afford that. so we've got a lot of reasons to get this right and to pass a bill, and that projection is one of the most horrific. maybe we can move to the chart on children. just a quick summary of what the bill does for children and then we'll walk through the children's health insurance program. a couple of basic points. pediatric benefit package. that comes with this legislation. including oral and vision coverage for children. many health plans don't provide this kind of coverage. it's one of those unwritten stories, or if it's been written, it hasn't been written enough where children lose out sometimes, even in a good health care plan for their parents. so it's not good enough to say well, we have got some coverage here and kids will be just okay. children, as the advocates remind us all the time -- these aren't my words -- children are not small adults. they have different health care needs and they have different

health care problems and challenges. pediatric benefits as part of the benefits package is a dramatic change and a very important change. this bill will require coverage -- not only require coverage for basic pediatric services under all health plans, but also oral and vision needs which improve a child's ability to learn and perform at school. so we can't -- you can't talk about getting better test scores in school and doing all kinds of things in our education system if a child is not given basic health care that a child needs, not the health care that an adult needs. a second point on what the bill will do. more pediatric providers. we have got to have strategies in place to recruit and incentivize and train more pediatricians. you can't just say you want more coverage for kids and throw money at it. you need to have -- you need to have the work force to do it. the patient protection and affordable care act will expand

the health care work force, including pediatricians, pediatric nurse practitioners, specialists in pediatrics, and pediatric oral health professionals, to give kids what they should have in this country of ours where we know what works. we know exactly what works when it comes to children's health insuranc -- insurance. and then finally for providing greater quality, improving the quality of coverage for children, the preventive health care that we're going to provide for children thunder is dramatic. and finally let me make a point about children overall. you know, we hear a lot of discussions about where health care -- what part of the country benefits the most and who will benefit and who won't. well, under this legislation, there's not an american i believe who won't be positively impacted one way or another, sometimes directly. but one -- one message came loud and clear during the debate on

children's health insurance, going back a number of years on the -- in the senate here. often, most people think of children and the benefit of the children's health insurance program as living in urban areas maybe or in a big city because that's where poverty's highest and, therefore, low- or middle-income families would benefit from medicaid and children's health insurance. and that's largely true, for sure. but what came through to me in that debate many years ago -- several years ago now, is something i never knew before, is that one-third of rural children in america get either the beneficiaries of medicaid or children's health insurance. not many people heard that until a couple of years ago. so this isn't about one specific demographic or geographic, i should say, location where

children are that need this benefits, whether it's medicaid or children's health insurance. we know this is a problem for rural children, for urban children, for children who live in small towns, and even -- and even -- even in suburban counties, that are perceived to be a little more secure economically. i point to -- when talking about what we have to do for children, i often pointed to a line from the scriptures. very simply we ned to hold them accountable as it relates to debate for children. the line in the scripture says, "a faithful friend is a sturdy shelter." and the question we have to ask when we're debating how we're going to help our children in this legislation is, will we be a faithful friend on children or not? it's actually a pretty simple question with profound, almost incalculable implications. are we going to be that sturdy shelter for children, who don't

have economic power, who don't have a lobbyist showing up on capitol hill every day saying take care of this child or take care -- or help this group of children. so the question for the united states senate, one of many questions that we have to answer by the end of this debate, is: will we that be sturdy shelter for children? will we be a faithful friend to children? and let me conclude with a couple of remarks about the children's health insurance program, in particular. you see up here in pennsylvania, and this is typical of a number of state but not every state, the pennsylvania children's health insurance benefits. with children's health insurance, children are guaranteed for receive comprehensive insurance coverage, including the following. now, every child should have this. i don't care who they are or where they live or what their economic status is. they should have immunizations. they should have routine checkups. prescription drugs, dental care,

maternity care for their -- for their mother, mental health benefits, up to 90 days hospitalization per year, durable medical equipment, substance abuse treatment, partial hospitalization for mental health services, and, finally, rehabilitation therapies and home health care. that whole -- that whole menu of benefits for children is not some theory or some -- some hope, in a sense. this is what the children's health insurance means to america's children, their parents, their family, and i would argue this is about economic development in the long run. this is about developing a high-skilled work force. if a child has these benefits in place, they can make it in life with a couple of other breaks and some other incentives. but if they don't have this list and they don't have the best possible health care, they're going to be in a lot of trouble. and all of us will be in trouble because our economy will never

be as strong as it can be and must be unless we do that. let me just go to the next chart which is a subset of that and this chart depicts what is in children's health insurance now, well-child visits. not talked about a lot, not a real glitzy subject for -- for people to debate, but a critically important part of what children's health insurance means and the benefits mean. a well-child visit. in the course of one year under children's health insurance, under the program that we hav have -- we put in, the congress enacted it almost 15 years ago -- a little more -- not quite 15 years ago -- and then we reauthorized it just this year. president obama signed the legislation. it means that instead of 7 million kids covered -- that's a great achievement and that's great -- but in a couple of years, we're going to be able to expand that to 14 million children.

and i want to make sure -- and i'm sure this is shared across the aisle as well -- that every child should have six of those well-child visits in a year. it's a key time for the parent and physician to communicate. doctors recommend, as i said, six in the first year. they get a complete physical examination, height, weight and other developmental milestones are measured. hearing and vision is checked. we all have had experiences where a child doesn't get those kinds of basic checks and they have hearing problems because it wasn't detected or diagnosed early. or vision problems. my daughter -- one of my four daughters had a vision problem. it wasn't caught at an early enough stage and we had some -- some real difficulties making sure she had the right care. important topics discussed. normal development -- what does that mean? a doctor should be able to talk to a parent about that and the program covers that. nutrition, sleep, safety, infectious diseases. and then general preventive care.

why should there even be a debate about whether children even get this or not? the good news is, we have a program that does that. and the good news is also we've just expanded that program. but here's where the challenge comes. in the midst of health care reform, the house of representatives did a lot of good things in their bill. one thing they did not do well is make sure that the children's health insurance program was as strong as it needs to be and must be, and that's the reason why i received the following letter. i won't read the whole letter but this letter came from barbara ellis. she's in brumal, pennsylvania. i spoke to her a couple of days ago about -- about her letter. and i won't read all of it but i think it describes it pretty aptly what we're talking about. she and her -- barbara and her husband ben live in delaware county, pennsylvania, brumal. we -- she says -- and i quote -- "we are a one-income family with two sons ages 6 and 8. due to the high price of health insurance, my children are currently covered under the free

pennsylvania children's health insurance program. program." that's the good news. here's the part where she's worried. "we qualify for free children's hushehealth insurance coverage n pennsylvania but my husband's income is greater than 150% of the federal poverty level, which means our children won't qualify for the coverage under the house's proposed plan." and then she says probably the most important part of this whole letter, she says, "this has us terrorized -- or tear fierksd he shoulterrifies, i sh. i'm reading it wrong. "this has us terrified." and so it would. any parent who has a peace of mind when they fall asleep at night they don't have to worry about whether their children have health insurance. but if -- if we don't do the right thing here, she will have that sense of terror. she says this as she concludes the letter: "it would help us

tremendously if you could support keeping the children's health insurance provisions intact which would, in turn, support families like ours." and that's what i've done by way of an amendment to our bill to make sure that we strengthen what the house did and strength eneven our own bill. our children's health insurance amendment, which i won't go through today, is strengthens and safeguards the program through 2019 and beyond to address any changes that health care reform may bring. we'll talk more about it. but this is the key. to make sure we have not just a set of benefits for children that are directly tied to their care and will help them for decades afterwards and help our economy and give their families peace of mind but also that in the process of making sure that we keep these kinds of benefits, that we keep the program strong. not just to 2013 but at least --

at least -- all the way to 2019. and i think we can do that. i think we can do that in the midst of this debate and get it right and give families and especially children that kind of protection. in a word, what we have to make sure that we do is to help sure that the united states senate and the congress and this administration does everything it can to prove and to demonstrate that we are a faithful friend to children, that we will always be their sturdy shelter. mr. president, i would yield the floor. a senator: mr. president? the presiding officer: the senator from alaska. ms. murkowski: thank you, mr. president. appreciate the good senator fr from -- from pennsylvania and his discussion and his very constant focus on children, children's health and just want

to commend him for his -- his good work in always reminding us of the importance of our children in so many aspects of our policies. so thank you for that. mr. president, i, too, rise this afternoon to talk about the -- the debate on health care and the debate that we seem to -- to have ongoing with the numbers. and whether it's numbers that are coming out from the congressional budget office, c.b.o., or for -- from our states or from other noteworthy entities, there's a great deal of back and forth as to whose numbers are right, whose numbers are wrong. well, a great deal of discussion in the past day or so about the numbers that we have received and the analysis that we have received from the office of the

actuary, from c.m.s., the center for medicare and medicaid services. the chief actuary is mr. richard foster. and a good deal of discussion as to these numbers, and i think the question that needs to be asked is, so why -- why would the numbers for from the c.m.s. actuary be any more significant than, say, what we have -- have seen coming out of the congressional budget office? well, mr. president, the -- the chief actuary of c.m.s. is -- is kind of the independent arbiter, if you will. they look at both the private and public health care expenditures. the chief actuary provides actuarial details that i think we recognize can be critically important for certainly my state, for any of other states' economists to develop individual state estimates of the financial

impacts, the effects of the health care reform proposal. as important as discussion on the broader scale is, the people back in my state want to know, well, what does it mean for us in alaska, what does it mean for increased access, what does it mean for us in terms of our premiums? are they going up? are they going down? how do we as a state that is very, very unique in its marke markets, geographically dislocated, smaller population, how does this health care reform proposal impact us? so the numbers in the assessment that we have received from -- from the office of the actuary is -- is very, very important. i -- i have mentioned that we all want to know, we all want to know what this democratic health care proposal will mean to -- to us as individuals in terms of

the increased premiums, the impact on the long-term sustainability of medicare, whether it's going to restrict access to care either in a state like alaska or throughout rural america, and ultimately, ultimately will this this $2.5 trillion bill bend this cost curve down on health care expenses that are pricing so many americans out of the market on health insurance? mr. president, i -- i think it's so important that we -- we focus on the cost side, on the spending side, and it's -- it is a -- that's a bipartisan thing. we haven't done a lot that is bipartisan of late, but i think it's clear that we all want to know that we are doing all that we can effectively to reduce those costs. and i -- i will note a letter that came from -- from six of our colleagues on the democratic side. this was sent when we were

debating the -- when the finance committee bill was being considered, and a letter went out to chairman baucus that provided that there are many wide-ranging options to address the broad and complicated issues of runaway health care costs, and we pledge our support to you in making the necessary and tough decisions. this is our number-one priority, the letter states. if we pass health care reform without addressing the issue of health care spending, we have failed. well, i couldn't agree more with my democratic colleagues that signed that letter. we will have failed if we have not addressed the issue of cost, the issue of spending. and again, this takes me back to the -- to the report from c.m.s., the actuary report. i want to -- i want to highlight some of the very important points that were raised by the

chief actuary. first, the reid bill reduces payment updates to health care providers which are unlikely to be sustainable on a permanent basis. and if you go through the report, on page 9 is a statement that as a result providers could 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 who are unwilling, unwilling to treat medicare or medicaid patients. and at page 18, the statement is -- "providers might tend to accept more patients who have private insurance and fewer medicare and medicaid patients, exacerbating existing access problems for the latter group.

either outcome or a combination of both should be considered plausible and even probable." well, mr. president, i can tell you for a fact, this is not just some maybe if, in fact, these things happen, these will. this is happening. i received a call just one week ago from a practitioner in alaska, in anchorage, a family care practitioner, and i was told that this practitioner who has been practicing for many, many years in her -- in the family care practice, that the decision had been made to opt out of medicare. and in the email that we received and the follow-up conversation that was had with this practitioner, we specifically cited that it is -- it is due to what is in -- i'm

reading from the email that we received." due to what is in the reid bill, as it will collapse my practice." now, mr. president, this is incredibly important to us, not only in a state like alaska where -- where we're in a crisis situation when it comes to providers who are willing to take new medicare individuals. right now in our -- in our state's largest city, we have 13 providers who will take new medicare individuals. 13. well, now if this individual who we have communicated with just a week ago is making the decision to opt out of medicare because of the low reimbursement rates, because of what is seen developing here on the floor of this senate and the impact that that will have on that family

care practice, we -- talk about not being able to sustain things. it is not acceptable, and so when i read the language in the actuary report that says that providers might tend to accept more patients or might find it more difficult to remain profitable and might end their participation in the medicare program, to me i'm looking at it , i'm seeing it is not might. it is happening, it is now, and it is impacting alaskans' access to care in my state, something that we should all be concerned about, and it's not just this one practitioner. we have heard that this has caused a great deal of anxiety within -- within alaska primarily, because that's where i'm -- i'm checking in with folks, but the anxiety about

their ability to sustain a practice, again with medicare reimbursement rates as low as they are in our state, we don't have a medical school so it's not as if we are growing more practitioners to come in. it is very costly to -- to have a practice in alaska. we have got a lot of strikes against us. but, mr. president, we have got to figure out a way that we -- we can continue to receive care from these fine professionals. but right now from a policy perspective, it seems like we're doing everything possible to drive them out. and i'm talking a lot about the situation in alaska, but don't think for a minute that it's just -- it's just isolated to my state. the statement that is made by the actuary, it is devastating news for states that are also facing problems to access in terms of finding a general care

doctor to see them. oregon, nevada, colorado, new mexico. there was a g.a.o. report -- now, granted this is a 2006 g.a.o. report, but it did an assessment of -- of what is happening in -- in locations across the country, and those areas where access is -- is compromised. and you look at the statistics coming out of g.a.o., and their wording is -- "this suggests the distinct possibility of a deepening problem in many of our western states." so it's not just in a few isolated communities. we have states that are looking at this and calling the crisis for what it is. so what we're doing in this health care bill currently before us is that we're using medicare as kind of this guinea pig, if you will, cutting from the medicare -- cutting from the

health programs, even though we all recognize that medicare is slated to go broke by 2017, and using the medicare money to expand medicaid, and if the medicare reports are true, expanding medicare as well. so the end result is to harm medicare patients as we expand medicaid. now, alaska is a little bit unique. we are one of two states where medicaid is actually a better payer or better in terms of the reimbursements than medicare, but even still the economists that we have at the university of alaska, the institute for social and economic research, the economists have said that medicare patients will lose access, and as they have suggested kind of go to the back of the bus if we expand medicare. and i -- i want to -- i want to use their language specifically.

this is from the -- the analysts at iser. he has stated that we can continue to be concerned that the newly enrolled through the medicaid expansion and the new exchange will create a big surge in demand that could easily create a traffic jam in the health care system and send the medicare beneficiaries to the back of the line in alaska due to medicare's low briewrmt rate -- low reimbursement rate. so expanding medicaid is bad for alaska. now the chief actuary at c.m.s. is saying that medicare and medicaid patients will both face limited access to care under this bill. and, well, in alaska -- and while in alaska medicaid patients may fare better, what's happening is at the cost, the expense, if you will, of

medicare patients. so you're robbing peter to pay paul. and keep in mind that as we look at the c.m.s. letter, the chief actuary's letter, it doesn't even address the democratic leader's desire to bring to the floor the provision that would expand medicare to those ten years younger than the current threshold age for medicare. so what we are seeing within this analysis is probably just the floor in terms of what the impact will be if we allow for this expanded medicare provision's buy-in, if you will. again, mr. president, my state's seniors are absolutely suffering on medicare with virtually no primary care doctors who will see them in -- in our state's largest city, and now we have got experts saying that medicare's patient access to care is going to suffer. we simply cannot -- we cannot

expand broken health care systems. we've got to fix the systems. you don't fix them -- you don't expand the broken thing and hope that it's going to fix itself. just yesterday, in our state's largest newspaper, the headline -- this was at the bottom of the fold. the headline was "health bills may hurt some alaskans," consultants say. it goes on to say -- "older residents could have more trouble seeing doctors." mr. president, if you don't think that that sends chills up and down the seniors in my state, knowing that the difficulty that they are facing now could be made worse. a point that i think is important to add to the conversation here, you might think well, alaska, you're -- you don't typically have a lot of seniors, you're a younger population. we are that, but it should be noted that we are per capita the

state with the fastest growing senior population in the united nations. we have got -- we have got a situation where as we have our -- our baby boomers aging in, we have got a situation where the numbers are increasing dramatically as far as those who who -- who will require the care. we have got -- the number of patients 65 and older at the -- at the health care facility, anchorage neighborhood health center, has jumped on the order of 50% within just a few years. the neighborhood health center saw twice as many medicare patients in 2007 as in 2001. the report has also found that

older alaskans have been visiting the emergency room in growing numbers. what -- what we are seeing is an expansion of those who -- who will be our medicare consumers. in 2008, there were 49,455 alaskans 65 and older, but by 2015, so just five years from now, the number is expected to increase 50%. by 2020 -- so just ten years from now -- the estimate is projected to increase to over 86,000 individuals in anchorage, and yet we have fewer and fewer primary care doctors who are willing to accept these medicare patients, and the proposal out there is that we're going to cut half a trillion dollars from medicare to pay for a new government entitlement. it just doesn't add up, mr. president.

back to the actuary's report. it goes on to state that "we estimate that total national health expenditures under this bill would increase by an estimated total of $234 billion during calendar years 2010- 2010-2019." so we know that bending down the cost curve that's been so essential to this health care reform bill, according to our own government's experts, is not going to be achieved in the democratic leader's health care proposal. unlike what senator baucus said last week, that senator mcconnell's statement, that this bill raises costs was -- quote -- "a false statement." this bill does, in fact, raise health care expenditures, and all you need to do is go to -- to the actuary's statements to determine that. actuary's report goes on to provide, the new fees for drugs, devices and insurance plans in the rebill will increase prices

and health insurance premium costs for consumers. this will increase national health expenditures by approximately $11 billion per year. well, mr. president, we know that this bill is going to raise money on the backs of patient consumers. this is going to happen in my state. it's going to happen in every other state and it's going to be done by taxing the industries that provide us with a prescription drug, the medical devices, like the tongue depressors, the medical thermometers, x-ray machines, and the like. and whether you agree or not on -- on taxing these industries, what the c.m.s. actuary is telling us is that these additional taxes are going to be passed on to the patient consumer to the tune o of $11 billion every year. and, again, the american people should know that your costs on

drugs or thermometers or diabetes test strips or labs, or x-rays, that these are all going to go up because new penalties imposed by the federal government will be passed on to the patients. mr. president, i do appreciate the work that mr. foster, the chief actuary, has -- has done in getting us this report. i had written him a letter on monday ask if we could get report so that the folks in our respective states could look through it and better assess and understand. they -- they want to know that they are relying on -- on good, sound assessment. but i will tell you, after -- after reviewing the actuary's report, i have -- i don't know how anyone could come to a different conclusion other than these -- these proposals, these bills don't look good for my state. they don't look good for the

medically underserved areas of the country such as urban areas with limited access to care because of their high medicaid populations or in rural america where general -- general care doctors simply are not taking medicare patients. mr. president, this is just a bad bill. it's a bad bill. it hurts our seniors. it doesn't bend down the cost curve. it spends $2.5 billion, and it raises health care costs. we have got to -- we've got to figure out a path forward that is reform that doesn't increase the cost to our constituents around this country. that truly does make a difference when it comes to -- to the delivery of health care costs in this nation. and that really does provide for expanded access. i have said numerous times, just giving an individual a card that

says, okay, now you are part of -- of health care -- of a health care plan. but if you don't have access to a provider, we really haven't done what we've promised to do, to help you receive good health care. so, mr. president, there's a -- there's a great deal, again, that is flowing out there in terms of he said, she said type of conversation on the numbers. and it is incumbent on us, here in the senate, to -- to give thorough vetting, thorough assetment. we've got to rely on the experts. and we hope we rely on those experts that have -- have been able to look at the -- the proposals fairly and evenly and give their best assessment. i have a great deal of confidence in -- in our

independent entity in the state of alaska, the institute for social economic research there at university of alaska. i appreciate what they have done to -- to -- to provide more focus on what this national proposal will do to the -- to access to care in my state and costs that will be borne by my constituents. i think the more -- the more we spend time understanding what we have in front of us, the more that we realize this is a bad deal for america. with that, mr. president, i thank you, and i yield the floor. the presiding officer: the distinguished senator from utah. mr. hatch: mr. president, yesterday the administration's own department of health and human services health analysis

warned americans about the impact of this bill. according to the official scorekeepers at c.m.s., that's centers for medicare and medicaid services, thoid health care bill will not only increase our national health care costs by $234 billion over the next 10 years, but will also reduce access and cut benefits for our seniors. now, this nonbiased report simply proves what we've been saying all along, you cannot reform a $2.4 trillion health care system simply by spending another $2.5 trillion of hard-earned taxpayer money. so despite all of the rhetoric from the other side about this historic legislation, the on-line thing this bill accomplishes after impose half a trillion dollars in new taxes and half traldz in medicare cuts, is to bend our nation's

cost curve upwards. as a long-time supporter of the medicare advantage program, i offered an amendment on the senate floor to stri strip $120 billion of cuts to the medicare advantage program that provides comprehensive health benefits including vision, dental and reduced cost sharing for almost 11 million americans, seniors. 11 million seniors. despite the statements from the congressional budget office, that this would include cuts for medicare seniors, democrats voted to keep the cuts in the package to finance more federal spending. $500 billion in cuts in medicare. who are they kidding? medicare is $38 trillion in unfunded liability. well, this report is another reminder on why it was a mistake -- why it is -- or should i say was a mistake to not adopt my

amendment. the c.m.s. actuary found that the cuts to the medicare program in the reid bill would not only result in -- quote -- "less generous benefit packages" for our seniors, but, more importantly, it would decrease enrollment in medicare advantage plans by 33%. these are seniors who need the help. many of whom can just barely get by. if we give them that help. clearly health care spending continues to grow too fast. this year will mark the largest ever one-year jump in health care share of our g.d.p. a percentage point, this -- this jump is a full percentage point to 17.6%. you can think of this as a horserace between costs and resources to cover those costs. the sad reality is that costs win year after year. growing health care costs translate directly into higher

coverage costs. since the last decade the cost of health care coverage has increased by 120%. three times the growth of inflation and four times the growth of wages. rising costs is the primary driver behind why we continue to see a rising number of uninsured in our country and why increasing numbers of businesses make it hard to complete -- to compete in a global market. without addressing this central problem, we cannot have a real and sustainable health care reform bill. so what does this $2.5 trillion tax and spend bill to address, what does it do to address health care costs? absolutely nothing. according to the congressional budget office, the premiums for americans who buy insurance on their own will actually increase by 10% to 13%, while premiums for small and large groups will

largely remain unchanged and continue to rise between 5% to 6% a year. furthermore, according to the c.m.s. report the new fees on prescription drugs, medical devices like wheelchairs and hearing aids and health care plans will not only increase overall health care prices, but also health insurance premiums for millions of americans. let me make this point as clearly as i can. this bill does not address the underlying prep of slowing down the growth of health care costs. it simply spends hundreds of billions of dollars in new subsidies to buy out the cost of those -- of these increases for families making up to $88,000 a year. and many -- in many states the average wage is like $30,000 to $32,000. yet, they're going to spend hundreds of billions of dollars in new subsidies to buy out the costs of families making up to $88,000 a year. instead of fixing the real

problem, this bill simply tries to spend their way out of the problems. does that sound new to you? this administration seems to think just throwing money at things is going to help. we've been hearing a lot recently about how democrats are throwing the government-run plan out of their bill to quickly jam this bill through the senate before christmas. the american people need to be careful about believing this propaganda. the democratic solution to government plan is a ponzi scheme. that would embarrass even bernie madoff himself. let me be fair here. i have to rely on news reports to discuss these provisions much you heard me right. news reports. why is that? because no one knows what is actually in the bill that they've sent to the c.b.o. not even my friends on the democrat side by and large know the reid bill is put together by a very few democrats with the white house in the back rooms of the -- of the capitol here.

nobody really knew what they were doing until they came out with it. and once we all saw it, we all realized what a mess that is. so now they found themselves in trouble, so they've gone and done another bill an they've submitted it to c.b.o. and hardly anybody on the floor knows exactly what all of the features are of that bill. we have a pretty good idea. but we don't know. no, no one knows actually, what's in the bill. despite the continuous claims of transparency that our friends on the other side are always talking about, the real bill continues to change on a daily basis behind the closed doors of the majority leader's office. now i'm just -- i'm really glad to know that it is not just the republicans who are in the dark about what is actually in this bill. democratic members of this body are also in the same boat. it's really unbelievable. we're being asked to move forward on a legislation that will reform one-sixth of the american economy and impact every american life and business

without knowing what is actually in the bill. we have to rely on news reports. i've never seen anything like this in my 33 years of senate service. one proposal that's come to the forefront in recent days is the idea of expanding medicare to include coverage for americans 55 and over. currently we all know medicare is for americans 65 and older. it is a bankrupt program. it's well intentioned. it does a lot of good. but it's bankrupt. it's a program that can barely pay for the benefits of the 40 million seniors in it today. medicare's on a path to fiscal meltdown with part-a facing bankruptcy by 2017. it underpays doctors by 20% and hospitals by 30% compared to the private sector. forcing increasing number of providers to simply stop seeing our nation's seniors.

according to the june 2008 medpac report nine out of 10 medicare beneficiaries have to get additional benefits beyond their medicare coverage. well, one reason that they got rid of the medicare advantage is so that people who want that coverage will have to go buy it themselves. the differences about well ove over $100 additional costs to our seniors. by the way, guess who sells that coverage? why, aarp. you wonder why aarp is so rabidly behind this bill. well, it's not hard to figure out. it all comes down to money and power. and arrogance of power, really. so what is washington's solution to address this problem an crisis? take up to $500 billion out of this bankrupt program and at the

same time push millions of americans into it. does that sound logical to you? the c.m.s. report states in clear terms that the medicare cuts in -- in this bill could jeopardize our seniors's access to care. the cuts will result in nearly 20% of all part-a providers like hospitals and nursing homes they would operate in the red within the next 10 years as a result of these cuts. 20%. that's a pretty big number. it should come as no surprise that this proposal faces strong opposition from a wide variety of provider groups. from doctors and hospitals who are under tremendous financial pressure due to underpayments from medicare. keep in mind the a.m.a. here in washington has backed this monstrosity. now, should i say the a.m.a. -- some people think that represents all of the doctors. it doesn't. it's a bunch of federal bureaucrats right here in washington who -- who basically

-- basically are very liberal. the average doctor out there is incensed about this. now, adding more lives to this insolvent medicare program will only further limit their ability to see all medicare patients, not just the new ones. now, even more troubling is the impact of this expansion on the premiums of our medicare seniors from this ill-conceived policy. this expansion will encourage an influx of sick americans from private coverage into medicare that will simply raise premiums for seniors already enrolled in medicare. so seniors, expect your costs of medicare to go up. so why are democrats pushing this idea? congressman anthony wiener said it best. i think he was very honest, very upfront. he said this -- quote -- "extending this successful program to those between 55 and 64, a plan i proposed in july,

would be the largest expansion of medicare in 44 years and would, perhaps, get us on the path to a single-payer model." well, the democratic end game on health care reform is crystal clear -- make as many americans as possible dependent on the federal government programs. democrats believe that by making millions of americans dependent on big-government programs on the backs of their grandchildren's future, they are taking a huge leap towards creating a permanent majority for themselves. why, it would be a natural constituency for them. let me tell you this. america is built on the spirit of self-reliance, not government handouts. poll after poll, especially the cnn poll which said that 61% of americans are now opposed to the bill and study after study is warning us that this is the wrong solution for our nation. this unknown bill, which continues to change by the day behind closed doors, is a direct violation of the president's own

pledge to only support a reform that would reduce costs, protect benefits, and not raise taxes. now, i sincerely hope that democrats will step away from their arrogance of power and listen to the will of the american people. it's not too late for us to push the reset button and work on health care reform in a truly bipartisan manner. we are eager and willing, as we have been all year, to work on a responsible solution that every american can be proud of. there are all kinds of things that we could agree on, that republicans would work hand in glove with democrats to solve if they were willing to do it. but keep in mind, the "help" committee bill was totally democrat, not one republican was asked to help. the house bill totally democrat, not one republican asked to help. i admit, my friend, the senator from montana, max baucus, worked hard to try and get a -- a bipartisan bill, but in the end, he only had three republicans in the gang of six and they left

him. and all of a sudden he fieppedz his bill -- finds his bill being put between the house bill and the "help" committee bill. behind closed doors with very few people involved, all democrats, from the white house and probably two or three or four or five from the senate, but no more than that. and that's what we have -- that's what we've had up till now is that -- this huge, 2,074-page bill. that will eat us alive as a country. mr. president, throughout this debate, i've heard a lot of rhetoric from the other side of the aisle about how republicans are opposed to this $2.5 trillion tax-and-spend bill because, as the democrats incorrectly suggest, we want the status quo. oh, give me a break. we all know this is completely false. we on this side of the aisle have asked the democrats over and over again to step back and wright a new bill with us, but they are so consumed with their arrogance of power that they simply want to push what they

have always wanted and that is more government and more government controls over all of our lives. america's a free nation, the greatest nation in the history of mankind. what makes us great is not our reliance on the federal government but our individual resolve and strength. americans want the federal government to help them, not support them. let me tell the other side of this. in a recent gallup poll, independents around the country oppose this bill 53-37. these are independents, so it would be wise for my democratic friends to realize that america is not behind them, not behind this bill, and it is time for them to listen to what the majority of americans want and that is not this bill. i cannot tell you the kind of opposition that i've seen in my state to this bill. it is almost unprecedented. i hear it in the letters, on calls, in airports, in grocery store aisles and on the streets. people stop me and say, "don't

let that thing pass." absolute power corrupts and that is what we are seeing in washington today. democrats control the white house, the house, they have a filibuster-proof senate, they have used this absolute power to rowber stamp this add -- to rubber stamp this administration's big-government agenda and have tripled our deficit within one year. one year. we will run deficits of at least $1 trillion a year for the foreseeable future while our national debt will triple. we are literally mortgaging the future of this country to foreign countries as we speak. enough's enough. let us step back and start over on a plan that we can all be proud of and all work on. mr. president, we hear a lot about how the republicans are simply standing up for big and evil insurance companies and how the democrats are the defenders of american families. well, nowadays, is this democrat hypocrisy more clear -- i should say, well, nowhere is this

democratic hypocrisy more clear than the individual mandate policy that is part of this tax-and-spend legislation. now, let's be very clear about who would benefit the most from this provision which would for the first time in our nation's history about the federal government the power to force americans to either buy health insurance or face a force by our friends at the international -- enforced by our friends at the internal revenue service. there are only two clear winners on this policy and it is not the american families. first is the federal government who will now use this authority as a blank checkbook to increase the penalty in future as a new revenue scream strea stream fors out-of-control spending habits. second are the insurance companies who will now reap the benefits of having americans be forced to buy coverage at the decree of the federal government. right now, states are responsible for determining policies that best meet their unique demographic needs and

challenges. massachusetts, for example, has decided to implement an individual mandate while utah has decided not to. under this bill, we are explicitly taking away this state flexibility and authority to give the federal government the authority to make this one-size-fits-all decision for all 50 states and every american. this is an unprecedented grab of state power by washington. a fund menlts threat to the very federalist vision that our founding fathers used more than 200 years ago to create the greatest nation in the history of the world, in the history of mankind. i am gravely concerned about the precedent this policy will set for us as a nation going forward. if the federal government can force us to buy health insuran insurance, what else can it force us to do? the possibilities are endless, just like my concerns which i share with millions of americans on washington's growing role in our private lives and personal

decisions. think about it. washington has become an unwanted house guest in our homes and lives that just will not leave. and if it does not start listening to the families, it will get kicked out sooner than later. think about it. a couple of our friends have even said, "well, it's like car insurance. the states require you to buy insurance for your car. and it's in the best interests of the community that you do s so." well, the reason they do is because you want to drive. it's an activity that you want to participate in. and so they get away with it. here if they have an individual mandate, they're forcing you to buy policies that you don't even want. they're forcing you to buy policies against your own wish

wishes. and they're forcing you to buy the policies that they say you have to buy or that they make available. and if you don't, you're going to be penalized. that's never happened before in our lives. and if they can get away with that, then i've got to tell you, they can get away with anything. and the liberties of all americans are going to be affected by it. this is not an activity. this is not something we choose to do necessarily. if we choose to do it, that's great. but to have the government come in and say, you have to buy this policy for the first time in history, you have to do this, even though you don't want to buy it, is unpres unprecedented. well, let me just say that i think it's fair to say that i'm not very enthused about the health care ideas of our colleagues, but i do want to end on a positive note. there's some good things that we could all do, some of which are

in the bill. it's not -- it's not totally b bad. it's only about 90% but, but there's at least 10 pes% that we could build on, that we could work together on. and i'm not just saying that. look, i've been around here a long time. i can name all kinds of bills that i've worked with some of the most liberal people in the whole congress to pass. hatch-waxman's a perfect illustration. that created the modern generic drug industry. henry waxman's as liberal as it gets. he's my dear friend. he was willing to face up to these realities with me and we did hatch-waxman. i call it waxman-hatch when i'm around him. i might add the orphan drug bill. we found that -- we found that there were maybe only two or three orphan drugs being develop. orphan drugs are drugs to benefit population groups of less than 200,000. well, it's clear that the drug companies can't afford to do it

for 200,000 people because it costs upwards of a billion dollars. biological drugs cost even more than that and they're not really drugs. the fact of the marry is, they cost -- the fact of the matter is, they cost even more than that. well, we came up with very small incentives but they were incentives with prestige, some tax breaks and all of a sudden, it was about a $14 million, $15 million bill as i recall in the early 1980's, when i was chairman of the labor and human resources committee, all of a sudden today we're -- we have well over 300 orphan drugs being developed, many of which have been developed. and from some of them, blockbuster drugs have evolved. or let's take the "chip" bill. that was a hatch-kennedy bill. ted kennedy, very liberal. he would have preferred to have the federal government do it all, just like our colleagues do today with this enormous number of 60 votes on their side. but he was willing to work with me.

i went to him and said, look, had two families from provo, utah, come to visit me, husbands and wives. in each family's case, both the husband and the wife worked. neither family's combined joint income was over $20,000 a year. at that time, it was too much -- too much to have their kids qualify for medicaid and too little for them to be able to buy health insurance. and i said, the only kids left out of the health care equation were children of the working poor. teddy, we've got to do something abousomethingabout that. and he saw it. and he said yes. he wasn't really happy with the bill in the end because it was exactly what i told them would be. it would basically be block granted to the state with federal suggestions, where the states would handle it in

accordance with the demographics of their own states. and it has worked amazingly we well. until now they're shoving more and more people into "chip" other than the children of the working poor that we originally decided to help. well, you could go on and on and on, on so many pieces of legislation, i'll just mention those few. i'm very concerned because i actually believe that if we get what they're talking about on the other side, they'll not only bankrupt the country, it will make more and more people dependent upon the federal government. like i say, a natural constituency for the democratic party. it's a matter of great concern to me. are our colleagues bad people? no, they're very sincere in almost every case. very decent people. they just simply believe that the federal government can do it better. and there are some things the federal government can d