marine education and training, and coral research. so the list goes on and on. next time you're in new york, go to the lincoln center. you'll see that they are -- we are spending $800,000 of your money for jazz at the lincoln center. jazz lovers, rejoice. and for those who are not jazz lovers, we've got $300,000 for music programs at carnegie hall. $3.4 million for a rural bus program in hawaii. apparently the $1.9 million in the 2009 omnibus was not enough. we gave $1.9 million for this rural bus program in hawaii, so we got to now give them $3.4 million more. custer county, idaho, population 4,342 as of the year 2000. i'm sure they've grown since.

$500,000 for development of a community center in custer county, idaho. the list goes on. the list goes on. and then, of course, it's loaded with controversial policy riders that should have been debated in the senate. the department of labor bill, the conference rescinds $50 million from unobligated immigration enforcement funds under section 286 of the immigration and nationally act. this will result in a decrease in the enforcement of immigration law. i guarantee you that if that provision had been debated here on the floor of the senate, that $50 million would never have been removed. the conference agreement includes new language providing authority to international labor affairs bureau, the agency charged with carrying out the department of labor's international responsibilities. it may be a worthy program, but

it should be addressed in legislation. there are so many others that are -- that are policy provisions in this bill, which have not been authorized, which is supposed to be done by authorizers. it -- the conference agreement provides for $35 million for the delta health initiative. the delta health initiative provides a service to individuals in only one area of the country, the delta region of the mississippi. visited the delta region in mississippi, and there are severe mettle needs. but couldn't we -- and there are severe health needs. but couldn't we authorize it? couldn't we have the proper debate and discussion? the list goes on and on. of course, there is $25 million for patient safety and medical liability reform demonstrations that was not included in the house or the senate. medical liability reform demonstration. there's a demonstration project

already in being? it's called the state of texas, where they have reduced medical malpractice costs dramatically, and the if he significances and caregivers -- and the physicians and caregivers are flowing back into the state of texas. mr. president, i'll be talking more this afternoon -- later this afternoon about all the pork and earmarking that's in this bill. and i have to tell you that the anger out there on the one hand the frustration -- and the frustration is at an incredibly high level. those of us who dirnl ale sure that most of us do spend a lot of time at town hall meetings and meager fromeetingsand hearir constituents, know that there is a level of anger out there the likes of which i haven't seen. here they are hurting so badly because they can't keep their homes, their jobs. in my home state of arizona, we are number tabo two in the counf homes that the mortgage payment

is higher than the home value. 48% of the homes in my state. so here we are with 10% unemployment, with deficits -- this year $1.4 trillion. and so there are dramatic increases, 7% increase in spending in one, 14% increase in spending in the other. they don't get it. they don't get it. they don't get it. americans are having to tightening their belts. my home state of arizona is in a fiscal crisis. they're having to cut services to our citizens because we can't print money in arizona. they only print money here. and here we are with omnibus appropriations bills with as high as 14% increase in spending, loaded down with billions of dollars worth of pork-barrel projects. it's -- i predict to my colleagues that the anger out there will be manifested in a

number of peaceful ways, including at the -- in the ballot booth. they're sick and tiert tired of. i saw a pool yesterday where the approval rating of members of congress has fallen below that of the approval rating for used car salespersons. now, i think it was at 4%, as i recall the poll. i haven't met any of the 4%. i haven't met anybody who approves of what we're doing. and this exercise that we're in right here on december the 12th, 2009, with a pork-laden omnibus appropriations bills which fruflously and outrageously spend their dollars when they're struggling to keep their heads above wort, is something that -- above water, is something that is going to be rejected sooner or later by the american people. i warn my colleagues, the american people are sick and tired of this. they didn't like it before.

now they're fed up with it. we'll be hearing more this afternoon. so, mr. president, i rise today to raise a point of order under rule 28 against h.r. 3288, the omnibus appropriations bill. i do this to ensure that this bloated legislation is not permitted to proceed to full consideration by the senate. specifically, rule 28 precludes conference reports from including policy provisions that were not related to either the house or the senate version of the legislation as sent to conference. several provisions, including in divisions d, departments of labor, health, and human services and education and related agencies appropriations act of this omnibus bill, are out of scope and were never considered on the floor of the u.s. senate. mr. president, i raise a point of order that the conference report violates the provisions of rule 28. mr. inouye: mr. president? the presiding officer: the

senator from hawaii. mr. inouye: notify waive all applicable sections of rule 28 and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the yeas and nays are ordered. under rule 28 -- mr. inouye: are we -- the presiding officer: -- there is eup to one hour -- there's up to one hour equally divided. mr. inouye: i yield myself ten minutes. the presiding officer: the senator hawaii. mr. inouye: i rise today with mixed emotions. when i assumed the chairmanship of the appropriations committee last january, i immediately reached out to the senior republican member of the committee from mississippi, senator cochran, to seek his support in achieving my central objective for the fiscal year, to return this appropriations

process to regular order. vice-chairman senator cochran agreed wholeheartedly, and together we committed to passing all 12 appropriations bills individually and to sending each of the completed bills to the president for his signature. it might be of interest to my colleagues that of the 12 bills assigned to this committee, 11 were passed by the end of july, many months asmght one was-- --many months ago. one was held up by the request of the house but passed in mid-september. this is december. these bills have been passed, and it might be of interest -- further interest to the senate that of the 12 bills, nine were passed unanimously, bipartisan -- 30-0.

three passed by one objection, 29-1. mr. president, completing action on our annual appropriations bill is our most fundamental responsibility. the founding fathers gave us the policy of the purse and for good reason. our systems of checks and balances, which has served us so well in the last 220 years, allows the executive branch to propose spending and make clear to us their intentions and desires. but the constitution gives the congress the ultimate decision-making authority, and it is our responsibility to fulfill this obligation. mr. president, regular order allows each senator the

opportunity to debate and to amend each bill on an individual basis. every senator on both sides of the aisle recognizes that regular order is the preferred course of action. mr. president, the underlying transportation, housing, and urban development bill will provide urgently needed funding so that we can keep our transportation system safe and strong and provide much-needed assistance to our most vulnerable populations. in addition, every one of the six bills that will be considered today was reported out by the full committee. and as i pointed out, three of them were passed unanimously and the other three by a vote of 29- 1. every one of them had been written in a bipartisan fashion,

with considerable input on the part of the minority party. the negotiations with our house counterparts have been spirited at times, but i can assure my colleagues that on the difficult issues, our subcommittee chairmen and ranking members have done an excellent job of defending senate positions and have come into fair and equitable compromises when such was necessary. mr. president, i would also note that on tuesday evening we held a full and open conference with the house at which every conferees, including 22 members of the senate -- bipartisan members -- and 14 members of the house -- also bipartisan -- was afforded the opportunity to offer amendments on any provision of the legislation.

for the record, comity was demonstrated by the senate conferees, and no amendments -- mr. president, no amendments were offered on our side. at the conclusion of the conference, 16 conferees, including four republican members, signed the conference report. i can say that this is a clean bill. there are no extraneous measures attached. for this reason, as i just mentioned, we have bipartisan support of the bill, and i'm part of that fact. -- and i'm proud of that fact. some have criticized this bill as spending too much. i would point out that the amounts recommended in this bill are below the amounts requested by the president and equal to the amount approved by the congress in the budget committee.

it has been a long process, mr. president. furthermore, the only area where the committee exceeded the amount requested by the president is for military construction and for veterans. moreover, some have criticized the majority for resorting to an omnibus measure once again. clearly, those who criticize are those responsible for this outcome. mr. president, when the senate needs four days to pass a noncontroversial conference agreement on energy, water appropriations bill, we know that the only reason can be that a few members want to delay our process. why do they want to do that? so they can complain when the calendar has sphierd and w expie

no time left for the regular order. mr. president, as a reminder to all of us, the military construction bill was delayed for six days of debate on this floor. it was a bill that was voted out of the appropriations committee unanimously, bipartisan-wise, and then delayed. but after the delay of six days, this senate passed it by a vote of 100-0. what was the opposition all about? what was the delay all about? what everyone here wawhen everyr of it. not a single dissenting vote. mr. president, it is obvious that there was an opposition to the bill. it was simply that a few members wanted to delay the bill. mr. president, now it's december the 10th, and it is nearly

time to adjourn the senate for the year. we have not completed our work and therefore we have consolidated six appropriations bills in one measure. my colleagues know precisely why we have reached this point, and it is not the fault of one member of the appropriations committee nor the fault of the majority. it is the fault of a handful of members who would rather cede -- see the responsibility for funding our federal government turned over to the bureaucrats and administration than have the congress exercise its constitutional responsibility. mr. president, i'm a very patient person, but at times the rhetoric of this debate is too much to take. with senator cochran, my vice chairman, as my partner, we have tried to move 12 individual

bills only to be thwarted by a few members. just a few members. that is why we are here and where we are today with an omnibus bill. as we look ahead, the consideration of fiscal year 2011 appropriation bills, i hope that all members of the senate will learn from the frustrations of this year. we can succeed in returning to regular order for appropriations. we just need a modicum of cooperation and the recognition that delay for the sake of delay serves no one's best interests, least of all the people of the united states. mr. president, i strongly support this clean bipartisan bill. i urge my colleagues to support

it as well. i yield back the time. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: mr. enzi: mr. president? the presiding officer: the senator from wyoming. mr. enzi: i would ask unanimous consent that we dispense with the quorum call. the presiding officer: without objection. mr. enzi: thank you, mr. president. for several weeks, i have been saying where are the appropriations bills? under federal law, we're supposed to have those done by october 1, october 12. -- october 1. see, this is december 10.

it must be past that deadline. well, here comes the bills. they're all packed into one. there won't be the debate that we would normally get if we handled them one by one. it's fascinating to me that one of them is health and human services. all year, we've heard how health is what's breaking the people of this nation, how important health care is, why we have to do health care reform under strict deadlines, strict deadlines that have shifted a number of times and are irrelevant to getting a good bill, but health care is that important. and it is 1/6 of the nation's economy. so why haven't we had the health care appropriations debate before october 1? why did it get put off until now? well, i guess it's because all the earmarks weren't ready yet, or maybe it's because they thought that this bill ought to pass and solve all of the problems. i think the bill could pass -- could have passed much faster. i think it could have solved a

lot more problems if it would have had the kind of bipartisanship that senator durbin keeps describing as having had happen, we would already have the bill done. but much of what he keeps repeating and the more times you repeat it doesn't make it more true. and every speech that he gives, he makes the same comments about how long the "help" committee worked on this bill and how many amendments from the republican side were automatically accepted into the "help" bill. and we always have to come out and correct that. yes, there were a number of amendments. that bill was put together over a period of two weeks with the new committee chairman. without a single input from republicans. it was brought to the committee for markup. we did have about three days to do amendments. we did a lot of amendments. they did accept some of the amendments. of course they -- we helped correct punctuation, we helped correct spelling, and we did

have a few amendments that were accepted that actually made a difference. now, after the vote, they didn't publish the bill for the public to look at. the amended version of the bill for the public to look at. i think that was so that they could rip out the republican amendments that they had accepted. that has never been done in committees. when amendments are accepted, they are left in the bill or at least the senator that proposed the amendment gets to talk about why maybe it should or shouldn't be in there, or at least he's informed that they are going to rip it out. not in this case. the bill's published, we're looking for some of these things and find that they are gone. and then they wonder why there is opposition to the bill? and then he talks about the hours that we spent together working as the group of six. and i appreciate him mentioning the hours, but hours don't make any difference if ideas aren't

taken. the purpose of the hours is to be able to express ideas that can be included in a bill. just getting to express them isn't enough. to make them bipartisan, they have to be included. and anybody that looks at the things that we've got on our websites would understand that we did have some real good ideas, some things that would make a change in the way we do health care in america. are those in this bill? no. now, this is the reid bill. this wasn't put together by the "help" committee or the finance committee, although significant parts of both of those bills, which we didn't have input into, are a part of it. and how was that designed? that was designed behind closed doors right over there. no republican input whatsoever. how does that make it bipartisan? how does that give us a chance to make it bipartisan? and then they wonder why they have amendments.

here's the fascinating thing on amendments. in the "help" committee, the democrats presented more amendments than the republicans did. you know, the republicans did get two that we voted on passed. the democrats had over 30 that they presented get passed. how come they even had to put in amendments? it's their bill. they are facing the same thing that's on the bill on the floor here. they are putting in more amendments than we are. every time we put in an amendment, they have a side by side on it to give them some cover to say what they said really wasn't that important, it wouldn't make a difference, and besides that we don't want to do it. they would have something to say well, we voted for that concept. now, if you put the bill together, you shouldn't need to be the ones filibustering and doing the amendments. and we really have a unique position here now. we have a democrat amendment and a democrat side by side. i don't remember ever seeing

that before. but we had a request this morning for three democrat votes and one republican vote. that's real bipartisanship. and yet, they want the cooperation. now, the thing that upsets me the most is when they keep saying that this will save money, that this bill is going to save the country money. and we're in this appropriations process and we ought to be interested in saving the country money. but c.b.o. didn't say that. c.b.o. did not say that this bill will save money unless you use a whole bunch of phony accounting. and there is phony accounting in this bill, and that's how they are able to say oh, yes, we save money, we save money. this is going to save the american people a lot of money. no, it does not. do not buy that story. look at the accountant. i'm the accountant. i've taken a look at it. but i'm not that good of an authority. but we just got the report from the c.m.a. chief actuary.

yes, that's the -- that's the actuary that's actually in charge of medicare and medicaid and he just did an analysis on it, and i'm going to go into some more detail on that analysis because he says this bill does not save money. this bill will cost .7% more than if we did nothing. is this health care reform? hmmm. and where's the transparency that we were promised would happen under this administration? transparency. they built the bill behind the closed doors over on that side of the senate chambers, and now a significant part of the bill which is called the public option, government option, government-run program, whatever you want to call it, that has now been drasticcally changed. and the newspapers have written about it and people have seen

it, but the newspapers haven't seen what's in there. the democrats, according to senator durbin, the majority whip, have not seen that bill. the only one that's seen it is senator reid and the congressional budget office. and he's not going to disclose any of that, any of that until after he sees what the score is going to be. that's the ultimate in transparency in my opinion. if you think you've got a really good idea, maybe you ought to let people see what the score is and see what the bill is. you really ought to if you expect us to debate it in a hurry. and that's what we're under, this hurryup situation, hurry up, hurry up, hurry up. hurry up so a bill that really isn't going to do anything until 2014 can be passed by christmas. this side is ready to reform health care. this side is ready to stay in through the weekend.

we already stayed in through last weekend. we'll stay in through christmas. we'll stay in the days after christmas. we'll stay in next year, but it's got to be right. the american public really expects this to be right. you know there has never been a major piece of legislation passed by this body in the history of the united states that was passed by one party. not yet there hasn't been. and there's a good reason for that. it's so full of flaws if just one side's ideas are incorporated in the bill, and this is no exception. this has a lot of flaws. this is a real move to the left to incorporate most of the people over there, but they weren't able to incorporate all of them, so now they are doing a secret public option to expand medicare to distract people without telling them what's in it and expecting us in a few days to vote on this thing. well, i'm going to share some of these numbers from the c.m.s. chief actuary a little later,

but i see that my colleague is here and is actually going to talk, mostly on the appropriations bill. i do say that this -- what i have had to say ties in directly to appropriations. it is spending money. we're going to spend spend $464 billion of medicare money with the system that's going broke and we're going to raise taxes. that's kind of an appropriations, too, to cover the other half of the trillion dollars in new programs that are not going to lower premiums or save the united states money, according to c.m.s. chief actuary rick foster. i yield the floor. mr. demint: mr. president? the presiding officer: the senator from south carolina. mr. demint: i want to thank enzi for not just what he is saying today but throughout this whole debate for making very complex issues many simpler, so people can listen in to what is being said here and understand really what we're doing. it has been a frustrating process here dealing with this

attempted government takeover of health care while the majority has us here on the floor debating us bill, they're behind a closed door over here creating a whole new bill and making periodic announcements about what might be in it. it's kind of like a magician, you know, who gets you looking at one hand while the sleight of hand is actually doing the magic with the other hand. and that's what we see happening here today. the majority wants to force this major piece of legislation through before christmas while people aren't paying attention, and in the middle of this, they have decided to take a break to expand spending at really unprecedented levels. i'm here right now to support senator mccain's rule 28 point of order that points out that the majority, the democrat

majority has violated all of these so-called ethic and transparency improvements that they were bragging about only a year ago. we're not supposed to take bills and in the secret of conferences add things that weren't in the house or the senate. that violates a specific rule, an ethics rule that the majority trumpeted not too long ago. and this bill contains out-of-control spending, it completely reverses congress' traditional position on many values issues such as taxpayer-funded abortions and needle exchanges in the district of columbia. it ends the d.c. opportunity scholarship programs that has done so much to help a small number of disadvantaged minority students. it increases funding for planned parenthood, the nation's leading provider of abortions, and it legalizes medical marijuana.

yet, the overall funding levels of this bill are really unconscionable at a time where we're in recession, so many people out of work. we have got massive debt that threatens our nation's economic future and our very currency itself. the bill represents a a $50 billion increase or 12.5% over last year's funding level. now, this is not mandated spending. this is discretionary spending. this is at a time that the president is saying we've got to get a handle on our debt, yet every bill that the democrat majority has pushed across this floor has major increases in spending. it's actually nearly a a $90 billion increase over the year before. and, folks, what the president said he was against, which was earmarks, this bill has 5,224

earmarks in the bill, costing nearly $4 billion in addition to the other spending. now, i can't read all of those but i think people across the country have learned what earmarks mean. here are a few examples. $3.8 million for an urban art trail in rochester, new york. probably a wonderful thing to do, but at a time in recession, in debt, do we need it? $3 million for bicycle racks in washington, d.c. $1.5 million for streetscape project in detroit around a casino. $578,000 to fight homelessness in union, new york, a town that reportedly has no homelessness. i could go on and on. it makes no sense to be doing this, but i think maybe one of the most egregious parts of the bill that i want to focus on for a few minutes really goes back

to those values issues. you know, it's one thing to make abortions legal. it's quite another thing to force americans who consider abortion immoral based on their moral beliefs, their religious beliefs. it's immoral to make them pay for it, to actually promote abortions. and that's what this bill does. everywhere you turn, this administration is promoting any life initiatives and advancing policies that most americans find morally objectionable: namely, taxpayer-funded abortions. we've seen that throughout this health care debate and we've seen now in the very set of bills that fund our government that it is promoting and funding abortion. folks, this nation has had a

debate about whether we should even allow abortions to be leg legal, but we have been in general agreement as a nation and even here in the congress for years that we should not force taxpayers to pay for abortion. that's a terrible use of the power of government. the omnibus bill reported by the house-senate conference allows taxpayer funds to be used to pay for elective abortions in the district of columbia because congress controls d.c.'s entire budget, including appropriating the city's local revenues. if this omnibus bill passes, congress will be allowing u.s. taxpayer dollars to fund abortion-on-demand, where it was previously probed. this iprohibited. this is a major shift in policy. we must step back and see where our priorities are as a nation. the values of our country are at stake in this legislation.

and as we look at this, i hope no american is so naive as to think that if they pass this government takeover of health care, that no matter what we put in the legislation, they will eventually fund elective abortions in this country. it shows everywhere they pass a piece of legislation, they are trying to promote abortion in this country. a vote for the omnibus is a vote for taxpayer funded abortion. a vote against senator mccain ace point of order is a vote for taxpayer-funded abortion. it's simple, it's clear. congress is responsible for the budget in the way its funds are spent. if we don't think the government should create an incentive for taking unborn lives, then we should not allow it in the legislation before us today.

in addition to this troubling revolution, the bill contains many other egregious reversals of long-standing policy contrast -- or contradicting traditional american values. the underlying bill legalizes medical marijuana and uses federal funds to exchange a needle exchange program in washington, d.c. both encourage the use of drugs. and this is another glimpse of what's going to happen with government-run health care. if this congress is promoting the use of medical marijuana, needle exchange programs, abortion in this funding bill, does anyone really believe that that won't be a part of a government-run health care system? of course not. additionally, this bill eliminates the successful d.c. scholarship opportunity program which aids low-income children by giving them scholarships to

attend private schools in washington, d.c. this affects only about 1,500 children, and i've had a chance to meet with some of them who are in schools that just aren't working. and this small scholarship program allow disadvantaged, primarily minority students here in washington, d.c., to go to a private school of their choice. and remarkably, in just a few years, the students who moved from the government schools to the private schools were two years ahead of their peers. it's the example of something that's working, that's helping disadvantaged students, and it's a good example of an administration that is more interested in paying off union interests -- in this case, the teachers' union, than doing what's good for our children in our country. to eliminate this program, this small, inexpensive program, is absurd. but it reveals to you --

no, i won't -- it reveals to you the true motives of the majority. and if we look at this bill and if we look at this eventual health care bill, if we ever have time to see it before they try to pass it, we're beginning to see a real glimpse, a true picture of where this democrat majority is going. and finally, this bill increases the funding for title 10 family planning services of which planned parenthood is the largest recipient. folks, planned parenthood is the nation's largest provider of abortions. and increasingly, they are what we call directed abortions. when people come to planned parenthood and look for advice on family planning, they're more often than not encouraged and pushed towards abortion. so all around this bill you see what's going on, is a major

change in policy not to make abortion available but to make americans pay for it and to promote it. i along with 34 of my colleagues here in the senate signed and sent a letter to the majority leader regarding the troubling anti-life policies in this omnibus bill. collectively, we vow to speak out to protect the long-standing federal funding limitations on abortion, a belief that has enjoyed broad bipartisan support for many years. for this reason as well as a number of other values issues that are irresponsibly addressed in this legislation, i support senator mccain, who raised a point of order against the omnibus under rule 28 of the standing rules of the senate. and i urge my colleagues to do the same. i remind my colleagues, a vote against the mccain point of order is a vote to force american taxpayers to promote and pay for abortion.

it's plain and simple. i'm sure there will be a lot of smoke and mirrors after my talk that will try to convince you that's not true but it's in the legislation and it will happen, and we need to stop it. i thank you, mr. president. and i yield the floor. mr. durbin: mr. president? the presiding officer: the senator from illinois. mr. durbin: i hope the senator from south carolina won't leave. he wouldn't yield for a question but i want to address his remarks and some of them are not accurate. and i don't want him to feel that i'm saying this outside of his presence. i would like to ask the senator from south carolina, while he has a few minutes there, if you could look in the bill and find the provision in the bill which kills the d.c. opportunity scholarship program. please present it to me now, because it's not there. it's not there. the d.c. opportunities scholarship program is a voucher program. it's a program created more than five years ago. it was authorized through the appropriations committee, not through formal authorization. and as many as 1,700 students in d.c., district of columbia,

ended up going to school and getting about $7,500 a year to help pay the tuition for their schools. now, the program has diminished in size, i will concede, even though i tried in a debate and in negotiation to change that. it is down to about 1,300 students. it is funded in this bill to the tune of $13.2 million. so for the senator from south carolina to stand up and say, as he did repeatedly, this program is killed, how does he explain the $13.2 million in this bill? mr. demint: if the senator will yield? mr. durbin: i will yield for a short time if it doesn't turn out to be a filibuster. the presiding officer: the senator from south carolina. mr. demint: the president has said he's going to end this program. and i will be back on the floor to explain the technical aspects of why it ends it. mr. durbin: i'm anxious to hear it. i'm anxious to hear it. i'll reclaim my time. explain all the technical aspects you'd like, here are the facts. $13.2 million goes to the d.c. opportunity scholarship program. 1,300 students currently in the program will be protected, will

receive the tuition grant of $7,500 per family in the coming year that. is a fact. and to stand here and say otherwise is wrong. mr. dema demint: you grandfathe- mr. durbin: i yield for the purpose of a question. mr. demint: does this bill fund the continuation of the program beyond the 1,300 who are already in it if mr. durbin: no, it limits the program to 1,300. mr. demint: it ends the program, senator. mr. durbin: no, it doesn't. for the 1,300 students current until the program, it will continue. mr. demint: the program does not continue. mr. durbin: what's to the program next year will be up to the united states senate and house of representatives. but for the senator from south carolina to misrepresent the contents of this bill is not fair. and secondly, this idea of government funding abortion? let me say to the senator from south carolina, here are the basic piferls o pillars on this controversial issue in america. first, the supreme court has said abortion is a legal

procedure. roe v. wade. second, congress said through the hyde amendment, we will spend no federal funds for abortion except in cases involving the life of the moth mother, rape, and incest. third, congress said any provider, hospital, doctor, medical professional, who in good conscience cannot participate in an abortion procedure will never be compelled to do so. this bill does not change that at all. in your state of south carolina, in my state of illinois, the leadership of that state, governor and legislature, decide what they will spend their state funds on. and that is done in states across the united states. and 17 states have decided that they will have state funds paid for abortions beyond the hyde amendment. their state decision. not our decision. in the district of columbia, we in this bill give them the same authority that your state of south carolina has and our state of illinois. no federal funds from the

government, from congress, can be spent on this exercise or use of funds for abortions beyond the hyde amendment. but if they choose to use their own funds, as south carolina makes its choice and illinois makes its choice, then they make that decision. there are many in congress here who have a secret yearning to be mayors of the district of columbia. they want to be on the city council. not just in the senate. they want to make every finite decision for the 700,000 or 800,000 peoplee people who live. mr. demint: will the senator yield for a question? mr. durbin: not at this time. i will tell you this, the people who live here are tax-paying citizens of the united states. they pay their taxes, they vote for president, they send their young men and women off to war, just like every state in the union. and i think they are entitled to some of the basic rights we enjoy in each of our own states. i also want to say a word about the needle exchange program. i get nervous around needles. i don't like to run into the

doctor and say, give me another shot. and most people feel the same way. so taking a n issue like this on is not a lot of town start with. why are we -- so taking on an issue like this is not a lot of fun to start with. so why are we talking about needle exchange program in the district of columbia? for one simple reason -- the aids infection rate in the district of columbia, washington, d.c., the nation's capital, is the highest in the nation. we are living in a city with the highest incidence of needle-related hiv-aids and meningitis and other things that follow. now, a needle exchange program says to those who are addicted, come to a place where we can at least put you in touch with someone who can counsel you, move you off your addiction and give you a clean needle instead of a dirty one. i hate it. i wish we didn't need t. i don't like it. but in states across the nation, they make the decision that this is the humane and thoughtful thing to do to finally bring addicts in before they infect other people and spread this

epidemic. the doctors are the one who tell us that this works. and states make decisions on it. i think the district of columb columbia, facing the highest incidence of infection from hiv-aids, should also make that same decision in terms of the money they spend, a provision that came over from the house of representatives would have limited the distribution of this program to virtually a handful of places in d.c. what we said is d.c. can make the rules, the district of columbia can make the rules about where the safe places for these needle exchange programs. as i said, i hate to even considerate prospect, but i can't blame myself to the relate that i we have this high incidence of infection in the district of columbia and the medical professionals tell us that this is working. we're bringing addicts in. we are bringing them in to a safer situation. we are counseling some of them beyond their addiction. we are saving lives. now, am i supposed to turn my back on that and say, i'm sorry. it offends me to think of this

concept. well, it offends me to think of people dying from needles needlessly. i didn't ask to take this d.c. appropriations bill on. this is not something that i ran for the house of representatives or the senate. but it's part of my responsibility. this is a great city with great problems, but there are some shining lights on the horizon, and one of them is michelle rhee, chance i don't remember of the public school system in the district of columbia. michelle is an amazing story of a young woman who was attending cornell university and she decided when she graduated to consign sign up-- --sign up for teach for america. she taught in baltimore, took a hopeless classroom situation and in two years turned it around. kids from the nation had test scores nobody dream of because of michelle's skill. brought nontraditional teachers

into the teaching classroom. it is a reform which will move us toward pay-for-performance where those teachers who do a good job and improve test scores arare brie rewarded. the results are starting to show. this week in the district of columbia, they reported math scores that showed dramatic improvements compared to cities around the nation. she has another responsibility. 45,000 kids are in the public schools, 28,000 are in the charter schools. the chart schools have to match the performance of the public schools or improve upon them. same thing for the voucher schools, the drk opportunity scholarships much the senator from south carolina stands up us and says, i eliminate the program. well, where does that $13.2 million go? it goes to the program, the d.c. opportunity scholarships. i did change the program. i changed the program because i failed initially when i offered amendments. here are some of the changes i

made and you be the judge as to whether these are unreasonable changes. i said for the voucher schools, half of them are catholic schools, half of them private schools -- i said for the voucher schools, every teacher in basic course semiconductors has -- basic course subjects has to have a college degree. how about that for a radical idea? these d.c. teachers have to pass the fire safety code. now is that a radical idea killing a program? if it means closing a school that's dangerous, sure, i'd close that school in a second before i isn't the my child or grandchild there. third, we said if you attend the d.c. voucher school, the students have to take the same test as the d.c. public schools so we can compare it. how are you doing? take a different test and different results. you know, we're never going to have a true comparison. i also added in here, at the

suggestion of lamar alexander, that each of the d.c. voucher schools either have to be accredited or seeking accredit taismghts i don't think that's radical. i don't think it closes a pravment the final thing is the people that administer this program have to actually physically visit school, at least twice a year. we had a hearing where the administrator of this program was shown pictures of some of these d.c. vowrn schools and he said, we haven't been there it. maybe once a year we get by. it has to be more than that. we have to make sure that these schools are functioning and operating and we're sending millions of federal dollars into them. we expect it at public schools and charter schools. shouldn't we ask the same of d.c. voucher schools? and i'll say this: at least those in the archdiocese of washington have disagreed to these things and have said, for our catholic schools, we're ready to meet these standards and tests. my hat is off to thevment it is a challenge, i am a sure, but it is one that i think they will meet. i think they're doing a very good job. i want to tifn to d to continue.

i did try to expand one aspect so that siblings would be allude to attend this program. i think that would be helpful. but we weren't successful. there were those who were opposed to it altogether. so i would just say the senator from south carolina has mischaracterized the d.c. voucher program. he has not fully explained that we have not changed the hyde amendment which prohibits federal funds for abortion purposes other than strict narrow categories and he went on to say something about the needle exchange program which doesn't reflect the reality and the gravity of the health crisis facing the district of columbia. this is not a radical bill. this is a bill which i think is the mainstream of america. it is a bill consistent with the same laws that apply in his state of south carolina and my state of illinois and most other states across the nation. i wish that we were not had this paternalistic position in relation to the district of columbia. i'd rather this city had home rule, had its own members of

congress, could make its own decisions. that's my goal. i'd like to see that happen. in the meantime, i think we should treat the people who live here fairly, give them a chance to deal with their significant problems, acknowledge success, as we just reported in the public schools, and try to help them where we can. this is in fact great city, and the capital of a great nation. i think the mayor does a good job here. i reserve the balance of my time. mr. enzi: mr. president, what's the time situation? the presiding officer: the senator from wyoming, eight minutes, 26 seconds. mr. enzi: i thank the president. the presiding officer: democrats, seven minutes, 30 seconds. mr. enzi: mr. president, i rise to discuss a new report on senator reid's health care reform bill. this kind of fits in with an appropriation that deals with health and human services that's over two months past due.

last night we received a new analysis of the reid bill that we've been discussing to about 11 days state, performed by the center for medicaid and medicare services -- that's c.m.s., which is under the health and human services department. the chief actuary, rick foster -- this is the guy in charge of all of this, he is the chief actuary, this isn't somebody outside of the system, this is the guy that's going to have to answer to all of this -- mr. foster serves as the independent technical advisor to the president and congress on estimating the true costs of health care reform. some of the findings in this report directly contradict some of the claims we've heard this week about the reid bill. for a week now we've heard how the reid bill will help slow spending growth and reduce how much we as a nation spend on health care. mr. foster's analysis shows that statement is false. according to this report, national health expenditures will actually increase by .7%

over the next 10 years. that's .7% if we did nothing different. despite promises that the bill would reduce health care spending growth, this report shows that the reid bill actually bends the health care cost curve upwards. we've also heard over the past week how this bill will reduce health insurance premiums. again, the administration's own chief actuary says this is false. the new report describes how the fees for drugs, devices, and insurance plans in the reid bill will increase health insurance premiums, increasing national health expenditures by approximately $11 billion per year. we've also heard how the reid bill will reduce the deficit, extend the solvency of the medicare trust fund and reduce beneficiary premiums. according to the foster report, these claims are all conditioned on the continued application of

the productivity payment cuts in the bill. which the actuary found were unlikely to be sustainable on a permanent annual basis. if these cuts cannot be sustained, one of two things will happen. either this bill will dramatically increase the deficit or beneficiaries will not be able to continue to see their current doctors and other health care providers. in reviewing the $464 billion in medicare cuts in the reid bill, the foster report found that these cuts would result in providers finding it difficult to remain profitable. the report went on to note that absent legislative intervention, these providers might end their participation in the medicare program. in addition, if enacted, the report found that the cuts would result in roughly 20% of all part-a providers -- that's hospitals, nursing homes, et cetera -- being unprofitable within the next ten years as a result of these cuts. as a former small business owner

myself, i understand the impact this will have on doctors, hospitals, and other health care providers. in rural areas like my state, these providers will go out of business or have to refuse to take any more medicare patients. the c.m.s. actuary noted that the medicare cuts in the bill could jeopardize medicare beneficiaries' access to care. he said, the reid bill is especially likely to result in providers being unwilling to treat medicare and medicaid patients. that's what we've been saying for about 11 days. the reid bill also forces 18 million people into the medicaid program. the foster report concluded that this will mean that a significant portion of the increased demand for medicaid services will be difficult to meet. these aren't the claims made by insurance companies or anyone who might have a vested interest in the outcome of the debate. these come directly from the administration's own independent

actuary. in light of this report, why are the sponsors of this bill continuing to argue for a $2.5 trillion bill of new programs which will increase health care spending, drive up premiums, and threaten the health care of medicare beneficiaries? we can do better. we need to start over and develop a bipartisan bill that will address the real concerns of american people. develop a bipartisan bill. it can't just exclude one side because there is a majority that won an election and gets to write the bills. we get tired of hearing that told to us. they say, where is your comparable bill? we're not trying to have a comparable bill. we're trying to have some input into the current bill or into the current problems. we ought to sit down, talk about the principles, find the actual things that fit into those principles, develop the details, and have a bill -- a bill that

goes step by step so that we get the confidence of the american people. and the step we ought to start with would be medicare. that's why i present this report from the actuary of medicare -- of c.m.s., which is part of health and human services, which is assigned most of the job of coming up with the details of the bill that we have before us. and that means that actual elected officials wouldn't be doing doing it. but thi this actuary says everyg that's been done on this side. aisle is false, unless there is some phony accounting going on. i yield the floor and reserve the balance of our time. mr. president, i'd suggest the absence of a quorum and would

ask unanimous consent that we divide the time. the presiding officer: without objection. the clerk will call the roll.

mrs. murray: i ask unanimous consent the quorum call be lifted. i ask unanimous consent that richard burkhfrom the appropriations committee be granted floor privileges during consideration of the consolidated appropriations bill. the presiding officer: without objection. mrs. murray: thank you, mr. president. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

a senator: mr. president? the presiding officer: the senator from vermont. mr. leahy: i ask unanimous consent the equal of the quorum be dispensed with. the presiding officer: without objection. mr. leahy: mr. president, division f of the omnibus provides funding for the state department foreign operations and related programs. provides $48.8 billion discretionary funding, funding, $3.3 billion decrease from the president's budget request. $1.8 billion below the fiscal year level. the -- one of the reasons why the president has said that he would fund these programs on budget, not through supplemental gimmicks, and i agree with him

on that. now, some senators made speeches about earmarks even though, of course, a lot of the earmarks have been requested by some who make the same speeches against them. i just want you to know that my budget, my appropriation, the state foreign operations conference, does not contain any earmarks, as defined by the appropriations committee. we fund many programs that are priorities for both democrats and republicans alike, including assistance for countries like afghanistan, pakistan, and iraq, long-standing allies like egypt, jordan der, -- jordan, israel, and so on. money to combat hiv-aids, including money for the global fund. $1.2 billion for climate change environment programs, including for clean energy programs and to protect forests.

$1.2 billion for agriculture food security programs. provisions dealing with corruption, human rights, funding for national organizations like the united nations, nato, the international atomic energy agency and prevent democracy and to -- and to promote democracy economic development and the rule of law from central america to central asia. and the funds to support our embassies and diplomats around the world, public diplomacy, broadcasting, programs like the peace corps and many other programs that support united states' interests. now, this omnibus bill, i don't support every single thing. i hoped as i know chairman inouye and vice chairman cochran could have brought each of the bills in the omnibus including the senate appropriations bill to the floor separately. unfortunately a handful of senators on the other side of

the aisle have made clear they will do whatever is procedurally possible to slow down or prevent consideration of these bills. well, on this one, it's balanced. as chairman and senator gregg as the ranking member, it's a balanced bill. i would ask consent that my full statement be made part of the record. the presiding officer: without objection. the question is on the motion to waive all applicable sections of rule 28. the yeas and nays have been ordered. the clerk will call the roll. vote:

vote:

vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote? thong vote, the yeas are 60, the nays are 36. three-fifths of the senators duly sworn and duly chosen and sworn have voted in the affirmative. the motion is agreed to. without objection. the presiding officer: the senate needs to come to order. mr. reid: mr. president, i ask unanimous consent that no further points of order be in order during the pendency of h.r. 3288. the presiding officer: is there objection? no objection, so ordered.

mr. reid: mr. president, it is my understanding -- mr. leahy: could we have order, mr. president. the presiding officer: order in the chamber. mr. reid: the next vote will be tomorrow morning at 9:30. we'll come in -- i would ask -- we'll be happy to come in at 8:30, but i would ask consent if we could have that vote at 8:30 -- i mean, 9:30, we'll come in at 9:00, if that's okay with everybody. mr. mccain: will the majority leader yield for a ghe. mr. reid: be happy to. mr. mccain: on the one hand the disposition of the pending dorgan amendment, could we have some idea about that? mr. reid: i think my friend from arizona asked a very pertinent question. we have made a consent -- we have offered a consent last evening and did i again today that we would have the votes that are now before the senate in sequentialal order. i offered an unanimous consent request to do that. we're happy to do that.

we could do -- i announced there will be no more votes today, so -- but we were -- monday when we come in, we'll be happy to do that. mr. mcconnell: i would say to my friend, the majority leader, the problem with that is we've been going back and forth, an amendment on each side. and the agreement that you proffered, if i understand it correctly, basically had two democratic side-by-sides. is that -- am i not correct? mr. reid: yes. but we -- on all amendments that we've had to this point, ever side -- democrats or republicans have, had the opportunity to do side-by-side if they wanted to. during the weeks that we've worked on this, what has transpired here i'm sure has happened before. simply stated -- the presiding officer: order in the chamber. the majority leader. mr. reid: simply stated, we

have been requested by the republicans to have some votes. we have disagreed to have the votes. i explained in some detail last evening why we can't do it in a piecemeal basis. procedurally it puts use in a quagmire. let's clear the deck. there will be other amendments after that that we would certainly try to have either side offer. but i agree with the senator from arizona. we should get rid of the drug reimportation thing one way or another. in addition to the amendment offered by my friend from idaho, senator crapo. mr. mcconnell: well, mr. president, my point was, typically a side-by-side is offered, one on each side. on the drug reimportation issue you've got basically two votes, both generated on the democratic side, which created some confusion. but we'll have to continue to talk about this and see if we can work our way through it. mr. kerry: mr. president? the presiding officer: the senator from massachusetts. mr. kerry: mr. president, i wanted to ask the minority

leader -- i would please ask the minority leader, some of us are a little perplexed. i know that the senate has its rules and we try to work through them, but we also at this time of year often try to accommodate families and try to accommodate schedules and so forth. and i'm curious as to why -- whether or not the minority leader might not consent to allowing us -- or why it is that we couldn't, since senators are here today, schedule the vote and agree to have the vote on the 60-vote margin today rather than tomorrow morning, requiring all the staff and everybody in the senate to come in on a saturday. mr. reid: if i could -- the presiding officer: the majority leader. reid ride if i could just make a comment before -- mr. reid: if i could just make a comment before my friend, the republican leader, comments. and everyone should understand, this should make it easier for everybody. i am going to be home all weekend if we're here, here, my home in washington, not my own

in searchlight. i won't be traveling the country doing any fund-raisers that people seem to be afraid of. mr. mcconnell: so, mr. president, i believe you asked me a question, didn't you? i think the senator from massachusetts asked me a question. the answer is that our good friend, the majority leader, told us on november 30 we'd be here the next two weekends. he said again this past monday we'd be here this weekend. i assumed and i know he certainly meant what he said. and our members are here and ready to work, would like to work on health care amendments, but we have, as a result of the privileged status of the conference report that's before us, have that displaced. but i think everybody was on full notice as to what the work schedule was going to be for last weekend and this weekend. mr. kerry: well, mr. president, if i could respond. i don't mean to, you know -- to assert myself in any way that's inappropriate with respect to the leader here. but we all know that in the

workings of the senate, what we're doing is both complicated and serious and critical to the country, and we are waiting for c.b.o. to appropriately -- i mean, consistently as a member of the finance committee we ad there a very strict notion that we would try to find the precise modeling and cost of whatever it is we might do and it is entirely appropriate to that to have a proper debate or discussion that we know exactly what the cost is of any particular proposal. that's what we're waitin waitin. so the majority leader is appropriately trying to move another piece of legislation that is ripe, that is important to the country, and this is just a matter of a question of courtesy to senators and to their families and to the staff of the united states senate who have been working extraordinarily hard. the question is simply asked, why, aes a matte a as a matter f convenience, we couldn't schedule a vote for today that

is instead being scheduled for tomorrow? because we could do that by unanimous consent. reid if i could just ask -- to have the record reflect -- mr. reid: i said we would be in session the next several weekends. but if you go back and look at the record, how many times have i said we'd be in session on the weekend and interestingly enough around here magic things happen on thursdays and fridays. but -- so i have had every intention, as i have every time that i have said that we should be in on weekends, and usually we're able to work something out. we haven't been able to this time. i accept that. i am not complaining about it. but certainly when my friend from massachusetts's question is a pertinent one, we have all senators here now, maybe we could have the vote early. but we're set statutorily. my unanimous consent request was

-- and i am not sure it was responded to -- was that we could have that vote at 9:30 tomorrow morning without having the mandatory one hour beforehand. i heard no objection to that. so we'll just come in at 8:30. i have somebody here who has to leave. we'll come in at 8:30 tomorrow, have a 9:30 vote. mr. kerry: mr. president, i would ask unanimous consent that the vote scheduled for tomorrow morning be held instead today at some convenient time within the next hours. mr. mcconnell: mr. president, reserving the right to object -- and i will object -- look, we've been told by the majority that the single-most important thing we could do is to work on weekends and try to pass this health care bill, which according to the cnn poll that came out last night, the american people oppose 61% to 36% before christmas. now, we're here. and we're prepared to work. we'd like to get back on the health care bill as rapidly as possible and vote on amendments

to the bill. it either is or i it isn't important for us to be here before christmas. so my members are not expected to take a break tbr this. we've been told by the majority all year long this is really important. first we had to get it done before august, then thanksgiving. now we have to get it done before christmas. we're here, ready to work. i object. a senator: mr. president? mr. president? the presiding officer: the senator from new hampshire. mr. gregg: mr. president, i note that there is nobody -- oh, i'm sorry. the senator from arkansas appears to be seeking recognition. i would like to speak. is the senator from arkansas seeking recognition to speak? the presiding officer: the senator from arkansas. mr. gregg: mr. president, i still have the floor. i was just asking a question. the presiding officer: yes. the senator from new hampshire

has the floor. mr. gregg: i would like to ask unanimous consent to be allowed to speak for up to ten minutes, and then the senator from arkansas could be recognized and then we'll come back to this side. mr. wyden: mr. president? reserving the right to object. and i have no intention of objecting. i would like to also propound a unanimous consent request that after the senator from arkansas has spoken and after the senator from new hampshire has spoken, that senator collins, i and senator bayh be recognized for up to 30 minutes for a colloquy. a senator: mr. president? the presiding officer: is there objection to the senator from oregon. mr. reid: i would ask my senator from oregon if he would allow this modification to his unanimous consent request? it would be as follows. consent that senator lincoln be recognized. she be allowed to speak for up to ten minutes. that senator wyden be recognized

for -- gregg be recognized for up to ten minutes. then senators wyden, collins, and bayh been qaidged in a colloquy for up to 30 minutes. following the conclusion of that 30 minutes, senator alexander or his designee be recognized for up to 30 minutes to engage in a colloquy with other members of the republican caucus. mr. gregg: i understand that's in addition to senator wyden's request which was i should begin with my first ten minutes, then we go to the senator from arkansas, then senator wyden, then the outline as represented by the majority leader. mr. reid: if that's okay with the senator from arkansas? the presiding officer: without objection, so ordered. mr. gregg: thank you. thank you very much. i wanted to rise to speak a little bit about this health care bill. i know there has been a lot of discussion of it already today, but i think it's important, very important that as this health care bill comes forward we know what it says. now, unfortunately, we received this 2,074-page health care bill

about five, eight days ago after it had been worked on for eight weeks in camera behind closed doors by the democratic leadership. we have only had eight days to look at it, and we now hear there is going to be a massive revision of it, a massive revision that's going to involve potentially expanding medicare to people who are aged 55. now, medicare is already broke, by the way. it's broke. it's got a $38 trillion unfunded liability and we're going to add another ten million people maybe into medicare? that makes no sense at all. i think it's important to review that what we know so far have been reviewed by a lot of different people but some of them haven't been all that objective. so there was a request made to c.m.s., which is an arm of the administration, therefore one would presume that it was not necessarily biased towards the republican side of the aisle. in fact, maybe just the opposite. i don't think it's biased at all, hopefully, but if there is a bias here, it would certainly

not be republican. to review the proposal of senator reid. now, let me read to you what the c.m.s. conclusion is, some of them, on the reid bill. the reid bill, according to c.m. s. actuaries, it would increase, increase national health care expenditures by by $234 billion during the period 2010-2019. why is this important? well, it's pretty darn important because we had representations that the purpose of this health care reform was to decrease, to move down the health care costs. now we find that this bill as scored by c.m.s. actuaries significantly increases the national health care expenditures. secondly, they concluded that the reid bill will leave 24 million people uninsured. 24 million people. that's almost 6 -- half of the uninsured today. now, why is that important?

we were told that the purpose of this health reform exercise was to, one, insure everybody. two, bend the health care costs. and three, make sure if you got the health care you liked, you didn't lose it. well, on two counts, it appears the reid bill clearly fails that test and gets an f on the issue of vetting the health care costs down and on the issue of insuring everyone, according to c.m.s., an independent group. third, it says that the new fees for drug devices and insurance plans in the reid bill. well, increased, increased prices of health insurance premiums for consumers. this will increase national health care expenditures by approximately $11 billion a year. so instead of bringing health premiums down as was represented by the president -- he said it was going to come down by $2,100 per family, it's going to go up, your health care premiums. what happens he had health care premiums go up? people stop giving you health care insurance because they can't afford it, employers can't afford it. so on the third issue, when you

lose your health care insurance if you like it? yes, you will, yes, you will because the price is going to go up under the reid bill. a couple of other points they make which are fairly important here. the actuarial analysis shows that the claim that the reid bill extends the solvency are shaky, they're shaky. the claim that it extends the medicare trust fund solvency. moreover, the claims that the reid bill extends the h.i. trust fund and reduces benefits premiums are conditioned on the continued application of productivity payment adjustments in the bill which the actuary found were unlikely -- that's their concept -- unlikely to be sustainable on a permanent basis. so the idea that this bill somehow assists medicare -- by the way, this bill cuts medicare about half a trillion dollars almost in the first ten years. when it's fully implemented, it cuts medicare by a trillion dollars in a ten-year frame, and over the next 20 years, it cuts

medicare by $3 trillion. the idea that this is going to somehow help medicare is fraudulent on its face, according to the actuary. fraudulent on the face is my term. it's unlikely, unlikely to accomplish that. then it goes into this issue of the class act which we have heard so much puffery about how wonderful this class act is, which is basically another ponzi scheme as was described by the chairman of the budget committee, not myself. and they said, the actuary, "the reid bill creates a new long-term insurance program. the c.m.s. actuaries found that faces very serious "-- this is their term --" very serious risk of becoming unsustainable as a result of adverse selection by participants. in other words, only people who are going to need long-term care will opt into this plan so this plan will basically not be able to pay the costs of the benefits it is proposing because it won't have funds coming in to support the people who need it because there will be no larger insurance pool of healthy people who aren't using the program,

only the people who need the program will use it. so the class act representation as has been referred to around here have been debunked by the c.m.s. this isn't our side saying these things. it's not our side saying -- it's not our side saying that the cost of this will -- this bill will drive up the cost of national health care. it's not our side saying 24 million people will be left uninsured when this is fully implemented. it's not our side saying the premiums will go up when it's fully implemented. it's not our side saying that the class act will be a seriously unsustainable program. it's not our side saying that medicare will not be benefited by this program. in fact, it will be negatively impacted by this program. it is c.m.s. saying that, an independent actuary -- not that independent. an arm of the administration. the administration's actuary is saying it, not our side. so i think it's legitimate to have some serious concerns about this bill. the c.m.s. goes on and says, "c.m.s. noted the medicare cuts in the bill could jeopardize the

beneficiaries' access to care. "now, that's serious, that's serious. it found that roughly 20% of all part-a providers, hospitals, would become unprofitable, 20% of all part-a providers, that's hospitals, would become unprofitable within the next ten years as a result of the proposals in the reid bill. well, you know, i know profit is a bad word on the other side of the aisle, but the simple fact is if you do not have profit in a hospital, the odds are pretty good you're going to go out of business. you're going to go out of business because you can't pay the cost of operating that hospital. even nonprofits have to have some sort of cushion in order to make it through. and now we have the c.m.s. actuary telling us that 20% of the hospitals in this country are going to go into a negative cash flow situation, going to become unprofitable as a result of what this bill proposes. well, colleagues, senators, why would we vote for a bill which increases the cost of health care for the hundred, it doesn't

bring health care costs down, which leaves half the people in this country who are uninsured still uninsured, which raises the premium costs for americans, which puts the medicare system at risk, which will put hundreds of providers at risk, hospitals, and which creates a brand-new entitlement which isn't sustainable. when that review is done by the c.m.s. and those conclusions are come to by the c.m.s., the independent actuary. why would we want to put that type of program in place? of course we shouldn't. of course we shouldn't. listen, this -- this bill, this 2,000-page bill, it was put together haphazardly. it was just, you know, sheets of paper stuck together. it ends up costing us us $2.5 trillion overall. every page costs us about a billion dollars. and obviously, it wasn't well thought out because the c.m.s. actuary looked at it and said it isn't well thought out, it doesn't accomplish its goals. so rather than moving forward with this bill, why don't we just step back and start doing things we know are going to

work? why don't we start doing a few things around here we know are going to work? now, the senator from oregon is on the floor, and he happens to be the sponsor of a bill which actually would make some progress in this area. i would be willing to step back and start from his bill because his bill at least makes sense if it were scored by the c.m.s. actuary, it wouldn't come out like this. they wouldn't be saying people were uninsured, that the price of health care was going to go up and that medicare was going to go into a disastrous strait and create an unsustainable entitlement. so we have got ideas around here that do work or are fairly close or at least have the foundation to work. why don't we use those rather than this bill? that's my only point. this bill is ill thought out. my conclusion -- that's not my conclusion. that's the only conclusion you can come to when you look at the c.m.s. actuary's evaluation of it. i appreciate the courtesy of the chair. especially appreciate the courtesy. the presiding officer: the senator from arkansas is recognized.

mrs. lincoln: well, thank you, mr. president, and i appreciate the courtesy of my colleague from oregon who are allowing me to speak now. and i want to rise today to talk a little bit about the health care concerns, particularly in our small businesses. i first want to compliment and thank my colleagues, particularly senator landrieu who is chairman of the small business committee, as well as senator snowe who i've worked with for years on the plight of the small businesses in our states and across the country, their needs to be able to really access the kind of competition and choice that allows them to make good decisions of spending -- and spending their health care dollars more wisely, being able to do what they all want to do in small business, and that is to cover their employees, to make sure that their employees and their employees' families are covered with reasonable, meaningful health insurance that actually covers what they need but is an affordable price. so i want to thank those women as well as senator stabenow who

i know has also been working on those issues. but i really come to the floor today, mr. president, to highlight the challenges that arkansas small business owners face in providing that quality, affordable health care for themselves, their families, and their employees under the current system. and look at what we can do to improve what their challenges are, what it is that they face. small businesses are our number one source of jobs in arkansas, and they are truly the economic engines of our local economies, but they are also the economic engines of -- of our national economy, not to mention learning laboratories. great ideas that will allow us in this great nation to be truly competitive in the 21st century. arkansas' nearly 250,000 small business and self-employed individuals make significant contributions to our state's economy and generated

generated $7.2 billion in 2008. small employers account for 97% of employers in our state. and i would dare say that nationally, i'm sure that they somewhere rate in those same numbers on a national level. addressing the needs of small business is absolutely critical to any health insurance reform legislation that we bring forward. as i mentioned before, senator snowe and i have worked together for many years to try and address these concerns, talking with with small businesses and their advocacy groups to try and figure out what it is that we can provide them just as we provide ourselves as federal employees the ability to access health insurance that's been negotiated where people have come together, pooled the resources of all of our risk as federal employees, all eight million of us to really get a better deal in the marketplace. we want to be able to allow small businesses to do the same,

to come together nationwide, pool themselves and their state exchanges, and be able to really take advantage of shearing their -- sharing their assets and their risk in the health insurance marketplace and get the best possible product that they can. those small businesses that are able to afford health care coverage for their employees in today's world continue to experience skyrocketing costs, jeopardizing our state and our nation's competitive edge, both among themselves nationwide domestically, but also internationally. we find that our small businesses are finding themselves more and more in the situation of having to be competitive globally, to be able to do the tbhais they do and to create -- business that they do and to be able to create the jobs that they need to create. yesterday i spoke with a radio station over from wynn, arkansas, in cross county, who said high costs have threatened his ability to be able to

provide coverage for his employees. or worse, skyrocketing costs are forcing business owners to consider giving up their businesses altogether, like the small business owner from mavern, arkansas, who wrote me that he was giving up his 17-year-old business because he can no longer afford his rising health care insurance premiums. his wife and his daughter each have a preexisting medical condition and he feels pressure to find a new job that provides affordable employer-sponsored coverage for his family. i heard from another small business owner in mena who told me that at the age of 65, he continued to keep himself on his own small business's health insurance plan in order to ensure that he could maintain providing health insurance to his employees, many of which he grew up with. they were friends of his from grade school or church and

community services and other places where he had built lifelong relationships not only as an employer and an employee but as -- as a part of a community, being able to maintain and providing that for him was so critical for him that he was willing himself to ante up. and i've heard from small business owners from all across my state who desperately want to offer health care coverage for their employees but it's simply not cost productive. the -- the fact is, is so many people think small businesses just want to opt out, that they don't want to provide health insurance, but they do. they do because it's important to them as a part of that community to do something for their employees, who also happen to be their friends and neighbors. they also want to make sure that their business is the best that it can be, and in order to do that, they've got to compete for those skilled workers. and getting the best workers means providing good benefits

and health care being the top of that list. another arkansan asked me to please include the self-employed in my efforts to secure affordable health care. there are many small businesses with only one employee, and health care under this scenario is extremely expensive. they are put in an individual market where they are rated against themselves in many instances and not giving the -- given the benefit of what we enjoy as federal employees and that is pooling ourselves together, adding our assets and our risks together so that we can mitigate that risk among all 8 million federal employees. madam president, this is just a few of the stories that i have heard from arkansans and that's why in every congress since 2004, i have introduced legislation to help small business owners afford health coverage for themselves, their employees, and their families. several of my provisions are already included in the health

insurance reform bill currently before the senate, including the tax credits to help small businesses afford coverage. and we want to improve upon that. insurance exchanges through which consumers can compare insurance plans side by side so that they will be able to choose the option that is best for th them, allowing their employees to see what is available to them and making sure that they're having access to all of the options in the marketplace. and the reforms that also force insurance companies to change the way they do business. by limiting what an insurer can charge based on age and by banning the practices of denying coverage based on preexisting conditions or increasing rates when customers all of a sudden get sick. you know, we look at our small businesses and, yes, there's a lot of young entrepreneurs but a lot of our small businesses are those individuals in that category above 55. these are people that,

unfortunately, are starting to see chronic disease challenges in their life as they age. and, unfortunately, they become a -- an issue -- or certainly their coverage becomes an issue when we talk about preexisting conditions. so it's really critical that we make sure we change the way that insurers do business as usual today and make sure that they're playing fair with the small business entities out there. just one more of my efforts was something we worked with senator snowe and senator -- senator snowe and durbin actually is to allow that there would be national private insurers, as there are today, but allowing them to set multistate plans nationwide. sell their plans in all 50 states t. woul.it would be withg national administrator that would be able to negotiate for

quality and strong coverage. some of this emerged as another potential part of the framework for national health insurance reform that can hel can really s achieve our goals of more choices and more affordability for consumers, particularly those in the small business marketplace. so i just want to thank you, madam president, for the opportunity to share with my colleagues and certainly those americans out there that are the ingenuity and the engine of our economy. i know my colleague from oregon has talked so much about choice and competition. it is so important, more important than ever in that small business marketplace and in that individual marketplace. and being able to provide exchanges and the ability for national insurers, private insurers to be able to provide these types of products across all 50 states in a multistate plan really gives our small businesses and our self-employ

self-employed, our individual marketplace, our independent contractors, like our realtors and others, the ability to have access to greater choice, greater competition in that marketplace and, therefore, a better product. graifort, morgreater, more meanl coverage at a more reasonable cost. that's what we want to see. and more upon thely, that's what our small businesses want -- and more importantly, that's who our small businesses want to see. thank you, madam president. i certainly yield the floor to my colleague from oregon and my colleague from indiana and the senator from maine as well, who i know will have a great addition to this conversation. thank you. mr. bayh: madam president? the presiding officer: the senator from indiana. mr. wyoming: madam president, i would like to begin by complimenting my friend and colleague from arkansas. we entered this body together and she has consistently advocated on behalf of small businesses, not only across arkansas but across the country. we both want to reform the health care system.

we know that this has a major impact on small businesses. they create most of the new jobs in our society, so if we care about job creation, we need to care about how health insurance costs affect businesses. they're going up too fast and senator lincoln has consistently advocated for doing what we can to get those cost increases down and, in fact, lower the burden on our small businesses. so this is not only a health issue, it's a jobs issue and she's been a real leader for many, many years now. and so, senator, it's a pleasure to work with you on these important issues. mrs. lincoln: thank you. mr. bayh: our class is doing well. i'd also like to say how much i've been privileged to work with my friend from oregon, senator wyden, who's been one of the most innovative thinkers in the area of health reform. and once again he's leading the way on an issue that i'm going to speak to for just a second. my colleague from maine is with us. it saddens me, madam president, to say that regrettably this is one of the few examples of bipartisan cooperation, where we've come together across the aisle, democrats and republica republicans, working together to figure out how in a practical way we can help solve the

problems that our country faces. here we have an issue of what to do about the 7% of americans who are in the individual insurance market but receiving no subsidies from the government. according to the c.b.o., they are at risk of having their premiums go up. that's not right. particularly at a time when even people who are making more than $8,000 very often are -- $88,000 very often are struggling. so the question is, what can we do about that? senator collins, senator wyden and myself focused on these individuals because we want to do what we can, in the words that my colleague from oregon emphasizes so often, to provide choice and encourage competition to improve both price and quality. that's what our amendments are all about. i'd like to read a very brief statement, madam president, and then turn it over to my colleagues. madam president, when i go home to indiana, the health care concern i hear the most about from ordinary hoosiers, particularly middle-class hoosiers, is, "what are we going to do to make my coverage more affordable?" many people in my state already have insurance but they're struggling to keep up with the skyrocketing increases in the

cost of that care. we began our health care debate and these deliberations in this body this past spring. in mid-october, months into our debate, some of us were struck by the fact that we had not answered the most basic questi question: how much is this going to cost and what can we do to bring those costs down? so i, along with some others, submitted in writing that question to the congressional budget office. what will this do for people in the small group markets like small business owners? what will this do for individuals in the large group markets who work for larger employers? and what will it do for individuals who are out there struggling on their own to provide health insurance for themselves and for their loved ones? when they released their report, i was pleased to see that the current legislation before us would either contain or lower costs for 93% of the american people. 83% of those in small group and large group plans, it's about holding even or modestly lower. for the 17% in the individual marketplace, about 10% of them

get -- 10% of that 17% get subsidies sufficient to actually bring their prices down, which leaves us with the 7% of those individuals in the individual market who get no subsidies and may see serious cost increases if nothing is done. the wyden-collins-bayh amendments accomplish just that. our first amendment promotes more health choices for both employers and workers who would otherwise have few, if any, choices. it would help individuals who would be forced to buy their own insurance at higher rates than they currently pay. would give them the option to purchase low-cost plans that offer essential basic coverage. it wean sure that congress does not mandate that anyone buy a more expensive plan than they currently have. our second amendment is a market-based reform that would pressure insurance companies economically to lower premiums and penalize them if they try to raise rates before the new exchanges are fully up and running. it would immediately adjust the insurer fee in the bill to give insurance companies a strong financial incentive to keep

premiums down. it would do this by making it economically smart for companies to hold the line on overexphed executive salaries -- overhead and executive sal expriz t salao root out administrative inefficiencies. our third amendment would give consumers who have insurance but aren't satisfied with it access to more choices to meet their health care needs. it would offer vouchers that individuals could use to shop in the new insurance exchanges we're creating. those who prefer their current plan to what's offered in the exchange could return the voucher and keep their existing coverage. if we pass these amendments, madam president, we can credibly tell the american people that our long efforts will have addressed rising health insurance premium costs for everyone, and that is at the heart of this effort that we have undertaken. madam president, in closing, i will say that americans are not looking for a democratic solution or a republican solution to our health care challenge. they are looking for us to come together to pass a reform bill that works in practical terms in

their daily lives. more choices, premium cost increases under control, eliminating preexisting conditions -- those are the things that will help middle-class families in my state and others across the country. i am proud that the wyden-collins-bayh affordability package will represent one of the few bipartisan efforts in this body. as i was saying, i regret the fact that it is one of the few but i'm proud that we have come together to work to address this important challenge. i hope my colleagues will agree that we have a responsibility to restrain premium costs for all american families by encouraging consumer choice and robust competition in the private marketplace. and i hope that we will pass these amendments because they accomplish exactly that. madam president, thank you for your patience. i yield the floor. mr. wyden: madam president? the presiding officer: the senator from oregon. mr. wyden: i want to begin my part of the colloquy with senator bayh and senator collins by thanking my colleague from indiana.

i also thank my colleague from maine in a moment because both have -- both of them have said from the very beginning of this discussion that the bottom line for millions of working families, for single moms, for folks who are walking on an economic tightrope across the country they're going to see this issue through the prism of what it means for them in terms of their premiums and their costs. and over these many months, senator bayh and senator collins and i have been toiling to put together some bipartisan ideas. we have filed these ideas as an amendment, submitted them to the majority leader, senator reid, the chairman of the finance committee, senator baucus, and we just wanted to take a few minutes today and talk in particular about why it is so essential that there be a bipartisan effort put together

for additional steps to contain costs. senator bayh is absolutely right in describing the congressional budget office analysis. certainly many people were fearful that that report would come out and on day one premiums would just rise into the stratosphere as a result of the legislation. fortunately, that was not the case for most people. we also feel that there is a whole lot more that can be done, and so we've said, democrats and republicans are going to try to prosecute that case. and, madam president, what it really comes down is ensuring that there is in the text of this legislation more choice and more competition. the reality is ever since the 1940's, the days of the wage and price control decisions that have done so much to shape today's health care system, most

americans have not had real choice in the health care marketplace and have not been able to enjoy the fruits of a competitive system. most americans have little or no choice. most americans don't get a chance to benefit when they shop wisely. and, as senator bayh noted and senator collins and i have noted over the last few days, that's something that we ought to change, and it is certainly not partisan. now, senator reid and senator baucus, to their credit, have agreed with me that there ought to be more choice for those folks who have what, in effect, are hardship exemptions. there are people, for example, who spend more than 8% of their income on health, who aren't eligible for subsidies, who have these hardship exemptions, and senator reid and senator baucus

and i have agreed that they ought to be able to get any help they're getting from their employer as a voucher and go into the marketplace and put into their pocket any savings that come about because they have shopped wisely. but as senator bayh has noted, we've got an opportunity to go further. employers who are in the exchange, they shouldn't be mandated to do anything. but if an employer in the exchange decides on a voluntary basis that their workers should have a choice to have a choice, under the proposal advanced by the senator from indiana, the senator from maine, and myself, they would be able to do it. and it is the voluntary nature of our idea that senator bayh has outlined, an approach that gives more options to both

employers and employees, that caused our proposal to win an endorsement from the national federation of independent business. madam president, i would ask unanimous consent at this time to introduce into the record that letter from the national federation of independent businesses. the presiding officer: without objection. mr. wyden: madam president, let me make one last comment, and then we are happy to have our colleague from maine to join us in this bipartisan colloquy, and that is to simply say that, as we go forward with this legislation, i hope we'll do more to look at the exchanges which are really the new marketplace for american health care. we haven't had that kind of approach since, really, decades of discussion about a system

that, for all practical purposes, tethered people to one choice that was a judgment by an employer and insurance company. i want to make sure in the days ahead that as many people as possible can keep exactly what they have today. that's something the president feels strongly about. that's something that every member of the united states senate feels strongly about. i also want employers and employees to be able to say that they're going to have a broader range of choices than they do now, and i think that can be done in a way that does not destablize employer-based coverage. in fact, i believe it will strengthen employer-based coverage, and i think that's one of the reasons the national federation of independent businesses has endorsed our proposal. we've got a lot of work to do, madam president, and i think there's a lot of good faith

among senators on both sides to get this done. i've always felt that hon an issue like this -- i've always felt that hon an issue like this, when we are talking about a sixth of the economy, you ought to fry to find as much common ground as you -- ought to try to find as much common ground as you possibly k the three of us have come together under a new set of amendments that does find some bipartisan ground, around principles the president of the united states has embraced -- choice and competition. and at this point i would like to yield whatever time she desires to our friend from maine, who is a wonderful partner. i thank her and senator bayh. i think americans are looking for commonsense ideas before all else. that is what we have sought to do in this proposal, and i yield to my friend from maine. ms. collins: thank you. madam president? the presiding officer: the senator from maine. ms. collins: thank you, madam president. first, let me thank my two

colleagues for their hard work on these amendments. my colleague from oregon, senator wyden, has been working so hard on health care issues for such a long time. my colleague from indiana, senator bayh, and i have worked together on other issues, and i'm proud of the fact that the three of us have been able to come together in a bipartisan way to present to our colleagues three important amendments. madam president, it is, as senator bayh has noted, so unfortunate that the debate on this bill has been so divisive and partisan. senator wyden approached me about trying to find some common ground on some issues that would unite us.

now, i should make clear, madam president, that the adoption of these amendments -- important, though, they are; great steps, though, they are -- do not solve all the problems that i have with the legislation before us. but they do improve the underlying bill in important ways, because they would help to advance the goal of more affordable insurance choices for consumers, providing more choices, more competition, and greater affordability, after all, should be major goals of health care reform. but the bill before us falls short in meeting those objectives. let me discuss our amendments. in summary, our amendments would allow individuals who are not

receiving subsidies to purchase lower-cost plans if that coverage is more affordable for them and more appropriate for them. we are also proposing health insurance vouchers that would provide more options for employers and employees alike. and we are proposing incentives to insurers to keep their rates lower than they otherwise might be. now, let me further explain our three amendments, madam president. first, we would open up the catastrophic plan, the so-called young invinceables plan, in the individual market to anyone regardless of age who is not eligible for a subsidy under the bill. madam president, it's incredible to me that we are going to so

constrain the insurance choices for an individual who is receiving no taxpayer subsidy at all. that does not make sense. we want to ensure not only that people can keep the insurance they have if they like it, but also that they have more options available to them. why should we say that an individual who is not receiving any help, no subsidy at all, can only purchase one of the four types of plans that are authorized by this bill? now, madam president, some would say, well, if you do that, you're going to have a problem where a person will perhaps have a health savings account to supplement catastrophic insurance plan, and then wait

till they're ill to trade up to a far better plan. but, madam president, there's a way to stop that from happening. we have drafted our amendment so that if an individual wished to upgrade his or her coverage, he or she would have to wait until the next plan year and then could only upgrade to what's known as "th "bronze plan, whics the next higher level. that would help with a situation where an individual waits until he or she becomes ill before upgrading coverage. we also want to make sure that consumers know exactly what they are buying and what kind of coverage they'd be getting. and that's why we would require

health plans to disclose fully the terms of the coverage to ensure that consumers fully understand the limitations. and, finally, this amendment would make clear that states have the ability to impose additional requirements or conditions for the catastrophic plans offered under this bill. but the bottom line is that health care reform should be about expanding access to affordable choices. and the bill that's on the floor now would cause many americans in the individual market to have to pay more for health care coverage than they do today. and that isn't right. if their health care coverage is working well for them, if they are higher income and can bear

the risk, if they have a health savings plan, if they are not getting a taxpayer subsidy, why should we dictate to this degree the level of coverage that they buy? so, i believe that this amendment is simply common sense. let me explain dwha it woul whad mean in my home state of maine, because i think it shows that one size does not fit all. in maine 87.5% of those purchasing coverage in the individual market have a policy with an actuarial value of less than 60%. the most popular individual market policy sold in maine costs a 40-year-old about $185 a month. it's a catastrophic coverage

plan that these individuals are often pairing with a health savings account. now, under the bill that we're debating, unless they are grandfathered and don't have any change -- for example, they haven't gotten married or divorced -- then that 40-year-old would have to pay at least $420 a month -- more than twice as much -- for a policy that would meet the new minimum standard or else pay a $750 penalty. now, there is an exception in the bill, but it's only for people who are under the age of 30. what we're saying is, let's broaden that so that if you don't receive help from government, if you don't receive a taxpayer subsidy, you, too, can buy that kind of catastrophic coverage plan.

a second amendment that the three of us are offering would provide more choices to small businesses and to their employees. given employers and employees -- giving employers and employees more choices should be among the chief goals of health care reform. our amendment would allow employers who choose to do so to offer vouchers to employees so that they can purchase insurance on the exchange. this would allow them, for example, to use the employer voucher plus tap into the subsidy available because of their income level and put some of their own funds into purchasing the kind of coverage that they want. as senator wyden has explained, this program is completely optional. employers could offer these

vouchers or decide to continue with their employer plan. and let me tell you one reason i think really strengt strengthene bill. we need more people buying insurance through the exchange, because if more people are using the exchanges, it broadens the risk pool, and the rates will be better for everyone. whenever in insurance you can have more people over which to spread the risk, that's how you drive costs and premiums down. so it's not surprising to me that our nation's largest small business group, the nfib, has endorsed our amendment. and let me just read one paragraph from the nfib letter, because it really sums it up. the nfib says, "this amendment addresses the shortcomes of the existing employer-based system

for small businesses. in the current system, small employers often have few options beyond take it or leave it. this new and voluntary option will encourage employers to provide insurance coverage for employees. it is the exact opposite of employer mandates that harm struggling businesses, discouraged start-ups, and kill jobs. i think the nfib has said it well. this will give more choices both to employers and to employees. and finally, madam president, let me say a few words about our proposal to modify the formula for the allocation of the the $6.7 billion annual tax on

health insurance providers. now, there are a lot of problems with that particular tax, madam president, not the least of which is because of the gap between when the tax is imposed and four years later when the subsidies are finally available. another problem is that the tax applies to nonprofit insurance as well as for-profit insurance. i'm working with senator carl levin to try to address that problem. well, here's what we're saying. the way that the tax is designed in the bill, there's little to keep insurers from jacking up the premiums, which is exactly the opposite of what we want them to do. they're going to just pass this tax on. so what we want to do is to give insurers an incentive to keep premiums as low as possible. so under our amendment, if you're an insurer that is

holding down the cost of your premiums, you don't pay as much a share of that tax. that makes sense. that helps us be fairer to the efficient insurer who is working hard to keep -- to keep premiums down. again, madam president, i'm very pleased to join with my two colleagues in presenting to the senate three amendments that will provide more choices, greater affordability, more options. these should be the goals of health care reform, and these amendments help to advance those goals. thank you, madam president. a senator: madam president, how much time do we have left? the presiding officer: three minutes 50 seconds. mr. wyden: madam president, i

want to thank my colleague from maine for her great statement. she summed it up so well. to close, senator bayh, and if we have time, i will add a thought or two. mr. bayh: i will be very brief, senator. senator collins, i would like to compliment you on an excellent presentation. you summarized it very succinctly and in a way that was compelling. i hope our colleagues will take note that among the three of us, we have the east coast represented and the west coast represented and the midwest represented. so we span the country and this body. so i hope that that will cause our colleagues to take some note. you focused on a letter from the nfib. this helps small business at a time when they are struggling to create jobs. i hope our colleagues will take note of this letter. and you also pointed out why should we control the health care choices of individuals who are receiving no government subsidies? it ought to be up to them. we accomplish all of those things. it's a pleasure doing business with you. this is a practical approach to solving these problems. i hope our colleagues will take notice. the last thing i'd say, senator, is i repeatedly have people come up to me and say boy, ron wyden

has some great ideas. we need more of his ideas in this bill. you have been accomplishing that. you have been a true leader for many years. choice and competition is being introduced and it's because of your good work. mr. wyden: madam president, just to close briefly, thanking my colleagues, i don't want to make this a bouquet tossing contest, but to have senator collins and senator bayh, those are as good of partners as you can possibly get. at the end of the day, americans are going to watch this bill and they're going to watch it next year during the open rollment season when millions and millions are signing up for their coverage, and they are going to be looking to see that we did everything possible to hold down their premiums. holding down their premiums, there are a variety of ways to go about it, but there is no better tool than to bring the principles of the marketplace, the principles that are used in every other part of american life, choice and competition to the challenge ahead with the help of senator collins and senator bayh. we are going to prosecute that

case. we're going to do it in a bipartisan way. and, madam president, with that i thank my colleagues and i yield the floor. a senator: madam president? the presiding officer: the senator from tennessee. mr. alexander: madam president, i ask consent that republican senators be permitted to engage in a colloquy during our time. the presiding officer: without objection. mr. alexander: madam president, i thank you. i know the senator from washington will have a chance to talk, but madam president, my grandfather was a santa fe railway engineer. he lived in newton, kansas. as far as i could tell, he was one of the most important men in the world. i was about 5 or 6 or 7 years old when i would go out there. he -- he drove one of these great big steam locomotives, and if there were as many yellow flags and red flags along the track when he was driving that santa fe locomotive as there are with the health care locomotive that's going through the senate today, i think my grandfather

would have been guilty of gross negligence if he didn't slow it down and see what those red flags and yellow flags meant. there's a lot of talk about making history with this bill, but there are a lot of different ways to make history, and one of the things that i hope that we'll be very careful to do in the senate is not to make a historic mistake with this health care legislation. now we have even one more red flag to consider. it came out last night from the chief actuary, richard foster, of the center for medicare and medicaid services. the center for medicare and medicaid services is not a republican organization nor a democratic organization. it's in the obama administration, but it's the agency in charge of the federal government spending for health care, which according to mr. samuelson who wrote a column in "newsweek" recently was 10%

the year 1980 and 25% today of our government's total expenditures. we'll go back to the reason we started all this on health care, let us remember that the reason we started the debate was first to see if we could bring down the cost of health care because the red flags and the yellow flags are everywhere, for small businesses, for individuals, for our government. we cannot continue to afford the increasing cost of health care in america, so our first goal here is to bring the costs down. yet, mr. foster, the chief actuary of the centers for medicare and medicaid services, in a lengthy report delivered last night on the health care bill, most of which we have seen but some of which we don't know about yet, still being written in the back room, says that it will increase costs instead of reducing costs, it will increase costs. it points out the obvious, which

is that the taxes in the bill will raise the premiums that 180 million of us pay who have employer-based insurance, and for those who have individual insurance, for most of them the same. it talks about the millions of americans who will be losing their employer insurance by the combination of provisions in this bill, many of whom will end up in medicaid where 50% of doctors won't see a new patient. but maybe the most important finding is the most obvious finding, the one which we have been suggesting to our colleagues day in and day out is one we ought to pay attention to, and which almost every american can easily understand, and it is this -- it has to do with medicare. the government program that 40 million seniors depend on. this bill would cut a trillion dollars -- well, let's start this way. medicare, the program we depend on, its trustees say is going broke in five years.

it's already spending more than it brings in, but it will be insolvent between 2015 and 2017. those are the medicare trustees. what does this bill do to that? it -- if i could just finish this point, what does this bill do to that? it would cut a trillion dollars out of the -- and i would ask the senator from arizona if the program is going broke and you cut a trillion dollars out and then as has been suggested over the last few days we add several million more people in, what do you suppose the result will be? mr. mccain: could i -- the answer is obviously that i don't know. and i'd like to say to the senator from tennessee -- and dr. barrasso is here as well. i'm not sure how -- a lot of americans have heard of the congressional budget office. i'm not sure many have heard of the centers for medicare and medicaid services which is part of the department of health and human services. aren't they the people whose entire focus is not on the

entire budget, as c.b.o. is, but just on medicare and medicaid so that they can make determinations as to the future and impact the various pieces of legislation on the specifically medicare and medicaid? is that a correct assessment? mr. alexander: the senator from arizona is exactly right. if i -- i believe i have my figures right. i believe mr. samuelson said in his column the other day that in 1980, the federal government was spending 10% of all our dollars on health care. today it's 25%. and this is the agency that's in charge of that massive federal expenditure every year. mr. mccain: i thank my friend, because the findings of -- as of december 10, 2009, which is entitled "estimated financial effects of the patient protection and affordable care act of 2009 as proposed by the senate majority leader on november 18, 2009" has some incredibly, almost shocking, results, i would say to my

friend from tennessee. we knew that this does not bring the bill -- the bill before us does not bring costs under control, but as i understand this -- and it is pretty, many i say, talmudic in some ways to understand some of the language that's -- that's in this report, but isn't it true the reid bill, according to this report now, creates not the republican policy committee but the centers for medicare and medicaid services, doesn't it say that the reid bill, i quote, "creates a new long-term insurance program called the class act that the c.m.s. actuaries found faces -- quote -- a very serious risk, unquote, of becoming unsustainable as a result of adverse selection by participants. the actuary found that such programs face a significant risk of failure and expects that the program will result in -- quote

-- net federal costs in the long term." and then i'd like to mention two other provisions to my friend from tennessee, and dr. barrasso who is very familiar with this not only center but medicare and medicaid services. the reid bill funds $930 billion in new federal spending by relying on medicare payment cuts which are -- quote -- "unlikely to be sustainable on a permanent basis. as a result, according to c.m.s., providers could -- quote -- find it difficult to remain profitable and absent legislative intervention might end their participation in the medicare program. the reid bill is especially likely to result in providers being unwilling to treat medicare and medicaid patients, meaning that a significant portion of the increased demand for medicaid services would be difficult to meet -- "they go on to say, the c.m.s. actuary noted

the cuts in the bill could benefit beneficiaries access to care. he also found that roughly 20% of all part-a providers, hospitals, nursing homes, et cetera, would become unprofitable within the next ten years as a result of these cuts. and finally, he goes on to say, "the c.m.s. actuary found that further reductions in medicare growth rates through the actions of the independent medicare advisory board which advocates pointed to as a central linchpin in reducing health care spending -- quote -- may be difficult to achieve in practice." this is a remarkable study. i would ask my friend from tennessee. mr. alexander: the senator from wyoming -- i thank the senator from arizona for being so specific about this and making it clear that this is not a republican senator talking. this is a republican senator

reading the report of the federal government's chief actuary for the medicare and medicaid program, and senator barrasso, a physician for 25 years in wyoming, brought to our attention some of these things earlier this week when he pointed out what this also says. i mean, isn't the point that if we keep cutting medicare, there are not going to be any hospitals and any doctors around to take care of patients who need care? mr. barrasso: that is absolutely -- mr. mccain: in addition i question, has dr. barrasso ever heard of the c.m.s. being biased or slanted in one way or another? isn't it one of the most respectable, respectable and admired objective observers of the health care situation as far as medicare and medicaid is concerned? mr. barrasso: my answer to that is they are objective, and that's why we didn't get this report -- and i have the same copy that my colleague from arizona has.

this -- this just came out. and the reason is they wanted to take the time to study the bill, which they got the middle of november. so they needed the time to actually go through point by point what the -- what the implications were. and you talked about the one segment where they talk about "faces a significant risk of failure." they also go on to say, "this will eventually trigger an insurance death spiral." and this is for people who depend upon medicare for their health care. there's an associated press story that's out today, and it says this provides a sober warning -- a sober warning -- today to members of the united states senate. this at a time when the senate is going to -- when it raised the debt limit in this country by over a trillion dollars. as the old saying goes, i say to my friend from the navy, spending money like drunken sailors. and yet they want to keep the bar open longer than -- and we want to increase the debt at a time when our nation cannot afford it, when we have 10% unemployment, and yet the folks

who know medicare the best and can look at this objectively and share with the american people what their beliefs are on what the impacts are going to be, this is going to be devastating for patients who rely on medicare for their health care -- that's our seniors -- devastating for small community hospitals. and i see the former governor of nebraska, senator from nebraska, who's here who knows, like i do in wyoming, the impact on our small community hospitals. but as the senator from tennessee said, this is all being done in the back room. we're not really privy to the newest changes, which i think are actually going to make matters worse. when "the new york times" today says "democrats >> new ideas would be even more expensesive. few details. questions exist about the affordability." what we're dealing with is a situation that's unsustainable. and that's why today the newest poll by cnn, a very -- you know, certainly not biased one way or the other, finds 61% of americans oppose this bill.

it is the highest level of opposition to date because more and more people are seeing and learning the truth about what's being proposed in the bill before the senate right now. mr. mccain: could i finally ask, this is the information on the bill as it is, correct, the one originally? this is without the expansion of medicare taken into this study, which already as you quoted "the new york times" and other health care experts, is going to increase costs even more as you expand medicare and you run -- among other thirntionz the run the risk -- other things, you run the risk of adverse selection, which means the people who are the sickest immediately enroll which then increases the cost and then who would be paying increased medicare payments? the young and the healthy. should we do that to -- to the next generations of americans, i'd ask my friend from wyoming? mr. barrasso: well, we should not. we need to be fair. we need to deal with this in a realistic way, but the bill in

front of us now is going to raise taxes $500 billion, it's going to cut medicare by almost $500 billion for our seniors who depend upon it, and for people that have insurance that they like, it's going to increase their premiums. they're going to end up paying more than if no bill was passed at all. and that's why across the board, more people would rather have this senate do nothing than to pass this bill that we're hooking at today because they understand that the impacts on this nation and our future are devastating. they will cause us to lose jobs with the taxes. they will cause us to lose care in small communities. and for our seniors who depend upon medicare, they're going to throw more people on to medicaid, another program where half of the doctors and half of those folks can't find a doctor to get to -- to see them. so all in all, there is nothing i see around about this bill or any of the new changes and certainly this report, nothing tosses the american people hey,

you know, you may want to think about this. the american people have thought about it. this report tells the american people this is not what you want for the health care of this nation. mr. alexander alexander: madam , i'd like unanimous consent to include in the record the first 20 pages of the roar of the centers for medicare and -- report of the centers for medicare and medicaid and ask the senator from georgia, while there -- this is a complex document in many ways, it's a matter of common sense, isn't it? i mean, if you take a program that's going broke and if you take a trillion dollars out of it and if you add millions of people to it, i mean, isn't the end result being there's not going to be somebody he lef lefo take care of the people who need step in isn't that the logical result that have just as the roar says? mr. chambliss: not only does that report say that but as you say commonsense ought to tell you that. but it's pretty obvious the folks on the other side of the aisle that are promoting this

bill don't get that message. and let me just quote the chairman of the finance committee who today issued this statement relative to the c.m.s. report that you have in your hand there. he said -- and i quote -- "the report shows that health reform will ensure both the federal government and the american people spend less on health care than if this bill does not pass." now, that statement is directly contrary to the statement in the report that you just referenced which says, from c.m.s. -- and i quote -- "we estimate that total national health expenditures under this bill would increase by an estimated total of $234 billion, or .7%, during calendar years 2010-2019." and not only that, but the report says that the national health expenditures would increase as a percentage of g.d.p. from $1 out of every $7,

which is about 16%, to $1 out of every $5, which is 20%. so what the report concludes is that not only are health care costs goin going to go up, but e senator from arizona said, 20% of all part-a providers, nursing homes, hospitals, home health, would become unprofitable within the next ten years as a result of the provision in this bill relating to the medicare cuts that you just talked about. you know, the american people do get it. that's why these poll numbers that the senator from -- from wyoming just stated coming out of cnn and why the fox poll that i saw this morning said 57% of the people in america are opposed to this bill. the american people are getting it, but for some reason, our friends on the other side of the aisle are not. mr. alex understandmr. alexandei

see the senator from nebraska and a little earlier we were having a conversation about the people in nebraska. it's very helpful to have independent evaluators who tell us that if you cut a trillion dollars out of a program that's going bankrupt and add million millions -- and then add more people to it, that doctors and hospitals are going to go broke. but we've heard that before from the mayo clinic and i think you've been hearing that in the state of nebraska. mr. johanns: i've heard it all over the state. you know, today, let me just say the fog cleared. the fog cleared. and the sun is shining brightly on this mammoth experiment with 16% of the economy. and this actuary says very clearly -- he's got no ax to grind with anyone -- he just says very clearly that costs are going to go up under this bill, that care is going to be jeopardized under this bill, that the very linchpin, the essence of what this bill was

supposed to be all about can't happen. now, if i might just with unanimous consent offer something for the record just to put some perspective here. i want to applaud my colleagues on this side and here's why. we wrote to the majority leader back in the first part of november and we said that c.b.o. had not been able to tell us what the ultimate impact would be on health care costs, and we felt strongly that we needed a second opinion. and so we asked that this bill be submitted to scrutiny by c.m.s., and that's what we're getting today. 24 of us signed on to that. and with unanimous consent, madam president, i'll submit this for the record, that letter. the presiding officer: without objection. mr. johanns: but today we finally have come to grips with the fact that all the promises

made are not being fulfilled by this bill. that the $2.5 trillion that will be spent will really accomplish nothing. that health care costs won't go down, they will, in fact, go up. that people will lose their private insurance. and i'll tell you, the most heartbreaking for me and any other senator who has rural hospitals, which is just about every senator, the most heartbreaking thing for me is that 20%, as the gentleman from georgia points out, will be underwater. that's nursing homes that care for real people. that's hospitals that provide services for real people. and i will tell you, in a state like nebraska, when hospital care disappears in a small town, that may mean hospital care disappears for hundreds of miles. mr. alexander: and if i could ask the senator from nebraska, did -- did not just a rural

hospital in nebraska or wyoming or some state, did i not notice that in the mayo clinic letter this week, they said, cuts like this or expansion of medicare under these circumstances would cause them to -- to -- to -- well, medicare period, they lost $840 million this year and they're beginning to say to some citizens from nebraska, montana, other areas, we can't take you if you're a medicare patient or if you're a medicaid patient. mr. johanns: yeah, what this bill does -- and they are saying that and that's what's happening, because they're losing money on -- they're definitely losing money on medicaid, they're losing money on medicare. so what -- what the reid bill really does here is it says -- it says, mr. alexander, you sell whatever, cars -- let's just use that as an analogy -- and i know you're losing $100 on every car. but let's just give you twice as

many to sell. well, you're going to lose twice as much money, and that's their solution to the health care crisis in this country. but what this actuary points o out, what the mayo clinic points out, what so many analysis now have pointed out under this bill is that this is going to put hospitals under, it's going to put nursing homes under. and there's another point that kind of gets lost in this complex debate. that nursing home or that hospital may be the only major employer in that community. and when you lose that, you not only lose your medical care but you lose those jobs. i've said on the floor before, this bill is a job killer. it is a job killer. there's just no way of getting around it. those jobs will disappear in that small town, that rural ar area, even in the -- the big cities. i just hope that our friends on the other side study this very

carefully. this is a roundhouse blow to the reid plan, to the reid-obama plan. this really, in my judgment, proves beyond a shadow of a doubt that this is going to crush health care in our count country. mr. alexander: i would ask the senator from wyoming and georgia who are here, let -- let's just go back to the very beginning. when we began this debate, the president in his summit at the beginning of the year very correctly, and i applauded him for that, all of us said we've got to reduce health care costs costs to us, costs to maul businesses and -- small businesses and costs to our government. but doesn't this report of the chief actuary of the government say the reid bill will actually increase health care costs? mr. barrasso: well, it does say that. and so much of what the president says, he said he wanted to get the -- bend the cost curve down. this report says that if we do these things that are in the reid bill, the cost of care will

actually go up faster than if we did nothing at all. and for people who buy their own insurance, the cost of their premiums will go up faster than if this senate pass nothing at all. mr. alexander: just so i'm understanding, so we're going to cut a trillion dollars when fully implemented out of medicare, we're going to add a trillion dollars in taxes when fully implemented for medicare, we're going to run up the debt, woabl this side, we're -- we believe on this side, we're going to increase premiums and costs are still going up? mr. barrasso: for people all across thacross the country, coe still going to go up. businesses -- the cost of doing business will go up. for families who buy their own insurance, their costs of their premiums will go up. for people who are on medicare, they're going to see tremendous cuts into that program and they depend on that health care. so costs are going up for people who pay for their own care, for businesses who -- who try to

build jobs. and we know that small businesses, according to the national federation of independent business, the small business -- businesses of this country, the ones that are the engine that drive the economy, 70% of all new jobs come from small businesses, they are going to be penalized to the point they're not going to be able to add those new jobs. and they say that we will lose across the country 1.6 million jobs over next four years as the government keeps collecting the taxes but doesn't even give any of this health care services because those have all been delayed for four years. mr. alexander: we have a couple minutes remaining in our time. i wonder if the senator from georgia, having heard the comments, has additional reflections. mr. chambliss: i'd like to ask a question of the senator from wyoming who is a medical doctor, who prior to coming to the senate was an active orthopedic

surgeon. i've had physicians come to my office in droves and talk to me about medicare before we got into this health care debate. what i've heard is in reference to the reimbursement rate being so low. in fact, the american hospital association has come out just in the last 24 hours and pointed out that hospitals across the nation get a return of about 91 cents for every dollar of care provided. that's not 91 cents of the amount of charges from the hospital to medicare. it's 91 cents of the cost of the care provided. so the return is about 10% less to a hospital than the cost that the hospital has in it. and my understanding is that at least 10% less than the cost provided for a physician is reimbursed to the physician under medicare. and as a result of that, the younger physicians particularly who are coming out med school with these huge debts that they've incurred as a result of

the long years they were required to be in school simply can't afford to take medicare patients. and they're not taking medicare patients. is that in fact what's happening in the real world? will it not get worse under this proposal? mr. barrasso: it is happening. it will get worse under the proposal that's ahead of us. that 90% figure is actually a high number. i know a number of physicians in hospitals especially in rural communities who get reimbursed less than that. the ambulance services don't even get reimbursed enough -- and these are volunteer ambulance services -- to fill the ambulance with gas for taking somebody long distances for medicare to where they may have hurt themselves, broken hip, to get them to the hofplt this hofplt -- get them to the hofplt this is bad for america. we say we want people to be able to get care. you throw a whole bunch more on the boat which is already sinking, which is what the democratic leader is trying to do, it will make it that much harder for our hospitals to stay

open, especially in these communities where there is only one hospital providing care. much more difficult. for any young physician coming out with a lot of debt to try to hire the nurse and pay the rent and the electricity and the liability insurance and all that, these don't even cover the expenses. that means they have to charge more to the person who does have insurance, the cost shifting that occurs. and as a result, for people that have insurance, they're going to see their rates going up. for people who rely on medicare, it is going to be harder to find a tkofrpblgt for those -- to find a doctor. for those on medicaid, those who need additional help, it is going to be hard for them finding care. across the board there is nothing good with this proposal. what we have seen today documented from the folks who are objective and look at the whole picture, they think it's actually as bad -- they admit it's as bad as we've been saying

it is. they're saying you guys have been right. what you have been saying about the cost of care, the impact on health care, and their phraseology is such that i think they absolutely pinpoint all the reasons that the american people now, by a number of 61%, oppose this bill we're taking a look at t.'s why the mayo clinic has said in the letter from their executive director of their health policy center said expanding this system to persons 55 to 64 years old will ultimately, ultimately hurt patients. hurt patients by accelerating the financial ruin of hospitals and doctors across the country. that's what we're looking at. mr. alexander: madam president, how much is left? madam president, if i could -- if i could conclude our time with permission of the senator from georgia and wyoming, instead of racing down this

train track with yellow flags and red flags flying everywhere, people often ask us, what would you do? what we would do is what we think most americans would do when faced with a big problem. not try to solve it all at once you, but to say what's our goal. our goal is reducing costs. what are the first four or five steps we can take to reduce costs? can we agree on those? we think we can. let's start taking them. for example, small business health plans, to allow small businesses to offer insurance to their employees at a lower rate. that legislation is prepared before the senate. reducing junk lawsuits against doctors, that reduces costs. allow competition across state lines for insurance policies. that reduces costs. going step by step to reearn the trust of the american people to reduce health care costs is the way to go instead of making what this new report from the center

from medicare and medicaid services helps to show, again, would be an historic mistake. i thank the president. i yield the floor. mr. roberts: would the gentleman yield for an observation? mr. barrasso: certainly. mr. roberts: i thank the distinguished senator for yielding. thank you -- the presiding officer: the senator's time has expired. mr. roberts: madam president? the presiding officer: the senator from kansas. mr. roberts: thank you, madam president. i'll just be very brief, but i would like to thank the senator from tennessee not only for his statement, but for his constant efforts. you know, facts are stubborn things, and yet, when you have pointed out basically what this report now confirms during the last few months, we've seen some commentary that says scare tactics, of all things. i happen to have the privilege of being the chairman of the rural health care caucus. i was in the house of representatives when i had the

privilege of serving there, and i am a cochairman with senator tom harkin of iowa. and there are about 30 of us that from time to time will correspond in messages back and forth to try to keep the rural health care delivery system viable. and we've been worried for some time in regards to what's going to happen to medicare, what's going to happen in regard to costs, what's going to happen in regards to rationing. and every hospital director, every hospital board in rural america has worried about these things, more especially about c.m.s., which has been described here in detail. that's the centers for medicare and medicaid services. now, i have to tell you that if you're a hospital administrator or if you are on the board of a local hospital in a rural area and you hear the word "c.m.s.," it's probably not viewed in the

best of considerations in that c.m.s. is in charge of enforcing what h.h.s. comes down with. in terms of reimbursement, in terms of all sorts of things -- competitive bidding. and i'm talking about doctors hospitals, nursing homes, home health care, hospice all of this. when they hear the word c.m.s. a cold chill goes down the back of their neck more or less like expecting lizzie borden to come through the back door. i am especiallily glad the chief actuary of c.m.s. has shined the light of truth in the darkness. he has said basically that this bill's going to increase costs and is going to result in rationing. it does not take into

consideration the latest reiteration that we hear from press and the media about including people 55 and 65 into medicare. it's going to be interesting if we have enough time -- although i know that the distinguished majority leader has asked for a c.b.o. score. but i would sure like to know what mr. foster would think of that idea. and i think it would be far worse. so i would just encourage all of my colleagues that belong to the rural health care caucus to take a very hard look at this. this confirms what we have been saying for some time. these are not scare tactics. these are actual facts. let me say too that i know that when this debate first started that some of the national organizations that represent doctors and hospitals, perhaps nursing homes, certainly not any home health care -- well, i take that back. there was a letter written by the home health care folks at

one time. but certainly not hospices. indicating that they were lukewarm-warm to the bill or would perhaps support it. i think the message was pretty clear: come to the breakfast or you won't come to lunch. that was pretty bare knuckle. they hoped by at least ensuring those that have insurance, that that would make their situation better. then of course came the latest iteration to this bill of putting in people 55 to 65, and then the national association in regards to our doctors and our hospitals said, whoa. let me point out that in kansas and in many states throughout the country there never was this support. they knew exactly what would happen if we passed this bill and c.m.s. would come knocking on their door. i might add that it wouldn't be c.m.s. that actually did that. it would be the internal revenue service under this bill, and that was one consideration where i made about a 15-minute speech,

and obviously not too many people paid attention. all patients, all doctors, all nurses, all clinical lab folks, anybody connected with home health care industry or hospice or nursing homes or whatever should have known that it's going to be the i.r.s. that's going to enforce this. so, as well as c.m.s. who has been doing most of the -- has been doing most of the enforcing. so, in kansas, the kansas medical society said no, no, we're not going to go a whropbg this bill. and -- go along with this bill. and i'm talking about the bill we've been talking about for some time. the kansas hospital association was adamant. they said no. that was because of advice they got from 128 hospitals in my state saying no, we can't reconcile with this because of the costs, because of the rationing. and we're only being reimbursed at 70% or less as we talk about it. and the doctors about 80%.

many doctors don't serve medicare now in kansas. let me rephrase that. some doctors don't serve medicare in kansas. this bill passes, and a lot of doctors simply will not serve medicare. and you can have the best plan or the best card in the world, it isn't going to make a difference if you can't see a doctor. it isn't worth a dime. then i have to say that the kansas nursing home association and the kansas home health care folks and the kansas hospice folks all said no, this is not where we want to go. this is self-defeating. this isn't going to do what the sponsors of the bill and what everybody had hoped for health care reform would actually see happen. so i don't know what the word is, not overwhelmed. i am extremely glad. i am somewhat surprised but i am extremely glad that c.m.s., again, has shined the light of truth into darkness.

i commend mr. foster, the chief actuary. i recommend this as required reading for everybody who was going to vote for this bill and certainly with the latest reiteration where we're adding anywhere from 10 million, to 20 million to 30 million people to medicare, which will make the situation much worse in regards to medicare being actuarially sound and costs going up, premiums going up and also rationing, the dreaded rationing, that it's not a scare tactic but actually a fact. i yield back my time, madam president. a senator: madam president? the presiding officer: the senator from washington. ms. cantwell: thank you, madam president. i've been on the floor now for about an hour listening to my colleagues on the health care debate and certainly want to express the opinion from many people in the northwest. we know that doing nothing about health care certainly will guarantee that premiums will go up. we know what's happened in the last ten years, they've gone up

100%. we know that doing nothing now means they'll go up 8% to 10% a year. we also know there's about $700 billion in waste in the system. this is about what we can do to reform the system so that we can stop the rise in increase that we're seeing in our premiums. and there's many good things in this legislation change fee-for-service system so that we're driving down the quantity of health care that is delivered instead of making sure that it's quality, making sure we make reforms in long-term care, making sure that we give the power to states to negotiate and drive down the cost of rates. so i hope my colleagues in the next several days will join us in the discussion about we continually kpwraouft bill to drive -- improve the bill to drive down costs. doing nothing will not get us to that point. i know my colleague senator collins was on the floor with some of my other colleagues -- the senator from oregon and indiana -- to discuss their

ideas on how we drive down the cost of cost containment. i want to send to the desk legislation on another subject that i would like to introduce, legislation on my behalf and senator collins, the senator from maine, dealing with putting a market signal on carbon so that we can get off of carbon and move forward on a green energy economy that will create millions of jobs in america. i know we're still on health care, so i'm not going to take a lot of time right now talk about this because we in the next several weeks and months ahead are going to have a lost time to talk about this issue. but i do want to say for my colleagues, as we are introducing this legislation, that the american people have been on a roller coaster ride with energy prices. i know the presiding officer knows this because she comes from the northeast and she knows what home heating oil costs have done to her state and surrounding states. i know my colleague from maine knows this as well, and i'm sure

that's part of her motivation in joining me in this cause. the american public cannot sustain having oil prices wreak havoc on our economy for the next 30 years. and we know from economists of what they say that sometime in the next five to 30 years we really will be at peak oil and once we're at peak oil, the cost to the u.s. economy will be even more extravagant. so the american people want to know what we're going to do to transition off of that and do so in a respectable way. what they're not so interested in, madam president is a proposal that would have wall street come up with a funding source by doing speculative trading to continue the games that have just been played for the last year, two years on various commodities that drove our economy into the ditch. i find it interesting that today in the newspapers coming from copenhagen that now they have

decided that 90% -- up to 90% of all market activity in the union trading markets was related to fraudulent activity. so that tells us that trading markets already existing on carbon futures have had great deals of problems and manipulation. i don't think we need to repeat that here in the united states. what we want to do instead is say, we're going to make sure that consumers get a check back to help them with their energy bills. we want to say, we are going to protect them from the skyrocketing prices of energy, but we are going to transition off of fossil fuel and onto new sources of energy, of biofuels, of alternatives like wind and solar, of things like plug-in electric vehicles, of an electricity grid that can be more efficient and a smart two-way communication system and in the end, our economy is going

to be better, we are going to create more jobs, we are going to make sure that consumers are not held hostage by future huge energy spikes. and i think if we do that, madam president, we are going to leave to the next generation a better situation. we are going to leave the planet earth in better shape. but, most importantly, we are going to take our u.s. economy right now that is struggling to move ahead and instead we are going to create thousands of jobs in the short term and millions of jobs in the next several years. that is good news, to think that the united states could become a leader in energy technology, that we're not going to be as dependent upon the chinese for battery technology of the future as we are right now on middle east oil. so i introduce this legislation with the most respect for my colleagues, senator boxer and kerry and lieberman and mccain, many of my colleagues who've been involved in this issue for many decades. but to work across the aisle

because i think if anything health care shows us, we have to -- we have to cut down the amount of time that it takes to move these important pieces of legislation by working together in an effort to show that we really do understand the needs of the american public. we have to drive down their costs, not just on health care but on fuel as well. and we have to give them economic opportunity for the future. and sending this market signal is the best way to create jobs and help protect consumers for the future. i thank the president, and i yield to my colleague. ms. collins: madam president? the presiding officer: the senator from maine. ms. collins: thank you, madam president. first, madam president, let me ask unanimous consent that my entire statement be included in the record as if read. the presiding officer: without objection. ms. collins: thank you, madam president. madam president, i am pleased to join my colleague from washington state, senator cantwell, in introducing what i

believe to be landmark legislation, the carbon limits and energy for america's renewal -- or "clear" act. let me commend the senator for her leadership on this important issue. madam president, one of the most appealing parts of this bill is it takes a fresh look at the issues that are facing our country in the area of developing alternative energy, promoting energy independence, and addressing climate change, the need for more green jobs in our economy. indeed, this bill addresses the most significant energy and environmental challenges that we face. it would help to reduce our dependence on foreign oil, promote alternative energy and energy conservation, and advance

the goal of energy independence for our nation. the costs of gas and oil impose a great burden on many americans, particularly those living in large rural states like the state of maine. high gasoline prices have a disproportionate impact on mainers who often have no choice but to travel long distances to their jobs, grocery stores, doctors' offices. this lessens the amount of money that they have to spend on other necessities. in addition, madam president, 80% of mainers heat their homes with home heating oil. that is one of the highest percentages in the nation. so the state of maine is one of the states most dependent on foreign oil of any state in the

nation. our nation must work together on comprehensive long-term actions that will stablize gas and oil prices, help to prevent energy shortages, avoid those spikes when we're held hostage to foreign oil, and achieve national energy independence. this effort will require a stronger commitment to renewable energy sources such as wind energy, as well as energy efficiency and conservation. the development and implementation of these new approaches to environmental stewardship and energy independence will also provide a powerful stimulus to our economy and the creation of green jobs. and, madam president, like my colleague, i want the united states to lead the way on green

technology, not lose our edge to china, for example. in addition to advancing these goals, the "clear" act is the fairest climate change approach from the perspective of consumers because it would rebate 75% of the proceeds generated by the cap on carbon emissions directly to citizens. i think that is a tremendous advantage of this bill over alternative approaches, such as the cap-and-trade bill. i also share the concerns of my colleague from washington state about the abuses that we have seen in energy and agricultural markets when speculators are allowed to participate in the market. that's why in our bill, which

imposes an upstream cap on carbon, only the producers are allowed to participate in the trading. i think that is a far better approach that will guard against market manipulation and excessive speculation. madam president, in the united states alone, emissions of the primary greenhouse gas, carbon dioxide, have risen more than 20% since 1990. clearly, climate change is a daunting environmental challenge, but we must develop solutions that do not impose a heavy burden on our economy, particularly during these difficult economic times. and that's why many a pleased to join -- and that's why i'm pleased to join as the lead

cosponsor of the "clear" act. climate change legislation must protect consumers and industries that could be hit with higher energy prices. we must recognize that many of our citizens are struggling to afford their monthly energy bills now and cannot afford dramatically higher prices. we also must produce legislation that would provide predictability in the price of carbon emissions so that businesses can plan, invest, and create good jobs. climate change legislation should encourage the adoption of energy-efficiency measures and the further development of renewable energy. madam president, i'm very excited about the possibilities for the state of maine because of its immense potential to develop offshore wind energy. estimates are that the

development of five gigawatts of offshore wind in maine would be enough to power more than one million homes for a year. it could attract $20 billion of investment to the state of maine and create more than 15,000 green-energy jobs, jobs that are desperately needed in our state. the "clear" act would help to achieve all of those goals. madam president, i could not support the bill that was passed to deal with climate change by the house of representatives. let me just read a couple of the descriptions of that bill. "the new york times" described it as -- quote -- -- quote -- h compromises, carve-ou carve-out, concessions, and out-and-out

gifts." "the washington post" described it as having pollution credits and revenue that were divvied up to the advantage of politically favored polluters. i do not believe this bill, which is a 2,000-page monstrosity, can garner the necessary 60 votes to proceed in the senate. the "clear" act, by contrast, would help to move a stalled debate forward by offering a fairer, a more efficient and a straight approach. you have only to look at our bill. it is 39 pages long compared to 2,000 pages of the house-passed bill. madam president, my full statement goes into detail on how the bill would work. and i hope that my colleagues will look closely at it.

but let me just talk about one part, and that is, in the "clear" act, 75% of the carbon auction revenues would be returned to consumers as tax-free rebates. they wouldn't be lost to speculation or to a half a billion dollars of fees every year to investment firms on wall street. no, 75% of those revenues would be returned on a per capita basis to consumers. and that means that 80% of americans would incur no net new costs under the "clear" act. the average mainer would stand to actually gain $102 per year from the "clear" act. and i can tell you, mainers would welcome that. it would help them winterize

their homes, meet their energy bills, invest in energy conservation and efficiency, or just have a little more money to get by. by contrast, under the house-passed cap-and-trade bill, the average citizen in this country would experience a net cost increase of $175 per year. boy, that is a big difference, and a big advantage of the cantwell-cal lin collins approa. what about the other 25% of the auction revenues? what we would propose is that those would go to a trust fund to fund energy efficiency programs and renewable energy research and development, to provide incentives for forestry and agricultural practices that sequester carbon, to encourage practices that reduce other greenhouse gases, to help

energy-efficient, energy-intensive manufacturers, and to assist low-income consumers. that fund would be called "the clean energy reinvestment trust," the cert fund, tangdz would be subject to the annual appropriations process so that congress could adapt assistance for climate-related being actis rather than being locked into a complicated allocation scheme that may well favor special interests. madam president, i am excited about this bill. it offers us a way forward to a green economy. it will help create jobs. it will alleviate the burden on consumers and particularly in new england where the presiding officer and i live as well as the northwest. it makes sense. it is a commonsense approach,

and i hope my colleagues will consider joining the senator from washington and me on this important legislation. and again, i want to commend senator cantwell's leadership. she has done a great deal of work to come up with this approach, and i'm excited to be joining her in this effort. thank you, madam president. madam president, i would suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

a senator: madam president? the presiding officer: the senator from idaho. a senator: madam president? madam president, are we in a quorum call? the presiding officer: we are. mr. crapo: i ask the quorum call be lifted. the presiding officer: without objection. mr. crapo: i ask unanimous consent to enter into a colloquy with my republican colleagues for 30 minutes. following us will be the republican leader. following the remarks of the republican leader, senator durbin be recognized to speak. the presiding officer: without objection. mr. crapo: thank you, madam president. i'd like to speak on health care. the pending business before the senate right now actually is the

omnibus appropriations bill which the senate moved to yesterday after having started the debate on the health care legislation. my motion is the pending business on the health care legislation, and so it is the -- that motion that i'd like to talk about. but before i do so, i could just like to again raise objection and concern to the fact that we have moved off the health care legislation debate to the omnibus appropriations bill, both because i believe we should stay on the health care issue and work it through, but also because we move to an omnibus appropriations bill that we have not had an opportunity to review carefully and that raises the spending, i believe the average is for these seven appropriations bills that have been compiled together, raises spending by an average of about 12%. once again, congress is in a spending feefall, and whether it be the stimulus package or the appropriations for our ordinary operations of government or whether it be the bailouts or

the tremendous other aspects of spending pressures and proposals, including the health care legislation that we have, there is -- there seems to be no restraint here in washington with regard to spending the taxpayers' dollars. but let's talk for a minute about the motion that was before the senate before we moved off the health care legislation. it was a motion that i raised to object to the tax increases on the middle class in america that were contained -- that are contained in the bill. the motion that i had was very simple. it focused on the president's pledge, and the president pledged that no family making less than $250,000 will see their taxes increase. not your income taxes, not your payroll taxes, not your capital gains taxes, not any of your taxes. the president pledged you will not see any of your taxes

increase one single dime. so the motion i brought is very simple. it is simply to commit the bill to the finance committee, to have the finance committee go through the 2,074-page bill and remove from the bill the taxes that are in it that apply to the middle class in the united states, as defined by the president here, that being those who are as a couple making less than $250,000 a year or as an individual $200,000 a year. and now, what we have seen is not only has there been delay on reaching that amendment but a counterpart proposal to the amendment has been brought up by the chairman of the finance committee, senator baucus. his counteramendment says can be , "it is the sense of the senate that the senate should reject any procedural maneuver that would raise taxes on middle-class families, such as a motion to commit the pending legislation to the committee on finance, which is designed to kill legislation that provides tax cuts for american workers and families, including the affordability tax credit and the small business tax credit.

tion tion -- tax credit." what a number of us are here to talk about today is the fact that this sense of the senate, designed to provide cover for those who don't want to vote to protect american taxpayers, is really a meaningless sense of the senate. let's begin with the very -- we're going to go through it phrase by phrase. and i'd like to ask my colleague from the state of wyoming if he would like to step in on the first phrase here and comment. the first phrase says what the amendment is. it is the sense of the senate. would my friend from wyoming like to comment on what that means? mr. barrasso: well, i would be happy to, and -- okay, so we agree. sense of the senate. it is meaningless in terms of actually having the force of law. and you talked about the issues of the spending and the taxes. so we come up with a sense of the senate. this is why people all across the country are trying -- we're

asking them to read the bill because the sense of the senate essentially means nothing. we kind of agree on this, but there is no law applied. mr. crapo: it's very critical to point out, a sense of the senate has no binding impact. it's just sort of what we think. let's go to the next phrase in the amendment. that the senate should reject any procedural maneuver that. in other words, the senate should reject a procedural maneuver. first of all, if the senate is going to reject a procedural maneuver, that refers to what's happening here on the floor, procedural efforts. it doesn't refer to any substantive measure in the bill. the amendment that we had pending, and which this is going to be a counterpart to, specifically refers to the substance of the bill and says the substance of the bill should be changed to take out the taxes, the hundreds of billions of dollars of taxes. and i wonder before we go to the next phrase, does my colleague

from wyoming care to comment? mr. barrasso: i do care to comment. i care to comment that the important thing is to get the taxes out of the bill. not what a sense of the senate is, not some procedural maneuver. it's the specifics of removing the taxes from the bill because when the president of the united states says for -- my plan won't raise your taxes one penny, which was his quote, we need to be able to make sure that the president is telling us the truth and we need to remove these taxes from the bill. now, the -- the joint committee on taxation looked at this bill, specifically looked at this bill, and it said that 38% of the people earning less than than $200,000 a year will see a tax increase, a tax increase under the reid bill. so we want to make sure that the president's words go with what's in the bill, so we need to actually remove the taxes. not just have a sense of the senate. and then the -- when we look at the chief of staff of the joint committee on taxation, he was

asked a question at the -- at the finance committee, and he says, when it all shakes out, we expect people paying taxes will be having incomes less than what the president said. so i want to get to the point of the crapo amendment, the amendment that says actually get these taxes and get them out of the bill, and this is a bill that's going to raise taxes by by $500 billion, and those are taxes that are going to impact on all americans. and at the time when we have 10% unemployment, when the senate is being asked to increase the debt level by another almost $2 trillion, the last thing we need to be spending our time on is a sense of the senate. we need to actually get those taxes that are going to affect the people, the hard-working people of america, and get those taxes and get them out of the bill. so as we're looking at that -- at this baucus amendment, it's

very nice but it reminds me of the bennet amendment that we had here last week. i think everybody voted for it, and "the new york times" in their editorial said it was a meaningless amendment. i want an amendment with some teeth in it that i can vote for, and i'm ready to vote right now. mr. crapo: my colleague from wyoming. there was a little pause there while we were comparing some of our notes here, but the next phrase in the motion -- or in the amendment says that -- it's referring to a procedural motion that would raise taxes on middle-class families. there is nobody bringing a motion here to raise taxes. the amendment says that it's referring the bill to the finance committee to take out the taxes on those who earn less than $200,000 or $250,000. i note that my colleague from kansas has arrived. did you care to jump in at this point? mr. roberts: i will tread with great care, i will say to my distinguished friend. and thank you for this colloquy.

but you ask what it means that the senate should reject any procedural maneuver that, that's in quotes, and what does that really mean? well, it applies only to the senate procedural motions. by itself, it would have no effect on any subsidy provision. that is, the way that it is commonly understood under senate rules. it means if adopted that the amendment would not remove any provision that has been identified as a tax increase on middle-class taxpayers which is precisely what the senator is trying to do. and so basically it means nothing. mr. crapo: that's exactly the point that we were trying to point out here. and the next phrase in the amendment says "such as a motion to commit the pending legislation to the finance committee." remember, that's referring to the previous phrase that refers to a motion to increase taxes. the only thing that we need to

say about this phrase is there is a motion to commit the bill to the finance committee, but there is not a motion to commit the bill to the finance committee to raise taxes. it's to cut taxes. and the next phrase in the -- in the whole -- in the amendment is to suggest that there is an effort to try to kill the legislation. now, this is my motion. i suppose the implication there is that by trying to take the taxes out of the bill, we're trying to kill the legislation. what does that mean? that means that if you take the taxes out of this bill, that the bill does not stand. i assume that's what the amendment is trying to say. the reason that it doesn't stand is because they are saying that the bill does not increase the deficit. well, the only way you can say that the bill doesn't increase the deficit is if you don't take into consideration -- or if you do bring into consideration the nearly $500 billion of cuts in

medicare, the nearly nearly $500 billion of taxes which are being put on the people of this country, and the additional budget gimmicks that don't start counting the spending for four years, plus a number of other budget gimmicks. what they're saying is if you don't take out one of the key legs of our bill, which is the way we raise all of the money for this massive new spending, then that will kill the bill. i think that's a pretty interesting fact that they have actually admitted in their own amendment. what kind of games are being played here. mr. roberts: would the senator yield for a question? mr. crapo: yes. mr. roberts: that phrase which you just mentioned which is designed to kill the legislation -- and my question has already been answered by the distinguished senator what does it mean, but there are no motions that have been considered or pending, including the pending motion to commit by the distinguished senator. is the motion designed to kill this legislation? because that's what you're going to hear on the other side, and

that's just not the case. mr. barrasso: what the senator is doing in the crapo amendment is actually trying to help the american people by taking this burden of $500 billion of taxes off of their backs, off of their shoulders, helping the american people. that's what i see he's trying to accomplish. at a time when with a gimmick they're going to start taxing immediately and the taxes go into play. today's the 11th of december. in 20 days they're going to start collecting taxes for services that they're not going to give for four more years. so it just seems that if anything that's going on here with the crapo amendment, it's saving the american people, keeping the dollars in their pockets, keeping dollars in the hard -- in the pockets of the hard-working people in our country. and, you know, and i'm not the only one saying that. there's a new cnn poll out today that specifically asks the question, because the president has made a statement about the fact that, you know, you wouldn't see your taxes go up.

"do you think your taxes would or would not increase if thi this" -- harry reid's bill is passed? and 85% of the american people in a cnn poll out today said they believe their taxes are going to go up. 85% of the american people. the presiding officer: and i would say to my colleague from wyoming that they are right. if this bill is not committed back to the finance committee to take those taxes out. the next phrase in the amendment is that -- this is referring to a procedural motion, recall -- "that provides tax cuts for american workers and families." in other words, they don't want to send it back to committee to have a procedural motion put into place that would stop them from providing tax cuts for the american families. again, it's just rhetoric. read the motion. the motion does not say to take out any benefits in the bill for anybody in america unless you consider taxing people to be a benefit to them.

but it simply says that the taxes in the bill that are imposed on people that the president identified to be in the middle class, who would be protected, must be removed from the bill. mr. roberts: would the distinguished senator yield for a question? mr. crapo: yes. mr. roberts: i don't think as republicans there's probably no principle that unifies us more than keeping taxes low on american workers and families, and i don't think our friends on the other side would dispute that notion. indeed, the democratic party assumed control of the white house almost a year ago, as everybody knows, seated large majorities here in the congress. the one unmistakable difference between the parties is this: our party has respectfully opposed -- i underline the word "respectfully" -- opposed numerous efforts by the majority party to impose broad-based tax increases on american workers and families. so one only need to look at the stimulus debate or the budget

debate or the cap-and-trade legislation, and i can go on and on and on, more especially with the health care debate, and the bill before us, indeed, don't you really follow from that general principle? mr. crapo: absolutely. and, again, i believe that what's going on here with this new amendment is simply an effort to sort of divert attention from the real issue that is before the american people and the motion that was before the congress -- before the senate before we were forced by a procedural vote yesterday to move off the bill and that is the question of the taxes in the bill. the final phrase just refers to a couple of the provisions in the bill that do have some support for improving the tax circumstances for small businesses and the affordability tax credit, meaning the tax credit that will be utilized to implement the subsidies for insurance. and, again, you know, we can say

it any number o number of timese fact is the notion that they are trying to avoid does not deal with either of these provisions of the bill. it deals with those provisions in the bill that tax the american people. mr. barrasso: i guess my question would be, i'm fine voting on these things but it doesn't mean anything, i think it's absolutely meaningless, the baucus amendment. the heart of the matter is the crapo amendment. that's the one i think makes the difference for the american people. if i were a citizen sitting at home on a friday afternoon watching c-span saying what's going on in the senate, what's going on, what's going to help me? i'd say i want to call my senator and say vote for the crapo amendment because that's the one that's actually going to help me keep money to my pocket. sense of the senate? oh, that's nice but it's meaningless. and i think we need to get back and i'm ready to vote right now for the crapo amendment because that's the one that i think is going to help possibly save my job if i'm at home and working and have a job and want to keep my job and say i'm worried about

unemployment in the country, i'm worried about the taxes and the impact that's going to be. because i'm worried if we don't get these taxes out of here, it's going to be a job killer for our nation and for our -- for families all cross this country. in i'd -- all across this country. in idaho, in wyoming, in kansas, in kentucky. i think we have great concerns for the economy, and at 10% unemployment, we need to get those taxes out of there now. mr. crapo: the senator's exactly right. if you go back and just try and get a little perspective on the entire debate, most americans would agree that we need health care reform. but when they say that, they're talking about the need to control the skyrocketing costs of their health insurance and for the costs of medical care, and they're talking about making sure we have real -- real, meaningful access to quality health care in america. and inis statements, the president has many, many times commented about different parts of that. you remember when he said, if you like what you have, you can keep it? well, we've seen that that's not true and there will be and have

been already amendments to try to address those questions. remember when he said, it's not going to drive down -- drive up but drive down the cost of health care and drive down your health care premiums? well, we've learned now that it doesn't do that either. it actually drives up the cost of health care insurance. and it's going to drive up the cost of medical care in this country. remember when he said, you will not see your taxes go up? in fact, he pledged that if you were a member of the middle class, who he defined as those make less than $250,000 a year as a couple or $200,000 as an individual, that you would not see your taxes go up? well, this motion is focused on that part of the debate. and what did we see happen? instead of letting us fix the bill, send the bill back to the finance committee to make the bill comply with the president's pledge, we saw two procedural maneuvers. one, to maneuver off the bill, to get off the bill and move to the omnibus appropriations bill, and then secondly, to put up a

bait-and-switch amendment that makes it look like there is some kind of protection being put in place when in reality it's nothing more than a sense of a senate relating to procedural motions that don't exist. and so i agree my colleague from wyoming and with my colleague from kansas, and i see that we have several of our other colleagues joining us here now that we need to keep the focus on health care and we need to keep the focus on those core parts of the bill that are critical to the american people. and i'll just -- before i ask my colleague from kansas if he would like to make any other comments on this, i will just reiterate the point that my colleague from wyoming made with regard to the american people's understanding of this issue. in that cnn poll that i believe showed over 60% -- i think it was 61% of the people in this country who do not want this bill to move forward because they are now understanding what it does, that same poll, 85% of

the people in this country believe that this pledge of the president is broken by this bi bill. mr. alexander: i would ask the senator from idaho and the senator from kansas, both of the senators were on the finance committee, i believe, and have been working on this health care bill for a long, long time. and it's typical of a big, complex bill like this, difficult to pass and you get a sense every now and then of whether it's likely to pass or unlikely to pass. and this week has been a particularly week for the bill. -- particularly difficult week for the bill. i've noticed the majority leader trying to create a sense of inevitability about the bill. but increasingly, it seems to me, with it becoming clear that with so much of it being paid for by new taxes, then last night the chief actuary of the government saying the cost is going up, premiums are going up, with the mayo clinic saying that it's beginning to -- to -- to not take medicare patients

and -- and that the idea of putting millions more americans into a program already going broke, which you're taking a trillion dollars out of -- which is a bad idea -- i wonder if in all this talk of history being made and the inevitability of this bill that the senator from idaho might not think, looking back over this whole debate, that -- that maybe -- you know, there are a lot of different ways to make history. that maybe a growing number of senators might be thinking -- not saying yet -- might be thinking that this bill would be a historic mistake and that all the king's horses and all the king's men are not going to be able to push this up over the -- over the top? mr. crapo: the senator from tennessee is right and he's put his finger on one of the key issues that's going on here in the senate that sometimes isn't highlighted as closely as i think maybe it should be. and that is while we're talking

about the need to make sure that this bill does not raise taxes on the middle class, to make sure that the bill does not increase the cost of health insurance premiums and to make sure that we maintain quality of health care and don't cut medicaid and medicare, the real battle here is an effort to create a legacy to essentially put the government into control of the health care economy. that's the debate. that's the legacy. that's the history that those who are push the bill are seeking to make. and they are seeking to make it at the expense of those on medicare, of those of the taxpayers in america and of the costs -- the cost curve that they say they want to drive down dealing with the cost of our health care. i see that our leader -- mr. mcconnell: i would just say to my friend from tennessee and idaho, december the 11th, 2009, may be remembered as the seminole moment in the health care debate. for those who are writing about what finally happened on this issue.

there were two extraordinary messages delivered on this very day on this health care issue. they were delivered from c.m.s. and from cnn. cnn told us how the american people felt about it. 61%, as the senator from idaho pointed out, telling us, please don't pass this bill. a week ago, quinnipiac said 14% more approved -- disapproved than approved. a week before that, gallup said 9% more disapprove than approve. we can see what's happening here -- widening public opposition. and then c.m.s. the actuary, the independent government employee who is an expert on this, that says this bill, the reid bill, doesn't do any of the things it's being promoted to accomplish.

so two important messages on december the 11th delivered from cnn and from c.m.s. mr. roberts: would the senator yield? mr. mcconnell: yes. mr. roberts: i'd like to thank our distinguished leader for pointing that out. it has been a seminole event. as i said before, i have the privilege of being the chairman of the world health care caucus. there's probably 30 -- rural health care caucus. there's probably 30 of us in a bipartisan caucus to try to protect and improve the rural health care delivery system. and i took that report by mr. foster, who is the actuary at c.m.s., and said this is required reading. i made the point that c.m.s., if you mention c.m.s. to a beleaguered hospital administrator or a member of the board or any provider, doctor, hospital, nursing home, home health care, hospice -- even hospice is cut -- in regards to the cuts, and if they know a

c.m.s. representative is knocking on the door, that's a lot like sending a cold shiver down their spine and thinking it was lizzie boreden. and of all the agencies that now are shining the light of truth into darkness in regards to the nature of this bill of increased costs and, yes, rationing. no, it's not a scare tactic. c.m.s. is that agency. now, it would be really amazing if we could get the c.m.s. to report back on -- if we knew what it was -- the media repor reports -- this is about how we get the informatio information s new iteration of a bill where allegedly we are going to add in people from 55 years old into the medicare system. you do that and now all of a sudden even the national organizations, let alone the stated -- the state provider associations who have been opposed to this, have said,

whoa, wait a minute, we can't -- we can't do that, that's going to break the system. what i would like to point out and i think is another piece of information that has sort of been overlooked, the c.b.o. has estimated the costs to the internal revenue service to implement taxes and penalties and enforce them -- i'm talking about the i.r.s. now, not c.m.s., not h.h.s. -- i.r.s. are the people that are going to implement and administer and enforce taxes and penalties in the bill. that's $10 billion of it that has been estimated. that's -- that would double the budget size of the i.r.s. and you've got to train these people, and then you've got to figure out what kind of questions they're going to ask of employers and employees in regards to the fines and the fees. you've got to read the fine print. lord knows how many cars they're going to get. maybe they can get some cash for

clunkers and get some cars and paint them black and go around town and do their thing. that's not going to be a happy circumstance. those two things that the leader has brought out are absolutely primary in this debate. i think this side-by-side is a strong end. i think it's very clear about that. i'd be happy to comment on that further, but i want to give anybody else an opportunity -- mr. alexander: if i can make a short comment, i want to thank the senator from idaho for his leadership on taxes. on senator mcconnell's, the leader's comment about those two events on the 9th, polls from the cnn and the report from the chief actuary, made meaning about the immigration bill -- made me think about the immigration bill two years ago, 2007. a lot of our best senators were working here to pass a comprehensive immigration bill. senator mccain, senator kennedy, senator kyl, senator

martinez on both sides of the aisle worked very hard do it. and there seemed to be a sense of inevitability that that bill might pass. the president was even behind it. tpwu began to have so many -- but it began to have so many problems. red flags began to pop up with it just like they are popping wup this comprehensive health care bill, that there came a time much like december 9 when a sense of inevitability was replaced by a sense that we were making an historic mistake and a bill that got on the vote with 64 votes only had 46 to get off. i have a feeling this bill, the more we learn about it, the wiser thing to do is to let it fall of its own weight and then to start over step by step to re-earn the trust of the american people by reducing health care costs. we can do that. and that's the sense that i have, and i appreciate the republican leader's observation about those two important events

on the 9th. mr. crapo: thank you very much with my colleagues here. i think the comments by our leader are very insightful as you start to see the evidence mount and the fact that the public is very understanding about the weight of this mounting evidence, we could be at the tipping point where it's become so evident that the purpose behind health care reform has not only been missed by this legislation, but it has been made worse, the objectives. i would just quickly point to this chart. if you talk to most americans about what they believe the purpose behind health care reform is, the vast majorities of them say it is to control the skyrocketing costs. well, those who are promoting this bill say that it does that, and they say it bends that cost curve we hear so much b. which cost curve can they be talking about? the size of government? it goes up by $2.5 trillion in

the first ten years of implementation of this bill. the cost of health care? the c.m.s. report that came out today is about the tenth report that's come out now, but this is from the actuary of the medicaid system and the medicare system who has analyzed it independently and says no, health care costs are going to go up not down. c.b.o. said the cost of insurance is going to go up, not down. the federal deficit, they claim the bill doesn't make the federal deficit go up. in fact, with regard to that, the only way they can claim that is if they implement their budget gimmicks of delaying the implementation of the bill for four years on the spending side as they raise taxes or if they raise hundreds of billions of taxes and cut medicare by hundreds of billions of dollars. these things are starting to be understood by the american people, and that's why, mr. leader that i believe you're starting to see those kinds of answers consistently in the polls. to's not just the cnn poll, as you know very well. it's poll after poll after poll

know which is showing that the american people get it. mr. roberts: would the distinguished senator yield for another observation and question? i'd like to get back to the side-by-side amendment that allegedly being offered by the distinguished senator from montana, the chairman of the finance committee. i said straw man, and that's pretty harsh, but i intend it to be. we've seen how if the language is examined the amendment at a minimum is a red herring. you can say the amendment has no other purpose than to facilitate a straw mankind of argument -- straw man kind of argument. on tuesday -- actually you laid down your amendment on tuesday, and the majority didn't show us this side-by-side amendment until shortly before we thought and they thought we were going to vote. so that very limited notice makes you think it might be more likely to distract from or muddy the clear question that the senator from idaho brought, and

that's the motion to commit, you know, before the senate. so the motion was designed to be straightforward. did you that. a vote for the motion is a vote to send the reid amendment and underlying bill back to the finance committee under the motion the finance committee would report back a bill that eliminates -- eliminates -- the the tax increases on middle-income taxpayers. couldn't say it any more simple. that's what the bill does. and the other bill is a straw man. and i would say that after the remarks by the distinguished leader, that this may be a seminal event -- he mentioned cnn and c.m.s., that's almost anocracy moron -- an oxymoron in regards to understanding. this is almost like pearl harbor, a day of infamy. for a bill we should be

considering, i think one of the key votes where the other start to -- other side could start to traoelz this without -- to realize this, without all the ideological, support for this bill that they could start the road back of doing it in a step-by-step way. doing it meaning real health care reform. i commend the senator. this side-by-side is a straw man. you are very clear in what you want to do. that is again under your motion, the finance committee would report back the bill that it eliminates the tax increases on middle-income taxpayers. you do that. you restart the debate in a bipartisan way where we could agree on many common goals. and i thank the senator. mr. crapo: i thank my colleague from kansas. mr. president, may i ask how much time remains? the presiding officer: the 30 minutes have been consumed. mr. crapo: thank you very much, mr. president. the presiding officer: who seeks recognition?

under the previous order, the republican leader is to be recognized. the republican leader. mr. mcconnell: mr. president, just following along further with the, my colleagues who were discussing the c.m.s. report, americans, of course, were told that the purpose of reform was to lower costs, to bend the so-called cost curve down, but the report released last night by the administration's own independent scorekeeper, as we've been discussing here on the floor of the senate, shows that the reid bill gets a failing grade. the chief actuary is the person the administration depends on to give it straightforward,

unbiased analysis of the impact the legislation would have. this is an independent expert. this is the official referee, if you will. so this is quite significant. according to c.m.s., the reid bill increases national health spending. according to c.m.s., there are new fees for drugs, devices, and insurance plans in the reid bill, and they will increase prices and health insurance premiums for consumers. according to c.m.s., claims about the reid bill extending the solvency of medicare are based on the shakiest of assumptions. according to c.m.s., the reid bill creates a new longterm insurance program commonly

referred to around here as the class act. the c.m.s. actuaries found faces a -- quote -- "very serious risk of becoming unsustainable." and c.m.s. found that such programs face a significant risk of failure. the reid bill pays for a $1 trillion government expansion into health care with nearly $1 trillion in medicare payment cuts. all of this, i continue to be quoting from the c.m.s. report. the report further says the reid bill is especially likely to result in providers being unwilling to treat medicare and medicaid patients, meaning that a significant portion of the increased demand for medicaid services would be difficult to meet. the c.m.s. actuary noted that the medicare cuts in the bill could jeopardize medicare beneficiaries access to care. the c.m.s. actuary also found

that roughly 20% of all part-a providers -- that is hospitals and nursing homes, for example -- would become unprofitable within the next ten years as a result of these cuts. as a result of those medicare cuts, 20% of hospitals and nursing homes would become unprofitable within ten years. the c.m.s. actuary found that further reductions in medicare growth rates through the actions of the independent medicare advisory board which advocates have pointed to as a central linchpin in reducing health care spending -- quote -- "may be difficult to achieve in practice." end quote. c.m.s. further found that the reid bill would cut payments to medicare advantage plans by approximately $110 billion over ten years, resulting in -- quote -- "less generous benefit

packages" and decreasing enrollment in medicare advantage plans by about 33%. 33% decrease in medicare advantage enrollment over ten years. so what should we conclude from this c.m.s. report, mr. president? the reports confirm what we've known all along. the reid plan will increase costs, raise premiums and slash medicare. that is not reform. the analysis speaks for itself. and so this day, this friday, is a, as we were discussing earlier, a seminal moment. we've heard from both c.m.s., the government's objective actuary, that the bill fails to meet any of the objectives that we all had in mind.

and we heard from cnn about how the american people feel about this package. 61% oppose. only 36% support. so both the american people are asking us not to pass it and the center for medicaid services actuary is telling us it doesn't achieve the goals that were desired at the outset. how much more do we need to hear, mr. president? how much more do we need to hear before we stop this bill and start over and go step by step to deal with the cost issue that the american people thought we were going to address in this debate? mr. president, i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

mr. casey: mr. president? the presiding officer: the senator from pennsylvania. mr. casey: thank you, mr. president. skilled that the quorum call be vitiated. the presiding officer: without objection. mr. casey: thank you. mr. president, we're in our discussion of health care, we've been focused 0en on a couple of major goals. the obvious goals i think are a major part of the legislation we're debating on controlling cost, the goal of providing better quality of care, providing care -- health care to millions of americans, tens of millions, really, that have no -- would have no chance to get that kind of coverage without

this legislation, and also the concern that we have about not only controlling costs but, in this case, we have legislation on the floor that actually reduces the deficit by $130 billion and over beyond the ten years by hundreds of millions in addition, in terms of deficit reduction. and one of the concerns that we have is that in the midst of a health care debate about numbers and the details of the programs, that we also don't forget that some parts of our health care system work well but also we might need a change that would benefit a vulnerable population or americans that don't have the kind of consequently or protection or peace of mind that they should have. one of the more successful parts of our health care system as it relates to new parents, especially new mothers and their

children, are what's known by the kind of broad category of nurse home visitation programs. they've been enormously successful over many, many years. and i have an amendment that i filed for this health care bill called "the nurse home visitation medicaid option amendment." well, it sounds a little complicated, but it's actually rather simple. but i think part of what we need to do in the next couple of days and weeks as we complete our work on health care. one point to make initially is that we know that these nurse home visitation programs work. they get results for new parents, new mothers, and have positive benefits to a new mother and their children -- i should say, "and her children." we all have had the experience for parents of the anxieties of

what it's like to be a new parent. but especially what a new mother goes through, all of the anxiety, and it is not limited to one income group. no matter what income you are, no matter what background, it is a challenge to fully understand what it's like to have a baby and to be able to care for that child appropriately. and that's one of the underlying concerns that we have. in our health care system we've got to do everything possible to give that child a healthy start in life, and the best way to give a child a healthy start is to make sure that his or her mother and hopefully both parents are able to hand the pressures -- to handle the pressures and manage the anxieties that so many new parents have. the amendment that i have -- that i filed supports optional nurse home visits. that means that if someone chooses not to take advantage of this program, obviously they

don't have to. the amendment simplifies the process for providers of nurse home visitation to seek medicaid reimbursement. and some will say, well, there is medicaid reimbursement now. yes, there is. but it gets complicated to the point where a lot of states are not getting the full benefit of that reimbursement. this amendment will impact the lives of medicaid-eligible pregnant women and their children, and the impact is profound. the amendment itself is cosponsored by senator gillibrand of new york, and will allow states the option to seek more adequate reimbursement for nurse home visitation services. so again, a state isn't forced to do -- to seek greater reimbursement, but i believe a lot of states could and should take advantage of this kind of an option. for pennsylvania, we've been trying to do this for years, even in the midst of having very effective nurse home visitation

programs. you can just imagine how valuable that is for a new mother, that they can -- they can get advice and help from a nurse or another kind of professional and get them through the early days and weeks especially of being a new parent. i believe a state like pennsylvania that has had a track record for these kinds of programs that have a direct and positive impact on children and their families, the mothers especially, that pennsylvania should be able to take advantage, as i'm sure many other states. the amendment cuts through red tape and allows these evidence-based nurse home visitation services. let me say those first two words again -- "evidence-based." this isn't some theory, some maybe, some let's try to create a program. these programs work. the evidence is, in a word,

"irrefutable" over many, many years that these nurse home visitation programs work and we want to allow states to be reimbursed under a state medicaid option. we have about 30 years of research to back up the following claims. just a dumb of -- four or five -- just a couple of -- four or five points here. this is a series of findings that relate to -- if you start with the category of for every 100,000 families who are served by nurse home visitation programs or nurse family partnership programs, all in that same category. for every 100,000 families, 14,000 fewer children will be hospitalized for injuries. 300 fewer infants will die in their first year of life. that alone -- that number alone is worth making sure that states have this option. what's the price of saving 300

infants a year out of 100,000 families? it is incalculable. there is no value that you can put hon that kind of lifesaving -- that you can put on that kind of lifesaving, as well as saving money. for every 100,000 families served by these nurse home visitation-type programs, 11,000 fewer children will develop language delays by age two. that is a profound -- that has a profound impact on the child, on his or her ability to achieve in school, and then his or her ability to develop a high skill and, therefore, contribute positively to our economy. there's no price you can put on 11,000 children learning more at a younger age. out of every 100,000 families, 23,000 fewer children will suffer child abuse and neglect in the first 15 years of life. again, no way you could quantify that with a number or a budget

estimate. but i'd like to be ail to say we support strategy -- but i'd like to be able to say that we support strategies that are evidence-based and scientific-based to make sure that children are not abused that they live through the first couple years of their life when they're at risk of dying, and then one more statistic. out of the 100,000 families we used as a measurement, 22,000 fewer children will be arrested and enter the criminal justice system for the first 15 years of their life. so just like the statistic about the first year of life and surviving the first year of life or not having -- not having in this case 23,000 more children suffer child abuse and neglect, these are impossible to measure, they are, in a sense, through the measure -- it is the measure itself, that we save children's lives, we make them healthier, they and their families are able

to contribute more to society. but this is the right thing to do, to give our states the option, just the option, of seeking greater reimbursement for these important services. and i've seen it firsthand. many years ago -- it must be at least 10 years ago in pennsylvania, i actually went to the home of a brand-new mother, lower-income mother, in north per-- innortheastern pennsylvan, without objectiowalked in the de nurse that was working with her. there was no way to put into words how valuable that relationship was between a new mother and a nurse, between a new mother and a health care professional, to give her the start, in any circumstance, but especially o if a new mother has financial pressures which are extraordinary and almost unbearable for some new mothers or has pressures as it relates

to her husband or boyfriend, who ever is part of her life. sometimes there is violence. sometimes there's other pressure that some of us can't even begin -- can't even begin to imagine. and there are other pressures as well, in addition to the obvious pressure of being a new mother and being a new parent and wanting to do the right thing. these programs work to give new mothers peace of mind and to give states the ability to directly and positively impact the life of that new mother and his or her child. so we should give the states this option, and that's why i'd urge my colleagues to support the nurse home state medicaid option amendment. mr. president, i would yield the floor and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. kyl: mr. president? the presiding officer: the senator from arizona. mr. kyl: i ask unanimous consent that further proceedings on the quorum call be dispensed with. the presiding officer: without objection. mr. kyl: i also ask unanimous consent that following my remarks, that senator brown from ohio and then senator lemieux from florida be recognized in that order. the presiding officer: without objection. so ordered. mr. kyl: thank you, mr. president. each day, it seems that there's a new analysis of the democratic proposal on health care that suggests that it's not such a great idea, and today a devastating report was made public by the obama administration itself, the department of health and human services group that is in charge of medicare and medicaid. it goes by the initials c.m.s. issued a report, specifically

the chief actuary, richard s. foster of the centers for medicare and medicaid services issued a report about the effect of the reid legislation on health care as it pertains to a whole variety of things. the cost of the legislation, the effect it's going to have on taxes, on premiums of beneficiaries, the costs with respect to medicare and the kind of things that will occur to beneficiaries in medicare and so on. it's -- it's a complete report by a person who i think all would agree is not only qualified to speak to these things but also quite objective, as the chief actuary of c.m.s. he reached a number of very interesting conclusions, and i just want to briefly discuss eight of them. the first thing is that he noted that his estimates were actually not a full ten-year estimate, and now i'll quote what he said

here -- "because of these transition effects and the fact that most of the coverage provisions would be in effect for only six of the ten years of the budget period, the cost estimates shown in this memorandum do not represent a full ten-year cost for the proposed legislation, end of quote. the reason that's important is we have been saying here for quite a long time that you can't just look at the first ten years in order to see the full impact of this legislation, because the first four years, most of the benefits don't exist. they are simply collecting taxes and fees and revenues, and then is when the benefits kick in, as a result of which when they say it's all in balance, it's in balance because they are paying for ten years, collecting money for ten years, but they only have to pay for benefits for six of those ten years. so the real question is what does it cost over the first full ten years of implementation, and it turns out that's about about $2.5 trillion. so it's -- i mean, we've known

this and we have made the point, and i think even the chairman of the -- of the finance committee here acknowledged the the $2.5 trillion figure if you take the first ten years of implementation, but i think it's good to actually have that confirmed now by the chief actuary of c.m.s. secondly, a point i have been making all along is that when the president said repeatedly if you like your insurance, you get to keep it, that isn't true, and it's not true for a variety of reasons under the bill. and again, this report confirms that what we have been saying is, in fact, true, namely that a number of workers who currently have employer-sponsored insurance would lose their coverage. and in addition to that, seniors who are enrolled in private medicare plans, which are known as the medicare advantage plans, would lose benefits, and many of them would no longer be covered. let me just read two quotations. first relative to employer-sponsored insurance, and second, people who are on medicare advantage plans. i'm quoting now -- "some smaller

employers would be inclined to terminate their existing coverage, and companies with low average salaries might find it to their and their employees' advantage to end their plans. the per-worker penalties assessed on nonparticipating employers are very low, compared to prevailing health insurance costs. as a result, the penalties would not be a significant deterrent to dropping or foregoing coverage." what does that mean? the insurer -- the employer under this bill has an obligation to provide insurance to his or her employees. if you don't do that, then you pay a penalty. the problem is that the penalty is much less than the cost of buying the insurance. so what we have been saying all along and what the c.m.s. actuary confirms here is that in a lot of cases, especially

smaller -- small employers and particularly companies with low average salaries will find it to their advantage to drop the insurance coverage and have their folks go into the so-called exchange programs. the penalty that these employers pay will be much less than what they are paying now to provide insurance, so these folks who are very happy with their insurance that they have right now are not going to be very happy when they get something substantially less than that through the so-called exchange. they may like the coverage they have now, but unfortunately what the president promised that they get to keep it is not true, and this is confirmed by what i just read to you. now, what about folks on medicare advantage? these are senior citizens above 65 for on medicare, and what they have chosen to participate in is the private insurance coverage component of medicare called medicare advantage. here's the quotation -- "lower benchmarks would reduce medicare

advantage rebates to plans and thereby result in less generous benefit packages. we estimate that in 2015 when the competitive benchmarks would be fully phased in, enrollment in medicare advantage plans would decrease by about 33%. -- 33%." everybody has acknowledged there would be a little reduction, but there has been debate about how much it would be. our initial objections are borne out by the c.m.s. actuary. decrease in enrollment in medicare advantage by about 33%. that's a third. now, this is important to me because 337,000 arizonans participate in medicare advantage, almost 40% of all of our seniors, and a third of them , if this works across the board, are going to lose their plan because of this. and in any event, they're all going to lose benefits because of the -- quote -- result in

less generous benefit packages. now, this hasn't been much in dispute because the congressional budget office itself has described precisely how much the benefit packages will be reduced by, and it's -- it's 90-some dollars. it's from $130 actuarial value down to $40-something actuarial value which is a huge reduction. so a reduction in benefits, a third of the people no longer on medicare advantage. bottom line, whether you're in the private insurance market -- excuse me. whether you're privately insured through your employer or you're a senior citizen in medicare advantage, you're not going to be able to keep the benefits and the plan that you like and have, notwithstanding the president's commitment to the contrary. third, medicare cuts. we have been talking a lot about medicare cuts, and my colleagues on the other side say well,

we -- we really don't think that the medicare cuts the -- cuts are the way you describe them. seniors are still going to have access to doctors and so on. this report is devastating and blowing a hole in that argument. let me just quote a couple of the things that they say. providers for whom medicare constitutes a substantive portion of their business can find it difficult to remain profitable, and absent legislative intervention might end their participation in the program, possibly jeopardizing access to care for beneficiaries. now, this is what we have been predicting. if you -- if you impose extra costs and mandates on the people who are providing the care, whether it be the hospitals, the physicians, home health care, if you're taxing something like medical devices, all of those impose costs on the people who are providing these medical benefits. and what the c.m.s. actuary is saying here is that the combination of those things

would potentially jeopardize access to care for the beneficiaries. there aren't going to be as many of these people in business to provide care for an increasing number of people. let me go on with the quotation that i think will make this clear. "simulations by the office of the actuary suggest that roughly 20% of part-a providers -- that's hospitals, nursing homes, and home health care -- would become, would become unprofitable within the ten-year projection period as a result of the productivity adjustments. "in other words, 20% of the hospitals, home health care folks and others are not going to be profitable anymore, they are going to be out of business because of the burdens that are placed u tlegislation. now, what happens when you have the baby boomers going into the medicare program? under the latest idea from the other side of the aisle, we're even going to have another 30 million people potentially

being able to join medicare, the folks from 55 up to 65, but you're going to reduce by 20% the number of folks to take care of them, the hospitals and home health care and so on. obviously, you've got a big problem. access will be jeopardized as the actuary says. and this is where rationing, in effect, comes in. there simply aren't enough doctors, hospitals, and others to care for the number of patients who want to see them. this is how it starts. first, long delays, long lines, long waiting periods before you can get your appointment, and eventually denial of care because there is simply nobody to take care of you. now, this is exacerbated by something else in the legislation which is the fourth point here. the actuary talks about the independent medicare advisory board. what's happening is that medicare is being cut in really three different ways. one, medicare advantage that i mentioned. two, the providers are being

slashed in the reimbursements that they're receiving. and three, this legislation creates an independent medicare advisory board that's supposed to make recommendations on how to effect huge reductions in the cost of medicare, and the primary way they will do that is by reducing the amount of money paid to doctors, to hospitals, to others who take care of patients. and that, obviously, will also result in less care for the senior citizens. if the cuts are so drastic that congress says no, we're not going to do them, then you don't have the savings that the bill relies upon to pay for the new entitlement. so one of two things happen, and they're both disastrous. either you have these huge cuts which are devastating on access to care or the cuts are so unrealistic, they don't go into effect, in which case the legislation can't be paid for, and then i guess you're going to have to raise taxes on the

american people because you weren't able to effect the savings from medicare. here is what the actuary says, and i quote -- "in general, limiting cost growth to a level below price inflation alone would represent an exceedingly difficult challenge." that's the challenge that's being put before them here." an exceedingly difficult challenge. actuary cost growth per beneficiary was below the target level in only four of the last 25 years, with three of those years immediately following the balanced budget act of 1997. the impact of the b.b.a. prompted congress to pass legislation in 1999 and 2000, moderating many of the b.b.a. provisions." what does that mean? in 1997, congress passed the balanced budget act which drasticcally reduced the payments to these providers in order to cut the cost of medicare. three out of the four years in which the costs were reduced or immediately following that legislation. but starting in 1999, and then

in the year 2000, congress realized those cuts are too deep, you're not going to get doctors and hospitals to continue to take care of patients if we continue to cut what they are paid for their services. so the cuts were ameliorated, and as a result, the savings were not achieved. and so what the actuary is saying here is that if that same thing happens again, if these cuts are so drastic that we actually won't let them go into effect because they would be self-defeating, then you're not going to have the savings that are promised and have been scored here as enabling this legislation to be so-called budget neutral. it won't be budget neutral. so as i said, one of two things happen. they're both bad. either you have the cuts which are devastating for seniors or you don't have them and they are devastating to taxpayers. five is the medicaid expansion. it is -- i think all of us agree on both sides of the aisle that medicaid is a very vexing

problem, because the states have to pay for a percentage of the medicare -- medicaid patients, and the states are generally in very poor financial shape, and they don't need more people added to the medicaid rolls that can't pay for them. my governor was in town earlier this week, and she said please, please don't add people to the medicaid rolls -- roles and expect the states are going to be able to pay for them. let me read a couple of the quotations from this actuarial report." providers might tend to accept more patients who have private insurance with relatively attractive payment rates and fewer medicare or medicaid patients, exacerbating existing access problem for the latter group." that's the medicaid group. the problem is the reimbursement is so low for medicaid, frankly, they are the last patients that a doctor sees, and their care is not the best. this is something if we're going to provide care for a group of people, we need to do it right, and unfortunately this is how

rationing begins. you don't have enough money to do it right. and then let me conclude this quotation -- "this possibly is especially likely in the case of the substantially higher volume of medicaid services where provider payment rates are well below average." my point." therefore, it is reasonable to expect that a significant portion of the increased demand for medicaid would be difficult to meet, particularly over the first few years." end of quote. what they're saying is there aren't going to be the physicians and the other people to care for the medicaid patients here, and as a result, a promise that we have made to these people, we're not going to be able to keep. so enrolling in medicaid does not guarantee access to care by a long shot. now, number six here, and, again, this is something we have been saying. this is not really too controversial because the congressional budget office has said the same thing that the actuary here says, but it's always good to have a backup opinion. and this is the tax on drugs, on

devices, and on insurance plans. we have all been saying that of course those costs are passed on to the consumer in the form of higher premiums, or in a couple of cases higher taxes, and that's what is demonstrated here, that consumers will face even higher costs as a result of the new taxes on the health care sector. i i might just say before i read the quotation here, it doesn't make any sense to me why in order to pay for this new entitlement, you would tax the very people that you want to take care of people. we're going to tax the doctors. we're going to tax the insurance companies. we're going to tax the device makers that make the diabetes pump or the stint for a pacemaker or some other device that improves or health these days. let's tax them. i'm saying why not tax liquor on tobacco. but why tax the things that make people healthier? go figure. that's what the bill does. here's what the actuary says -- quote -- "we anticipate that such fees would generally be passed through to the health

consumers in the form of higher drug and device prices and higher insurance premiums with an associated increase of approximately $11 billion per year in overall national health expenditures beginning in 2011." remember how we were going to drive costs down with this bill, we weren't going to be paying as much? what does the actuary say? we anticipate that such fees would generally be passed through to health consumers in the form of higher drug and device prices and higher insurance premiums. by $11 billion a year. this is going backward, not forward. the whole idea here was to reduce costs and premiums and instead they're going up. number seven, here's another t tax. we're going to tax the higher premium plans. in response to a -- and this is a 40% tax on these plans. what will employers do? according to the actuary, employers will reduce employees'

health care benefits. well, that makes sense. if you're going to tax an insurance flan has a lot of good -- plan that has a lot of good benefits in it, then the employer is going to say, rather than paying that tax, i'll reduce the benefits. precisely what c.m.s. says. another case in which, if you like what you have, sorry, you're not going to get to keep it, we're going to tax it, and then the employer's going to reduce the deficits. here's the quotation from c.m.s. quote -- "in reaction to the excise tax, many employers would reduce the scope of their health benefits." this is exactly what we've been saying. so, mr. president, here are seven specific ways in which the c.m.s. actuary, working for the obama administration, department of health and human services, has verified the complaints that republicans have been making about this legislation for wee weeks, that it will raise premiums, it will raise taxes, it will raise costs, it will

raise the cost of health care, it will raise the cost to the government, it will provide fewer benefits, it will result in the transition of people from private insurance to the public -- to the exchange which is created in here and will result in less access to care because there will be fewer providers to take care of more people. what a wonderful reform. this is why when i talk about this legislation, i don't talk of health care reform. and i'm reminded of a line from a novel in which the individual says, reform, sir? don't talk of reform. things are bad enough already. and, indeed, they are we do have problems. and one of those problems is premium costs going up. i note that my colleagues in the house of representatives on the republican side offered an amendment, which, according to to the ca calculations of the congressional budget office and according to the house republicans, would have actually reduced premiums for $3,000 a

year for the average family rather than increasing them. so republicans have good ideas about attacking the specific problems that we face today. but what we don't need is something under the guise of reform, whicreform which is so o intrusive into our lives and, with all due respect, not well thought out in terms of its long ranglong-range implications, tht you end up with, according to c.m.s., according to the actuary of the united states government department of health and human services c.m.s., raises premiums, raises taxes, reduces access to care, increases the cost, and provides fewer benefits. i cannot imagine how we could go home at christmastime and say to our constituents, what we're giving you for christmas this year. the presiding officer: under the previous order, senator from

ohio is recognized. mr. brown: thank you, mr. president. i rise to speak in opposition to a provision in the patient protection and affordable care act, a bill i strongly support but rise in opposition to a provision that would impose a 40% excise tax on certain health insurance plans. its my strong belief a benefits tax is the wrong way to pay for health reform legislation. beginning in 2013, this legislation would impose this excise tax on insurance companies and plan administrators for any health insurance plan that is above the threshold of $,500 for sing -- $8,500 for sing expel singles a0 for family plans. the tax would apply to the amount i in the premium in exces of that level. this tax would not only be imposed on basic health benefits, it would be imposed if the combined value of basic

benefits, dental benefits and vision benefits exceeded the $8,500. in other words, americans would be better off without dental and vision coverage than with it. how could a disincentive to dental and vision coverage be a good idea? the answer is it's not. a sudden increase in the business threshold will be tied to the consumer price index plus 1%. what this means is that more and more workers and employees will be affected and employers will be affected in subsequent years. in fact, the congressional budget office estimates that by 2016, this benefits tax would affect 19% of workers with employer-provided health coverage. c.b.o. further projects that revenues resulting from the tax would increase by 10% to 15% every year in the second decade after it takes effect. and though this appears to be a tax on insurance companies, we shouldn't be fooled. insurance companies are likely to pass these costs on to their customers, forcing employers to pay higher premiums and encouraging employers to cut or

limit coverage. health reform legislation should not -- should not penalize middle-income americans who have foregone salary and wage increases in return for more generous health benefits. i remember as -- as the presiding officer in his leadership of the banking committee remembers during the auto discussions when president bush first moved to help the auto companies that were under such duress that many people on the other side of the aisle saw the legacy cost as something bad, the legacy cost that the auto companies had when, in fact, these legacy costs were benefits negotiated by unions, those unions had -- the workers had been willing to give up present day wages to have better health insurance and better pensions. this is the same kind of issue. health reform legislation should not encourage the elimination of existing health benefits. it's clear to me that that doesn't make sense. instead, health reform

legislation should ensure that americans who have negotiated good health benefits, including dental and vision coverage, are able to keep those benefits without penalty. i've heard many of my colleagues argue that this excise tax will bend the cost curve is what they like to say of health care costs and expenditures. the commonwealth fund, however, found that there's little empirical evidence that such a tax could have a substantial effect on health care spending. makes no sense to bend the cost curve by compromising access to needed health services now, leading to higher costs later. you're squeezing on a balloon, not changing the trajectory of health spending. to bend the cost curve, we need to identify and reward the provision of the right care in the right settings at the right time. we need to target duplication, promote best practices, clamp down on those who overprice health insurance and health care products and services, exploiting their role in ensuring the health of the american people. we need to give americans more purchasing power and inject more competition into the health care

marketplace. we don't need to reverse the check on health care coverage by discouraging americans from having a good -- from having good health coverage. there's so much that's critically important in this health reform legislation that makes so much sense. from delivery system reforms to prevention and wellness initiatives, to provisions which strengthen medicare, to making insurance affordable and accessible. but this counter productive tax on middle-income americans is not a provision i support. that's why i've cosponsored an amendment with senator sanders that would eliminate this benefits tax and instead impose a surtax on the weltiest earners -- wealthiest earners, those who benefited so much from the bush-era tax cuts. our amendment would replace the benefits tax on health insurance plans with a 5.4% surtax on adjusted gross income for individuals who earn more than $2.4 million a year and couples who earn more than $4.8 million per year. instead of taxing middle-class americans for having good health

coverage, our amendment would help address the disproportionate impact of the bush tax cuts, which were outrageously tilted toward the wealthiest of the wealthy. multimillionaires, billionaires fared far better than middle-class families under the bush administration. let's not continue that ill-fated tradition in -- in this congress. mr. president, i want to also speak for a moment and ask that it be placed in a different part of the "congressional record." i rise to honor first sergeant brad simmons -- the presiding officer: so ordered. mr. brown: okay. i rise to honor first sergeant bridally simmons, united state states -- bradley simmons, yais marine corps, for his years of service in the united states senate and for his continuing service to our nation and to the marine corps. for the past year, first sergeant simmons has worked in my office and served the people of ohio as the first enlisted marine fellow in the united states senate ever. before joining the senate, first sergeant simmons served in

kuwait with the 3rd assault amphibian battalion. he also participated in the initial attack and continuing operations in iraq. his heroic senate as a section leader during that time earned him the navy and marine corps commendation metal and a combat distinguishing device for valor. first sergeant simmons' strength, dedication and firsthand experience overseas made him an invaluable resource for my staff and our nation's service members and veterans. understanding of the difficult transition for returning service members and veterans, first sergeant simmons reached out to help them and their families in tangible ways. from helping ohio veterans with their v.a. claims to assisting a wounded service member during rehabilitation to meeting and speaking with families whose loved ones are overseas, first sergeant simmons demonstrated an unequivocal commitment to his fellow service members. his tireless work on the vision scholars act of 2009 will help

ensure that veterans suffering from eye injuries would not also suffer from the current nationwide shortage of vision specialists at the v.a. the vision scholars act of 2009 passed the senate last month with great assistance from -- from first sergeant simmons. but first sergeant simmons has been more than a trusted advisor. he's been a teacher and a friend to so many of us. as he likes to say, he's been running a full-scale marine corps familiarization program in my office for the past year. with the storytelling talent that left you laughing, with a moment of contemplation in the life of a marine, or with a little p.t. encouragement for the desk-bound, first sergeant simmons made us appreciate the leadership qualities that are found throughout the ranks of the marine corps, especially in him. from interns in my was to constituents in my state to all my staff in ohio and washington, he succeeded in educating us about the honor and the tradition and the sacrifices readily made by our -- by our

marines and by all of our military forces. he made us better at our jobs and better citizens in our communities. he accompanied me to walter reed to visit troops recovering from combat injuries and later assisted in helping a few of them transition to life as a civilian or on active duty in the guard or reserve. he invited my staff to the pentagon to a welcome home those recently injured in iraq and afghanistan. during this past year, first sergeant simmons taught us about the determination and the commitment of men and women who give honor to the marine corps. a lot's changed in the past year for our office and for first sergeant simmons as well. he came to my office as a gunnery sergeant. at his promotion ceremony not long ago, his superiors explained that the marine corps does not base promotion in rank on previous performance and accomplishment. instead, promotion is based on a candidate's innate capability and potential to do the job well in the rank of first sergeant