands when all of a sudden we come out with a new proposal that the press accounts say we could enroll 24 million people in a system that further contributes to cost-shift.

well, let me say to my colleagues, i was in full agreement with the president when he came out and said, here are our goals. : we have to reform health care. we have to focus on making sure that every american has access and affordable options to health care. we have to make sure that it's fiscally sustainable. why in the 21st century would we design a health care system that we couldn't be certain was financially sound for generations to come? the truth is, by every account, in a real ten-year period -- ten years of taxes and ten years of benefits going out -- this bill before the revision yesterday is a $2.5 trillion bill. it will contribute to the debt. it will borrow money that our children will be obligated to pay interest and to pay back.

this just compounds the problem. a breakthrough. this isn't about policy. this is about in a back room in washington in the united states capitol, the majority leader trying to get the 60 votes. it's real simple. listen to the american people, and we would start over. and we'd start over with the principles of the president. make sure what you do reforms health care, attracts 100% of the american people because of access and affordability, and it's fiscally sustainable for generations to come. the friewj is, we've been on -- the truth is, we've been on the floor for two weeks. we've debated a bill that does coverage expansion. i admit openly, it covers 31 million more americans. but it misses the mark of doing any health care reform.

because you see the bill before the press accounts of the last 24 hours assured every american that if you had private insurance or you paid out of pocket, your health care cost was going up. there was no way it couldn't. now what we've done is we've shifted and said we're going to increase the amount of cost-shift. let me explain for just a minute what cost-shift is. cost-shift is when somebody goes in and has provided a medical service, if they don't pay for that service or they don't pay the entire cost of that service, what's left over is shifted somewhere in the system. well, somewhere in the system is the next person that walks in with insurance and pays out of pocket, and because of the blend that they've got to meet, they pick up the difference. why has health care had such a phenomenal increase in cost?

it's because as we increase the roles of medicaid, as we had more seniors go into medicare, we had more costs that were shifted. now up to this point, the president, the congress, many were only focused on the uninsured and the underinsured. well, they are a contributor to the cost-shift; there's no question. but let me suggest to you that if we provide insurance -- and we had provide access and affordability for every american. if you eliminate that by putting people into medicaid, all you're doing is exacerbating the cost-shift. if in fact you create a health care system that has an incentive for abindividual not to purchase their own health care because it's cheaper to pay the fine, all you're doing is exacerbating the problem of cost-shift. health care reform is about

changing the health system so that cost-shift is eliminated. quite frankly, it starts with making sure that we pay 1 hub hundred% of what the -- 100% of what the cost of services are, but we're not in that debate. this debate on the senate floor right now, two weeks before christmas, is about coverage expansion. it's not about health care reform. if it were about health care reform, we'd be talking about how do we create an incentive for private companies to create products that provide an individual to construct their health insurance so it matches their age, their income and their health condition? that's what we're doing. we're sitting in washington creating one-size had been fits-all saying -- one size fits all saying if this doesn't fit, we're going to create a government option for you, and we'll subsidize you to put you in the government option. where is that fair to the american taxpayer? that's why senator crapo's bill

is so important. refer it back to committee, start over. we've got our priorities wrong as it relates to our ability to dip into the american people's pocket, use their money to fund something. it's not going to benefit them one bit. this would be a different debate if we looked at every american uncovered and say we maximized fiscally but not necessarily abused the american people's pocket to do it. america is the most compassionate country in the world. but when we debate things like this, we are also the most foolish country in the world because it is irresponsible on our part to abuse the power of this government, to spend money like this without the benefits that we set out to do. so, it's my hope that as we go

through the weekend we'll have an opportunity to see what the new proposal is that's laid down on the table. again, i've got to go by what i read, and that's not always accurate in this town. c.b.o. has stated that a similar proposal, which was a proposal for a buy-in at the age of 62, would revert -- would result in an adverse selection in the medicare program which would drive up premiums. let me quote c.b.o. i don't want it just to be phaoefplt quote c.b.o. -- "a potential problem with this option is the amount of collection this program experienced could be greater than anticipated, which would put upward pressure on premiums." that's the entity that's evaluating the cost of the

current proposal that nobody knows what's in it. and this was a proposal that was sent to them some time ago that had the buy-in starting at 62, not 55. and their assessment of it with a buy-in at 62 that the adverse selection, meaning more sick people were going to migrate to this new option, would cause upward pressure on premiums. upward pressure on medicare premiums. upward pressure on premiums across the board. so, madam president, it is my hope that we'll have an opportunity very soon to know what's in the proposal, to be able to debate the facts versus just try to educate ourselves based upon the leaks in the media. but there's one thing that's certain, the american people have voiced their position on health care reform. they don't see it as reform. they don't see it as positively

affecting themselves. they see it as too expensive. they see it as a breach of trust on a plan that seniors have become 100% reliant on because they paid into it. this has got a lot of problems. it's not just the new proposals. it's the proposal that's been on the table for some time. it's my hope that we'll continue this debate as long as it takes to make sure that at the end of the day we do what's right for the american people and not necessarily what's skpe dishes to members -- expeditious to members that would like to be home for the holidays. i thank the president. i yield the floor.

the presiding officer: the senator from iowa. mr. grassley: madam president, earlier today i explained to my fellow senators and hopefully to my friends in the media that the reid bill does not provide a net tax cut for americans.

contrary to the democrats' claims, that seems to be the situation. they claim that there's a net tax cut, and i hope i proved earlier today that it does not have a net tax cut. some americans are cut, but you forget some americans have increase in taxes. i pointed directly to this data as prepared by the joint committee on taxation to show that a group of middle-income taxpayers will see their taxes go up under the reid bill. and that would be this class of taxpayers right here. i don't have disagree with democrats saying that

$40,786,000,000 of tax cuts, but also tax increases for a large share of americans. i want to build on those remarks. as i stated, there is clearly a group of individuals and families that benefit from the government subsidy for health care. however, that group is relatively small. another much larger group would see their taxes go up. so let me take a minute to provide you with some statistics that we pulled from the joint committee on taxation data, looking at both the winners and the losers under the bill. according to the joint committee on taxation -- and for the benefit of the public, the joint committee on taxation is intellectually honest group of professionals that are nonpartisan as they give congress information on the impact of policies that we make

here in our various committees or individuals or the senate as a whole. according to this professional group, the joint committee on taxation, out of those individuals and families affected by four major tax provisions under the reid bill, individuals earning more than $50,000 and families earning more than $75,000. so you got individuals $50,000, families $75,000 would see on average their taxes going up. only individuals with incomes below $50,000 and families with incomes below $75,000 would on average see some tax relief on account of receiving subsidies for health insurance. the joint committee on taxation data indicates that in 2019

individuals earning less than $50,000 would on average receive tax relief through this subsidy equal to $8 # 5. -- to $8 # 5. families earning less than $75 would ,000 would on average see relief equal to $2,035. this so-called tax relief, however, is in the form of advanced refundable tax credit. that is delivered directly not to the taxpayer, but to the insurance company providing health insurance coverage. signed, sealed, and delivered directly to the insurance company. 100% of it. not to the individual. to the insurance company.

but clearly this group is a winner under the reid bill. but, the same joint committee on taxation data indicates that in 2019, individuals earning between $50,000 and $200,000 would on average see a tax increase of $593. families -- that's for individuals. now let's go to families earning between $75,000 and $200,000 would on average see tax increases of $670. so what does all this mean? this means that the reid bill does not cut taxes for all americans. to the contrary, the reid bill breaks president obama's promise not to tax individuals making less than $200,000 and families

making less than $250,000 a year. aupbd just can't know how many -- and you just can't know how many times during the last presidential campaign whether it was in debates or whether it was in individual appearances by the president when he was a candidate. he made very clear that nobody under $200,000 a year income was going to see a tax increase. to the contrary, the reid bill breaks president obama's pledge not to tax individuals making less than $200,000 and then a higher figure for families making less than $250,000. now, does the tax relief provided to individuals earning less than $50,000 and families

making less than $75,000 represent a tax cut? generally no, because based upon the joint committee on taxation report, of the $395 billion the government will spend on tax credits for health insurance or subsidies for health insurance, $288 billion will be refundable, meaning individuals and families that have no tax liability will still receive the full benefit. the joint committee on taxation tells us that the remaining $106 billion will go towards reducing real tax liability. the congressional budget office classifies a benefit provided to tax filers with no tax liability as government spending, not as a

tax decrease. this is compared to a tax benefit that actually will reduce taxpayers' tax liability. this means that thed $28 billion of -- $288 billion spending of the government through the tax code cannot be true -- when claim that the reid bill provides a tax cut. and the reason -- because the democrats do not count this government spending as a tax cut, they cannot hide the fact that the reid bill increases taxes. bottom line, the reid bill does not provide a net tax cut. instead the bill raises taxes and it raises taxes on

individuals and families earning less than $250,000. contrary to candidate obama's presentation during the campaign that nobody below that figure would get a tax increase. so check data. no one can di dispute it. it's right here in these figures. everybody in the united states is represented by these figures here, highlighted, are the ones who are going to get a tax increase. and that's the rest of the story. i yield the floor.

a senator: madam president? the presiding officer: the senator from pennsylvania. mr. casey: thank you, madam president. we are on the floor today, as we have been for many days and weeks now, discussing health care. and one thing that i think is -- undeniably clear is that there is a -- a basic divide in the senate on health care. that's not news to most people. but i believe on this side of the aisle there's a great deal of consensus about what health care reform should be about. we've been trying throughout this debate to make it very clear that we're not only concerned about the tens of millions of americans who don't have any insurance at all. that's obviously a focus of our work and a focus of the debate. but we're also concerned at same time, as we must be, with those

who have insurance. families with insurance, families who believe that they have the security of insurance. but, unfortunately, under our system many of them don't. many families, in fact, millions of families over the last couple of years have had a member of their family denied coverage because of a preexisting condition. that should be illegal. and in this legislation, we deal with that directly for the first time ever. we also provide other protections. when you say consumer protections, that's a nice sounding phrase. but in some ways it doesn't really describe what we're doing. we're trying to prevent people from being denied coverage because of preexisting condition. we're trying to make sure that a family, like the family i've spoken of on this floor and the ritter family of manheim, pennsylvania, that they don't -- they had the tragedy of finding

out a number of years ago, there two 4-year-old daughters, twins, had leukemia. then the insult and outrage of the system saying to them, your daughters have leukemia. we have experts and a lot of knowledge and technology to help them, but we're going to limit their care. one of the first things in this bill is that we're not going to put caps on treatment for people who are very sick. we also recognize, as president obama said a number of months ago, that if you get sick, you shouldn't go bankrupt. that's happening more and more in america. it's an outrage. and we shouldn't allow it to go on any longer. we're trying to keep premiums affordable. fortunately, the congressional budget office helped us make that argument. in their own way they weighed in on that question and talked about the fact that so many american families will have their premiums reduced, if not

kept level. we're obviously trying to enhance quality and prevention, all of these strategies that we know work, and the research is irrefutable and we try talk about them. as a way of a good example, instead of talking about them, put them in the law. why should we have prevention strategies and then say, that would be nice if insurance companies did that in their policies instead of making it the law. and we will. both in terms of prevention strategies and quality. finally, as a quick summary of what we're trying to do, we're trying to control costs. i think this bill does that. we still have work to do and amendments to make. but this bill does that. it also cuts the deficit b by $130 billion over 10 years and muc much more, several hundd billion in the years after that. one -- one fundamental recognition, i guess, in this

debate at least on this side of the aisle is that our system has left people out. in some cases have left them out in a very tragic way when they're denied coverage because of a preexisting condition. our health care system has left out others in different ways. and i rise today to speak about an amendment that i filed, along with senator klobuchar, a cosponsor of this amendment, that seeks to -- to address a group of americans who have been left out of health care system and forgotten about at a very difficult time for -- in their lives. the name of the amendment is the pregnant and parenting teens and women amendment. and it recognizes what i believe to be a -- a -- a fundamental reality in america. i'll describe two scenarios. one that so many of us have had the opportunity to experience as

parents, but especially those in this chamber and those who are -- are listening to this debate who are women who become pregnant. for many women that moment when they find out they're pregnant is a moment of joy. it's the miracle of pregnancy. and they feel that job and they share it with their family and their friends. and it's a time of real happiness. and many of niec these women int first scenario don't need help or have adequate support in the framework of -- whether it is government help or nonprofit. there is a second scenario in america, a second category where a woman finds out she's pregnant

and that moment of discovery is not a moment of joy. for her it's a moment of terror or panic or even shame. she may be in a doctor's office or she may be at home or she may be in a number of places. but for her that moment begins with a crisis in which she feels overwhelmingly and perhaps unbearably alone. all alone. she could be wealthy, middle income or poor. but most likely if that pregnancy is a crisis, most likely she is poor. whatever her income, she feels very simply all alone. a pregnant woman who is facing those horrific circumstances may be a woman who has an abusive spouse or boyfriend who's tormenting her.

she is all alone in many instances. another pregnant woman may believe she cannot support or care for her new baby at this point in her life. she is all alone. another woman might believe that her financial situation is so precarious that she cannot care for or raise a child. she may feel all alone and helpless. if she decides to bear a child, she needs our help. she needs our help to walk with her along that difficult journey. not only through the nine months of her pe pregnancy, but also te early months and years of that child's life. i believe that's an obligation that we have. i know some may not agree with that. but it's important that we're honest about where we -- where we stand. so we -- we face that reality for -- we understand, i should say, that many women face that

reality. so what do we do about it? do we just say, well, that's too bad? and that's kind of their problem and we should let them find their own way. or there's a little program down the street, that might help them. or there might be a little government program over here or there might be some charity and they'll do just fine. don't worry about them. well, this country, i think, has shown the compas capacity to hep people in crisis. to give people a sense that they're not all alone. that there's a way to help. unfortunately neither political party has adequately met this challenge, in my judgment. we hear a lot of discussion about it. we hear a lot of sentiment about it. but we don't do nearly enough about it. here's what the amendment will do. it will provide assistance and support for pregnant and

parenting college students. second, it will provide assistance and support for pregnant and parenting teens. third, it will improve services for pregmeant women who -- pregmeant women who are victims of domestic violence, sexual violence and stalking, and it will provide resources available to parenting teens. first funding for colleges to provide pregnant and parenting resources located on campus or in the local community including the inclusion of maternity coverage, which a lot of insurance companies don't provide now unfortunately and -- and insultingly, in my judgment. make -- make it available -- make, i should say, available riders for coverage for additional family members in student health care. on a college campus, if that

woman has chosen to get housing and child care and flexible alternative academic scheduling to allow her to stay in school. education to improve her parenting skills. baby clothing, baby furniture. all of the things that some of us take advantage of in our families prior to or upon the birth of a child. the other part of this is funding for programs that help pregnant an parenting teens stay in or complete high school and a prepare for college or vocationavocational education by providing resources and assistance. and, finally, assistance to states in providing intervention services, accompaniment, and support of social services for pregnant victims of domestic violence and other kinds of violence as well as stalking. and, finally, making people aware, providing public awareness an outreach so that pregnant teens and women are

available of the service -- aware of the services available to them. so we can't stand here on the floor and say that we care about these folks and we want to help them if we're not willing to make good on that promise. it's not enough to have good intentions. it's not enough to say there might be a program out there. we know for sure that at least these three categories, maybe others can add to it, maybe others cannot. but these three categories of pregnant women are in many cases all alone. neither political party nor our government and i would argue other parts of our society are doing enough. it is time as we debate health care that we say one part of our health care system is going to be made much, much better in addition to the substantial changes on protecting families from the ravages of what insurance companies have done to some families, protecting them at long last both with insurance.

insuring 30 million americans. cutting the deficit. having prevention strategies. controlling chronic disease and making it something we can manage better and save money. all of that is important. but i don't think in the debate here, we should leave out those who all they're asking for is just a little bit of help that -- that we're not giving them and we should never ask -- we should never ask a pregnant woman to walk that journey all alone. i think that's the least that we can do in this chamber, in this debate. madam president, i would yield the floor. the presiding officer: the senator from iowa. mr. grassley: my friends on the other side of the aisle have taken to the floor to make the