were due to medical costs. this legislation will help reduce the rate of growth of health care costs. in fact, the president's council of economic adviseers, -- advisors just announced there would be a 1% reduction in national health care costs. and the c.b.o. basically said that there would be -- that this bill is deficit neutral and that it would have an effect of reducing health care costs. this bill will reduce health care costs. a harvard study found that in addition when people don't have health insurance, they are most likely to be much more ill. a harvard study found that every year in america, lack of health insurance leads to 45,000 deaths. if americans do not have health insurance, it leads to about 45,000 deaths in our country. that's intolerable, mr. president. how can we in the united states of america, we pride ourselves as being the biggest, the strongest, the most moral

country on the globe, how can we allow 45,000 petraeus per year just because somebody does not have health insurance? people without health insurance also have a 40% higher risk of death, 40% higher risk of death if one does not have health insurance. what about -- how dos bill affect medicare? according to the c.m.s. actuaries, h.h.s. actuaries, medicare is projected to go broke in about year 2017, but c.m.s. has estimated that this act will actually extend solvency to the year 2026. that's very important, mr. president, an important message to senior. the medicare solvency of the trust fund will be extended in this legislation for at least nine more years, beyond 2017. i wish it were farther but that's a lot better than not extending solvency. extending solvency for that period of time. the bill also would increase the

number of -- the percentage of h insurance from about 83% to 94%. that, too, is no small matter. on legislation would reform the insurance market, protect those with preexisting conditions, prevent insurance companies from discriminating and capping coverage, and require insurance companies to renew policies as long as policyholders pay their premiums. let me just say a bit more and whittle more precision about premium costs. the centers for medicare and medicaid, the office of actuary have confirmed this. they confirmed that this legislation will cover 33 million americans, that is currently uninsured, and will do so while significantly reducing medicare costs and medicare spending. just think of that. this legislation will cover 3 33 million americans who are currently not covered and at the same time reduce medicare and medicaid costs.

don't take my word for it. that's the projection of the chief actuary of h.h.s. in addition, i mentioned the chief actuary says this will extend the life of the trust fund for nine years. moreover, this legislation reduces the cost to seniors, to a family by $300 in -- the medicare part-b premiums according to the c.m.s. actuary will be $300 lower than it otherwise would be and the out-of-pocket costs will be -- for a couple, i think that's roughly $400. that's a total of about $700 reduction for a couple in 2019, reduction of medicare part-b premium costs and reduction in out-of-pocket costs. essentially, the actuary concludes -- and i'll read the quote -- "the proposed reductions in medicare payment updates for providers, the actions of the independent medicare advisory board and the

tax hotax on high-cost health insurance plans, will have significant impact on future health care cost growth rates." "significant impact on future health care cost growth rates." the actuary says it will bend the cost curve. that's evident. also the actuary concludes in 2019, health expenditures are projected to rise by 7.2% with no change but 6.9% under the proposal. that is, under the proposal, health care costs will rise at a lower rate than they will if this legislation does not pass. in addition, this report shows how health insurance costs for millions of americans will reduce premiums by 14% to 20% for people in the individual market. actually, that's the congressional budget office that reached that conclusion and not the actuary. the congressional budget office has basically concluded that for

93% of americans, premiums will be lowered. for 3% of americans, premiums will be lowered. it is true that for those who are employed, as 5/6 of the persons who now have health insurance, the preems yums won't go down -- premiums went go down a heck of a lot but they'll come down due to this legislation. and for the% whose premiums -- and for the 7% whose premiums are not reduced, they'll have better coverage than they now have. that's because of market reform and rating reform and no more rescissions, et cetera. so this is a very, very good dealment i'd like to say one word too on health care cost reduction. a lot of senators have quoted an article by gawande in the "new yorker" magazine explaining why the phenomenon of agree graphicc

parts of the country, due to the way we pay hospitals and doctors for the are you imbursement system and, therefore, explaining about the basic reason why there's so much waste in the american health care system. well, dr. gawande has recent just recently published another article in the "new yorker," i think it was a week or two ago. and that n that article, he beaskly says -- and in that article, he basically says that of all the ideas that have been provided by practitioners and providers and people worried about the rise of health care costs in america, all the ideas are in this legislation. they're all in there. all the ways to work to start to lower health care costs are in this legislation. and he also says that the pilot projects, the demonstration projects in this legislation are good because you have to work a little bit, you've got to experiment a little, you've got to try this, try that, see where bundling works, see where bundling does not work. but the provisions are there.

and we can all be quite confident this administration's going to do its level best to make sure these projects work. that is, bundling, the moving towards quality as a basic reimbursement re quantity. the administration is going to work very hard to make sure they work. and i will say too as chairman of the finance committee, the committee with primary jurisdiction over these subjects, that we're going to have a lot of oversight hearings next year because it is very much in the interest of the american people to make sure this legislation works and works very well. and clearly with aggressive oversight hearings next year, we can help make sure that happens. one other point here. this bill represents a net tax cut, not a tax increase. a net tax cut for individuals. not a tax increase. and why do i say that? i say that because that's what the joint committee on tax says.

who is the joint committee on tax? the joint committee on tax is an organization in washington that seives both the house and senate -- that serves both the house and senate, serves republicans and democrats, is not bipartisan, is very solid and confident. they're the outfit we rely on when we write tax legislation. basically they say that by the year 2019, americans will see a net tax cut of $40 billion and that tax cut is equal to an average tax decrease of more than $440 per affected taxpayer. and for low- and middle-income taxpayers making less than $200,000,this cut is even greater. average tax cut is equal to more than $640 per affected taxpayer in the year 2019. to repeat, this bill, according to the joint committee on tax, is a net tax individual -- net individual tax cut. a cut. not an increase but a cut. and almost as great as the 2001 tax cut.

many of us know how great that was. this is -- this is the biggest tax cut since 2001 in this legislation. mr. president, i also to want point out a couple other points here. and that is a lot of people say gee, some of this does not take effect for several years. let's just go through what takes affect right away in 2010? what are these provisions that take affect right away? the first is -- i'll read the list. is -- it's -- the fancy term i is -- is pools to help people with -- with preexisting condition get access to health insurance even before the annual denial of preexisting conditions basically kicks in. that's $5 billion for federal support for high-risk pools providing affordable coverage to uninsured persons with preexisting conditions. that takes effect right away. second is reinsurance for retiree health benefit plans. basically that means that for --

there's immediate access to federal reinsurance for employer plans providing coverage for early retirees between the ages of 55 and 64. essentially that means that the reinsurance, extra dollars are available for the outliers. that's a fancy term of saying the high-cost people in that age group, 55-64. in addition, we extend dependent coverage for young adults. today, you know, families provide health insurance for themselves and their kids and once the child is age 21, no more health insurance. we raise that level to 26 so a person could stay with the family and still have the family's health insurance. moreover, this legislation requires that the health insurance provide prevention and wellness benefits, but no deductibles and no cost-sharing requirements. that too will help quite a bit. we all -- the legislation --

that takes care right away. moreover, right away, 2010, the legislation prohibits insurers from imposing annual and lifetime dollar limits. that takes effect right away. not later, not 2014, but right away. prohibition against insure urs from imposing annual or lifetime limits. big problem today. moreover, this legislation will stop insurers from nullifying or rescinding health insurance policies when claims are filed. rescissions are a big problem today. 2010, this legislation passes, no more rescissions of health care policies. moreover, this legislation sets minimum standards for insurance overhead costs to ensure that most premium dollars are spent on health benefits. not costly administration or executive compensation and profits. we also require disclosure of overhead and benefit spending and premium rebates. that's right away. what about small business persons? small businessmen?

this legislation offers tax credits to small businesses with low wages to make covering their workers more affordable. it takes affect in 2010. credits for up to 50% of insurance premiums be available to firms that choose to over coverage. i might also say that we -- there is stronger small business provisions too i'm quite certain will be in the managers' amendment, that is, greater incentives to the tune of about $12 billion to $13 billion for small business will be in this legislation and will also be in the managers' amendment. moreover, what takes affect next year, not later? we impose a coverage gap in the medicare drug benefit. that basically means we close the doughnut hole. we're starting to close the doughnut hole. seniors pay very high prices for brand-name drugs if they're in that so-called doughnut hole. we close it so seniors don't have to pay those high prices anymore. as public access to information,

more transparency. i could go on and on and on. there are many provisions which take effect right away and not the later date. mr. president, i believe that debate is drawing to conclusion on the four matters under consideration. we may be able to have votes as soon as 5:30 and i see my colleagues from kansas and iowa on the floor and i yield the floor. mr. brownback: mr. president? the presiding officer: the senator from kansas. mr. brownback: mr. president, i ask for five minutes of time off of senator mcconnell's time, the minority leader's time, the republican leader's time. the presiding officer: without objection. mr. brownback: thank you, very much, mr. president. i thank my colleagues for this opportunity to address the lautenberg amendment, in favor of the lautenberg amendment. i oppose the base bill, i oppose the health care bill overall. i've spoken a number of times on the floor in opposition to the overall bill. it's way too expensive, cuts medicare, raises taxes, inserts the funding of abortion in.

it's something we haven't looked at for 30 years because we've had hyde language that they've not funded -- that we've not funded abortion and instead this does and puts it in and it's going to i think result in poorer health care for a number of americans. the issue i rise on today is on the lautenberg amendment and in support of the lautenberg amendment. this is an amendment that we have seen in this body four times previously over the last ten years. each time the lautenberg amendment has passed overwhelmingly and that's because of the safety concerns for drugs coming into the united states. i would note the secretary of h.h.s., health and human services, secretary sebelius, most recently before this position, governor of the state of kansas for the past six years in that position and then most recently named secretary at h.h.s., i've worked with secretary sebelius over the years. through her office, they have stated they cannot basically certify the safety of these drugs. and there's a letter that's been

gone over with at some depth and length from the food and drug commissioner saying they won't -- it's going to be very difficult for them to certify the safety of these drugs. and yet what the lautenberg amendment does is say okay, if you can certify safety and this is going to reduce price, then they can be admitted. that seems to make sense. that's why four times over the last ten years this body has passed a lautenberg amendment type of equivalent, and i think that's appropriate. i would also note that there is a huge industry in the united states, the pharmaceutical industry, that's quite concerned about the safety and efficacy of what this bill would do in not allowing the safety of the drugs, if you don't pass the lautenberg. they're very concerned about that. and towards that regard, i would enter -- i would just read from piecepieces of a letter put to y kansas bio-- the kansas biosciences organization. they sent this letter to me saying, "on behalf of the

members of kansas bio, please accept in letter in opposition to senator lautenberg's amendment to the -- to senator dorgan's health care amendment. we believe that the drug importation is an extremely is threatening endeavor. the service providers to our nation's and our world's drug development and delivery companies." kansas bio is an industry organization representing over 150 bioscience companies, academic institutions, state affiliates and related economic development organizations. in the state of can canned, throughout the kansas city region, senator dorgan's amendment opens up the risk of allowing foreign drugs that do not have f.d.a. approval in the united states and thereby posing significant health and safety risks to the patients." it is signed by the president and crow of kansas bio authority. i'm ranking member on the senate appropriations subcommittee on

agriculture, rural verntle and foofood and drug administration. i am keenly interested from the committee structure in this issue. in addition, the university of kansas in my state -- in addition to having the top-ranked basketball team in the country -- has athe a top-ranked pharmaceutical company in the country. they're concerned about the dorgan amendment in place. that's why they support things like the lautenberg amendment which ensure -- assured two things. that you have safety and that any value in this proposal is passed along to the consumer. the f.d.a. has been tasked with the responsibility of safeguarding this country's prescription drug supply and has executed that responsibility, i believe, quite well. it would be unwise for this body, then, to not value their opinions in regard to this matter. the lautenberg amendment counts on the f.d.a. expertise and proven track record and permits legal importation of

prescription drugs into the united states only if the secretary of health and human services, secretary sebelius in this administration, as head of the f.d.a., can certify to congress that prescription drug importation will do two things, pose no additional risk to the public health and safety and result in a significant reduction in the cost of covered products to the american consumer. the safety and cost savings certification amendment would restore this language. the lautenberg amendment does that. this congress must require a safety and cost-savings certification from the secretary of h.h.s. before opening the floodgates of drug importation. requiring this certification is the responsible way to ensure that american citizens will be protected from potentially life-threatening counterfeit, contaminated, or diluted prescription drugs. now, as i mentioned, the senate has voted on this previously four times. each time overwhelmingly adopting something like the lautenberg amendment.

many of my completion may remember the safety and cost savings certification was first signed into law when the senate passed the medicine equity and drug safety act of 2000. during that debate, concerns were raised by many in this body that drug importation would expose americans to counterfeit and polluted prescription drugs. to alleviate these well-documented fears, the senate passed this second-degree amendment then unanimously. unanimously. to date, as noted earlier, no h.h.s. secretary has been able to certify that the drugs do not pose a significant health and safety threat. for those reasons, i support the lautenberg amendment. i yield the floor. a senator: mr. president? the presiding officer: the senator from new jersey. mr. lautenberg: yeah, mr. president, i -- i think we have some time available, and i

would like to continue with some remarks. i thank the senator from kansas for his remarks and his concern also about the efficacy and the safety of drugs that might reach our citizens. and i listened carefully to the remarks of my colleague from north dakota and where he said the principal focus of our amendment is to protect the profits of the drug companies. no, i want to protect the health and the well-being of the american citizens. and i look at an industry that has a prolonged life expectancy,

has made life more productive and pleasant for many whose disabilities may have them imprisoned in their homes. and when we look at what has happened over the years and where conditions like malaria and polio and small pox and antibiotics and chemotherapy have been continued to be developed primarily by american drug companies. those who have the reputation for bringing the best products to market, most carefully scrutinized and most effective. and so what i want is for those products -- for those companies to continue to be developed, that will extend wellness and will continue to improve longevity. and i continue to want these products to be available more

reasonably, more cheaply, more affordable. i had an experience in my life, mr. president, and people have heard me talk about this at times, but my father caught cancer -- was disabled with cancer when he was 42 years old, and our family was virtually bankrupt as a result of the cost for drugs and hospital service and physicians, and so i know how valuable -- and my father had cancer, and i've seen what's happened now with the opportunities for us. some optimism in cases -- in situations where cancer develops. so we're not looking -- we're looking to make these products, these drugs, more available, more affordable, and the thing

that strikes me, mr. president, as we review where we are in the development of a new health ban -- or a reform of the existing health programs. and i hear the criticism coming from people who have indicated they really don't support a health -- a more available health product, that they talk about the -- what happens with the -- when votes come about that moves the health care bill along. there's absolute obstinacy that prevails with many of our friends on the republican side. and so, mr. president, i looked at what good, proper products can do. the hope that we have for

childhood diseases that are so painful to see, and we look for improvements in those, whether it is autism or diabetes or other conditions. we want desperately for our companies in this country of ours to continue to develop -- or companies anywhere. but when they come to this country, we have to know that they're safe because there is nothing that can excuse the sacrifice of safety for whatever discounts you might get on the product, products that have been noted can kill you if they're the wrong formula or contaminated product. and so, mr. president, our differences between the dorgan and lautenberg amendment boils down to one word: safety. know that when you open the

bottle, when you take the liquid, that you're not doing or that you or your children or your loved ones aren't doing something that harms their health. they owe that feeling of security and comfort, as they try to cure themselves of sickness or disease. and that's what we're looking about here, mr. president. and i hope that my colleagues will stand up and say, no -- no, no, don't do -- don't let these products come in without the tightest scrutiny that can be developed, without the most secure process of production and shipment can be exercised. and so with that, mr. president, i yield the balance of my time. the presiding officer: who yields time?

the presiding officer: the senator from montana. mr. baucus: mr. president, may i ask how many minutes i have remaining? the presiding officer: 15. mr. baucus: mr. president, i yield myself minutes to my good friend from iowa, who i think is going to be speaking against my position, but he is a good fellow, so he should have five minutes. mr. grassley: this is typical of the comity of the united states senate, and i thank my good friend for doing that. i have a little different view on some of the things he said about taxes here, and i respect his giving me some time because we don't have time on this side. so it is nice of his doing that. republicans and democrats are working off of the same data provided by the joint committee

on taxation. for some reason, my friends on the other side of the aisle seem to want to read this data selectively, so i'd like to look at this data. and i want to stress that this data is from the nonpartisan joint committee on taxation. they're experts. they're nonpolitical people that tell it like it is. so, i -- my friends on the other side are correct in one thing. this bill provides a tax benefit to a small group of americans, and you can see right here that this benefit is to the people here where the minus sign is in front of the numbers. and these numbers are in white. as i pointed out previously, when you see a negative number on this chart, the joint committee on taxation is telling us that these people are receiving a tax benefit.

this income categories -- the income categories where you see these negative numbers begin at zero and stretch to $50,000 for individuals and $75,000 for families. that would be $50,000 and $75,000. so i want to give my democrat friends credit for being on the right side -- or right on this part of the data. but i want to show you where i disagree with them and their choosing to overlook other parts of the data. and the data i'll soon refer to here on this chart. when we see negative numbers on this chart, as i've said, the joint committee on taxation is telling us that there is a tax benefit. so conversely, where there are positive numbers -- this would be an example of positive numbers -- the joint committee on taxation is telling us that these taxpayers are seeing a tax

increase. so those numbers i've already pointed to. they begin at $50,000 for an individual and go up to $200,000 for an individual. when we see a positive number, then it's reversed. the joint committee on taxation is telling us that these taxpayers are in fact seeing tax increases. so if we see positive numbers for individuals making more than $50,000 and we see positive numbers for families making more than $75,000, it's just this simple: we know that these people's taxes are going to go up. the joint committee on taxation is telling us that taxes for these individuals, once again, for a third time, will go up under this 2,074-page reid bill.

these individuals and families are making less than $200,000, and what's significant about less than $200,000? it is that this violates what the president promised in his campaign, that individuals that are middle class under $200,000 are not going to see one dime of tax increase. so to come to any different conclusion is saying that the data on this chart and, of course, the professionals at the joint committee on taxation, that both are wrong. to come to any different conclusion is saying the chart produced by the joint committee on taxation is wrong. i yield the floor and thank my colleague for the time he gave to me.

pwau mr. president? the presiding officer: the senator from -- mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: how much time is remaining? the presiding officer: 11 minutes. mr. baucus: 11 minutes on this side. does anyone have remaining time? the presiding officer: the senator from idaho, mr. crapo, has 3 minutes. the republican leader, 3 1/2. the senator from north dakota has 7 1/2. the senator from new jersey, i think he yielded his time back. the senator from new jersey, one minute. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i yield myself five minutes. the presiding officer: without objection. mr. baucus: mr. president, i'd like to make it very clear,

essentially this legislation does several things. this is the core part of this legislation. what is it? first, this legislation very significantly reforms the health insurance industry, especially for people who individually buy insurance, and also for people who buy with a small company and even who buy insurance with a large company. it's insurance market reform. it stops insurance companies from, frankly, undertaking practices which i think are very un-american, if you will. that is denying people coverage based on preexisting condition, denying them health insurance because they have some kind of preexisting something. that's ridiculous. or saying you can't have health insurance because some other health care status. or saying we'll give you a policy, and a month or two months later rescind it

willy-nilly. or putting in these very restrictive limits on what the company will pay during your lifetime or what the company might pay in health insurance benefits for a year. in addition, in this legislation reform is called rating the states have. states basically can charge whatever they want and allow companies to charge whatever they want if you're a little older compared with you're younger, if you're a woman compared with if you're a man, lots of different ways states allow health insurance companies to rate, that is charge. it's wrong. number one, insurance market reform. this legislation stops some of the outrageous practices insurance companies practice today. number two, this legislation begins to get control over health care costs in this country. we have to, mr. president, start to get control over health care costs.

this legislation does so. it also is deficit-neutral. that is, it does not cost one thin dime for us to enact this legislation. it's all paid for. i might also said sa*eu it provides health insurance coverage for about 31 million americans. 31 million americans who currently do not have health insurance today will have health insurance if this legislation passes. i don't have to remind all of us of the importance of health insurance. insurance market reform, lowers the cost of health care in this country, provides full coverage and i think equally important, begins to put in place called delivery system reform. that's kind of wonkish. i think one of the most parts of this bill, namely, change the way we start to pay doctors and hospitals, on quality rather than quantity. start to put into effect different systems that sound kind of wonkish but will be very important over three or four or

five years. it's bundling. it's group home. it's reducing, lowering the practice of hospitals that readmit too quickly after a patient is discharged. there's so many reforms here. i strongly urge everyone to keep his eye on the ball. insurance market reform in this legislation, lowering costs in this legislation, lowering taxes in this legislation, insurance coverage for 31 million americans today who do not have it and start to put in place payment reforms which are going to help get this country on the right path so that after several years we have a health care system that we're all very, very proud of, one that gets rid of all the waste we have in our country today. we pay $2.5 trillion a year in health care, about half public and half private. people who study this say we waste between as much as $800 billion a year. not million.

billion a year in fraud, in waste, dollars that don't go directly to health care. this legislation starts to get a handle on that. it stops all that waste, gets a better handle on that fraud so after two or three or four years, something we're very proud of. mr. president, remind ourselves again, if we don't do this, pass this legislation, we'll rue the day we didn't because we'll have to start all over again two or three or four or five years from now, and the problems will be much worse. cost for families is going to be much greater. cost to american businesses much greater. our budgets will be in much worse shape. medicare and medicaid -- this legislation, by the way, extends the solvency of the trust fund for another, i think it's nine years. remember the bottom line here. remember the basics. let's not get too caught up in the details and the weeds and get extracted by stuff that's not in the core provisions of this bill.

the provisions i outlined i think are compelling reasons why this legislation must pass and why it would be so good for america. and i reserve the balance of my time. a senator: mr. president? the presiding officer: the senator from idaho. mr. crapo: mr. president, i ask unanimous consent to use the balance of my time as well as that of the leader, the republican leader. the presiding officer: without objection. mr. crapo: thank you so much, mr. president. i'd like to respond to a couple of points that have been made about whether this bill truly addresses what the american people are asking it to address. if you ask most people in america what they want in health care reform -- and they do want health care reform -- what they will tell you is they want to see some control over the skyrocketing costs over health care, particularly the skyrocketing costs over insurance premiums. and they'd like to see increased access to quality medical care. it's been said a number of times by the proponents of this legislation that this bill accomplishes some of those objectivities but let's look at what the congressional budget office told us on the core

issue, namely, what's going to happen to your insurance premiums if this bill is passed. and what the congressional budget office very clearly said, which is also backed up by seven or eight or nine or ten other studies in the private sector as well as the joint committee on taxation and was backed up further by the chief actuary for the medicare and medicaid services, is that for at least 30% and the most vulnerable people in america, if you are looking at whether your insurance premiums are going to go up or down, they're going to go up, not down. if you're a member of the 17% of americans who get your insurance in the individual market, your insurance is going to go way up. in fact, it's going to go up by as much as 10% to 13% in addition to what it would have gone up without the bill. if you are someone who gets your business from small groups, from a small-group market, your insurance costs are going to go up from 1% to 3%. and if you're one of the americans who is able to get your insurance in the large-group market, then you can

basically expect that the bill will have no significant impact on you. there is a possibility of a slight reduction, but the potential is really that it's just going to have no impact at all. so what does the bill do? for 17% of americans in the individual market and for 13% of americans in the small-group market, it clearly makes your legislation -- your health care premiums go up. and for those who are in the remainder of the market, it basically doesn't achieve the objective of health care reform. and at what price? we often hear that we need to bend down the cost curve. well, as i've indicated, mr. president, this legislation doesn't bend down the cost curve americans are talking about, namely, the price of their health care or their health insurance. what does it do with regard to the federal government? well, it's going to increase the cost to the federal government of health care by $2.5 trillion of a massive new entitlement program. so that price curve is not bent

down. and then what are we left with? some say, well, the deficit is going to go down under this bill. there's only one way the deficit can go down under this bill, and that is if you take away the budget gimmicks, the massive tax increases and the massive medicare cuts. but just -- i'll just talk about the budget gimmick because of the lack of time. the spending side of this bill is delayed for four years. the taxing and cutting, kphaeurl cutting side of the -- medicare cutting side of the bill is implemented on day one. we have ten years of tax increases to offset six years of spending. i think that's the way the number was reached. you have to figure out how many years to delay the spending start before you can say that there was a deficit-neutral bill. the reality is this bill doesn't deal with any of those tax curves -- those spending curves. now, the amendment that we'll be voting on in just a few minutes here is my amendment that would simply address the tax side of the bill. and all it says is let's change

the bill to comply with the president's promise, namely, that people making less than $200,000 a year individually or $250,000 as a couple would not pay more taxes. what we found from the joint tax committee is it analyzes this bill is that 73 million americans in that category will pay more taxes. in fact, it's not 73 million americans. it's 73 million american households that will pay more taxes and see a tax increase under this bill. and not just a small one. it's a massive, hundreds of billions of dollars of new taxes that will be imposed by this bill. in response the proponents of this bill say this bill really is a tax cut. the only way they can say this bill is a tax cut is by looking at the subsidy that is going to be provided, and that subsidy is as congress interestingly does, described as a tax cut. it's called refundable tax credit, although three-fourths

of it, 73% to be accurate, goes to people who do not pay taxes. yet, it is called tax relief because it's administered through the tax code and is described as a refundable tax credit. the c.b.o. gets this and americans get this. the congressional budget office says these aren't tax cuts. this is spending, and it is scored that way by the congressional budget office as it analyzes the bill. and the only way you can say that this bill involves these kinds of tax cuts is if you say that a provision that will simply result in the payment of a check by the federal government to an individual who has no tax liability to a system with their health care costs is a tax cut. well, let's accept that. even in that case, only 7% of americans qualify for that subsidy, and the rest of the americans qualify for the tax increases. and to say that the president's promise was that i won't cut your taxes more, or i won't

increase your taxes more than i will cut someone else's taxes -- and by the way i'll call a direct subsidy a tax cut -- is not exactly what i think the president meant. it's definitely not what the american people thought he meant when he said that americans making less than $200,000 or $250,000 as a family would not pay more taxes under this bill. so again, my proposal simply says send this bill back to the finance committee. they can turn it around quickly if they want to, and have them take out the provisions that violate the president's pledge on taxes. and with that, mr. president, i reserve the balance of our time. a senator: mr. president? the presiding officer: the senator from north dakota. mr. brown: mr. president? the presiding officer: the senator from ohio. mr. brown: thank you. i thank the senator from north dakota. i rise in support of the amendment on re-importation. this is not about importing drugs from china, india or mexico where drug safety

standards are not up to par, although american drug companies have outsourced a lot of their manufacturing to those companies and found all kinds of problems with the ingredients that they import into american drugs. but that's not the issue here. that only underscores the hypocrisy of u.s. drug companies in imposing the dorgan amendment. most importantly, this is about importing drugs from countries like germany, canada, new new zealand and japan. these are consumers in these countries, patients in england, france, germany and new zealand. those patients have the same protections we do. i've been in drug stores in canada, just two hours from toledo, ohio, less than that, and you see the same drug in the same dosage, the same packaging, the same company making them. and in those -- in canada, they're 35% to 55% lower than the summit.

one drug, cholesterol lowering drug, lip to, $63 in the netherlands, $32 in spain, $40 in the united kingdom. every one of these countries, $30, $40, $50 for lipitor, same drug, $125 in the united states. we pay more even though most of the -- in most cases these drugs are either manufactured in the united states or developed in some cases by u.s. taxpayers and developed certainly in the united states for americans, but we pay two and three times more. 2009 consumer report survey found due to high drug prices, one out of six consumers failed to fill a prescription, 23 consumers cut back on groceries. they choose between do i get my groceries or do i pay for this

drug? consumer after consumer will put their pill in half and take one part today and one part the next day which is not what their doctor says they should do. we know this isn't good for american's health. we know this isn't good for america's pocketbooks. it's not good for the taxpayer, not good for small business or big business, the large companies paying the freight, paying these costs, it is american consumers, taxpayers, and businesses are suffering from the high costs. pharmaceutical hike up prices and rake in massive profits. they're one of the three most profitable industries. the pharmaceutical industry in 2008 recorded excess sales of dz -- this isn't a bad year, a bad year for most of us in this country. in 2008, the -- the presiding officer: the senator's time expired. mr. brown: i ask my colleagues to support the dorgan amendment. a senator: mr. president?

the presiding officer: the senator from montana. mr. baucus: mr. president, i ask unanimous consent that at 6:00 p.m. today the senate proceed to vote in relation to the amendments and motion specified in the order of december 14 regarding h.r. 3590. that prior to each vote there be two minutes of debate equally divided and controlled in the usual form. after the first vote in the sequence, the succeeding votes be limited to 10 minutes each. further all that provisions in the december 14 order remain in effect. the presiding officer: there objection? without objection, so ordered. a senator: mr. president? the presiding officer: the senator from north dakota. mr. dorgan: mr. president, some issues that we deal with near the senate are unbelievably complicated. this one is not. this one is painfully simple. the question of whether the american people should be charged and continue paying the highest prices in the world for brand name prescription drugs. my amendment says no. from other countries where there is a safe chain of custody identical to ours, the american people ought to have the freedom

to shop for the lower-priced drugs that have sold there at a fraction of the price, f.d.a. approved drugs. i want to thank senator begich from alaska for his work. this is bipartisan. a broad number of democrats and republicans work on the reimportation of prescription drug bill, giving the american people the freedom to acquire low-priced drugs. senator begich has been a significant part of that. i wanted to say thanks to him on this amendment. a senator: mr. president? the presiding officer: the senator from alaska. mr. begich: i appreciate your comments. i think you're right. out of all of the complex bills, this seems so simple. when i was mayor, we worked on this issue, it seems logical, since we border canada, it seems logical. i know you stated these comments before, i think it is important for, especially my viewers, who are watching from alaska, because there is a four-hours difference. there is a savings to taxpayers very clear here. there are savings to the

consumerrer, which is important. remind me of the numbers. but i want to be sure i have them as i talk about this bill. mr. dorgan: mr. president, this amendment will save $100 billion in 10 years. nearly $20 billion for the federal government and nearly $08 billion for the american consumers. mr. begich: that's what this health care bill is all about. it's not only about getting quality care, it is about finding opportunities, as we heard one senator talking about bending the cost curve, it's impacting the consumer in a positive way by $80 billion. the other thing i heard a lot on the floor that you talked quickly about and that is the chain of control. which, you know, i drove here 19 days with my family through canada, five days, we bought some drugs, we -- i had a cold. i'm still here. i'm standing. i'm healthy. tell me again. remind me about that chain of control on these drugs an where these produced. mr. dorgan: mr. president, i would say to the senator from

alaska, these prescription drugs would be able to be reimported from australia, new zealand and european countries that have an identical chain of custody to our chain of custody so there is safety. we're in politics so on the floor of the united states senate is the place of a lot of tall tales. i understand that. mr. begich: i'm learning that as a new member. mr. dorgan: early on, one of my colleagues said this is about untested, unregulated drugs coming from parts of the soviet union. that is so unbelievable. it's not describing an amendment that i offered. nothing on the floor that i'm aware of. we're talking about a chain of custody identical to the u.s. when that's the case, if it's the case, why would the american people not have the freedom to acquire that same drug when it's sold at 1-teth or 1 half the price? mr. begich: i have one last question. even though we didn't ask for a colloquy, this is kind of a

colloquy. i appreciate the back and forth. this is one reason why i support this bill is for all the reasons that you laid out, the control is there the protection for the consumer is there. the savings to the consumer and the taxpayer are enormous. as we deal with these issues. if there's one thing i heard over and over again through e-mails and correspondence to my office is, help us save on prescription drugs. to emphasize that point, and i want to make sure that i have the numbers right, over 10 years, from the federal government to the consumer it is $100 billion. mr. dorgan: mr. president, the savings is $100 billion. i want the pharmaceutical industry to do well, to make profits, to make prescription drugs. i just want fair pricing for the american people. i don't have a beef with the industry. i want them to do well. i want them, however, to give the american people fair prices because we are paying the highest price in the world for brand name prescription drugs and i think it is unfair. this amendment will fix that. there's a competing amendment that nullifies it. that says all of this will go

away and we're done with this bill and nothing has happened fought the brakes on prescription drug prices. i hope my colleagues will stand with me and the american people to say that we support fair drug prices for the american people. that's what we're going to vote on in a few minutes. i appreciate the questions from the senator from alaska. mr. begich: thank you, mr. president, thank you to the senator from north dakota for the clarification on the questions and how important this is to those in alaska. the presiding officer: the senator's time has expired. the senator from montana. mr. baucus: mr. president, i just ask -- just a parliamentary inquiry here. the -- the order just entered provided for two minutes equally divided before i suppose each of the amendments. is that in addition to or is that a part of -- of the time that's been allocated to senators? the presiding officer: in addition to. mr. baucus: thank you.

the presiding officer: the senator from montana has five minutes remaining. mr. baucus: so if the senator from montana wishes to speak on his amendment, he has five minutes plus two minutes? the presiding officer: five minutes plus one minute. mr. baucus: excuse me equally divided. thank you. mr. president, i just want to make it as clear as i can, that the congressional budget office essentially says their premiums will go down for about 93% of americans. i say that because my good friend from idaho, i think was leaving a different impression. let me summarize what c.b.o. says. and i put a chart that will be provided in the record, but under the senate rules, we can't put charts in the record. i'm going to summarize what this chart says. 70% of americans get their health insurance from the large group market. that is, people work for larger employers. 70%. and c.b.o. said for that 70% of

americans, premiums will go down a little bit. that up to about 3% reduction of premiums. the next group of americans who get health insurance, it's called the small group market. that is small companies, small business. that is 13% of americans get their health insurance. c.b.o. says for that 13% that it will be maybe premiums will go up between 1% or down 2% overall, but for those folks who get small business people who get tax credits, and there's very significant tax credits in this bill, and i think they'll be even more significant when the managers' amendment is up. c.b.o. said with modest tax credits those premiums will go down 8% to 11%, as 13% of americans who have insurance, those premiums will go down 8% to 11% among those who have credit. look at what's called the nongroup market, individual market, that's 17% of americans.

for those folks, if you compare their current insurance with the -- what they'll have in the future, those premiums will go down 14% to 20% down, according to the c.b.o. iin addition, c.b.o. says that persons who have tax credits, we're talking about the individual market, those people will find on average their premiums will go down 56% to 59%. remember, 17% americans buy insurance individually. that 17%, 10% because of tax credits in this bill will find their premiums go down 56% to 59%. the 7% remaining -- remember i said 93% reduction. the 7% remaining will find that because of better benefits their premiums will go up 10% to 13%, but they'll have a lot better benefits. a lot higher quality insurance than they'll have today. frankly, my judgment is that the quality -- higher quality of

insurance they have, because of this legislation, will outweigh the increase in the premiums. but anyway, 93% premiums will go down. mr. president, let me just speak a little bit on my amendment which as i understand could be the first amendment voted on. remind my colleagues that this is a tax cut bill, it cuts taxes. it cuts taxes very significantly. over the next 10 years, this bill will provide americans a $441 billion tax cut to buy health insurance. $441 billion in tax credits to buy health insurance. credits or tax reductions. in the year 2017, taxpayers earn by dz 20dz thousand to -- $20,000 to $30,000 will see an average tax cut of 30%. they will see an average tax cut of 37%. that is from the joint committee on tax. in addition two years later the

average taxpayer making less than $75,000 a year will receive a tax credit of $1,500. just to repeat, the average taxpayer making less than $7,500 a year will receive a tax reduction or a tax credit of more than $1,500. the crapo motion is an attempt to kill health care reform. it is to keep americans from getting these tax cuts. i think we want americans to get the tax cuts. in the crapo motion is successful, the people will not get the tax cuts. i think we should reject this procedural maneuver designed to kill tax cuts in this health care bill. and that's what my side-by-side amendment says, and that is the first amendment, that is, let's vote to keep the current tax cuts and i urge my -- a vote on that positive and a vote no on the crapo which is -- which eliminates the tax cuts that's not what i think most americans want. i urge my colleagues to vote for

the sid side-by-side amendment. mr. president, i yield the floor. the presiding officer: under the previous order there will be two minutes debate equally divided prior to voting on the baucus amendment. who yields time? a senator: mr. president? the presiding officer: the senator from mississippi. a senator: i ask unanimous consent that my remarks on this legislation be printed at this point in the record. the presiding officer: without objection. the presiding officer: the senator from idaho. a senator: mr. president, i'll just take one minute on this and i think we're ready to vote.

mr. crapo: there are two contrasting amendments here. the senator from montana indicated that my amendment, which simply asks the finance committee to make this bill comply with the president's pledge, would somehow kill the bill. that's not at all true. and, secondly, that it would stop the tax relief in the bill that the senator from montana has identified, the refundable tax kruts. the bottom line is -- credits. the pop line is that -- the bottom line is that all my amendment does is say, let's have the president's pledge to the american people honored in this legislation. let's take out the taxes that 73 million american households will say under this legislation. hundreds of billions of dollars of new taxes. a senator: mr. president? the presiding officer: the senator from montana. mr. baucus: essentially the crapo amendment is a motion to recommit the -- the underlying bill, the pending bill to the

finance committee, take out all the tax cuts. that's what it is. so i oppose it. i urge senators to vote for my amendment, which is a sense of the senate that the senate should reject such procedural motions basically because we want to keep the tax cuts that are in this bill. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. vote: a

a vote:

the presiding officer: is there anyone wishing to vote or change their vote? hearing none, on this vote, the yeas are 7, the nays are 1. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is agreed to. the presiding officer: under the previous order, the motion to reconsider is considered made and laid upon the table. the senate will be in order.

under the previous order, there will now be two minutes of debate equally divided prior to a vote in relation to the crapo motion to commit. the senate will be in order, please. take your conversations out of the well. mr. baucus: madam president, the senate still is not in order. moor nad? the presiding officermadam prese senator from idaho. mr. crapo: madam president, this is a very simple vote we're going to have now. this is the amendment that will correct the bill to comply with the president's promise not to tax anyone who makes over $200,000 as an individual or $250,000 as a family. the previous vote we just had, i think it was a unanimous vote for it, simply said to take the tax relief out of the bill. we've had plenty debates what tax relief is or isn't in the bill, but this is the vote that will say let's fix the bill and

take out the hundreds of billions of dollars of taxes that are going to fall squarely on the middle class. mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: madam president, the crapo motion to commit is an attempt to kill health care reform. if it succeeds, it will keep 31 million americans from getting health care coverage. if it succeeds, it will keep americans from getting the tax cuts in this bill. if the crapo motion succeeds, over the next ten years, americans will get $441 billion less in tax credits to buy health insurance. i urge we do not vote in favor of the crapo motion. i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote? hearing none, on this vote, the yeas are 45, the nays are 54. under the previous order requiring 60 votes for the adoption of the this motion, the motion is withdrawn. under the previous order, there will now be two minutes of debate equally divided prior to a vote in relation to amendment number 2793, as modified, offered by the senator from north dakota, mr. dorgan.

mr. dorgan: madam president, the senate is not in order. the presiding officer: the senator from north dakota. mr. dorgan: the senate is not in order. the presiding officer: the senate will be in order. mr. dorgan: madam president, this amendment is about fair pricing for prescription drugs for the american people. a colleague of mine just came up to me and said, my daughter takes nexium. costs her $1,000 a month. i said, well, i happen to have a chart about nexium here. this illustrates better than i know how to illustrate the difference in pricing. here's what nexium costs. $424 worth of nexium in the united states is sold for $40 in great britain, $36 in spain, $37 in germany, $67 in france. now, if you like this kind of pricing where the american people pay the highest prices in the world for prescription drugs, if you like this kind of pricing, then you really ought to vote against this amendment. but this amendment is bipartisan, republicans and

democrats, over 30 members of this senate have supported this approach, saying let's provide fair pricing for a change for the american people. we shouldn't be paying the highest prices in the world for prescription drugs. all i ask is that you support this amendment to give the american people the opportunity for fair pricing, for a change. the presiding officer: the senator's time has expired. a senator: madam president? the presiding officer: the senator from new jersey. mr. menendez: madam president, i rise to oppose the dorgan amendment. let's be clear. there are those who want to did i minimize safety. but the one entity in this country who's sphorlgt safety of food and drugs is the f.d.a. and commissioner hamburg has mentioned in her letter of all of the potential risks of the dorgan amendment. secondly, we've heard about the european union, as an example of why we should permit reimportation. what did we here hear from the european community last week? that this just two months they seized 34 million fake tablets in all member countries and that

this was beyond their greatest fears. thirdly, how do we create affordability? by closing the doughnut hole and this amendment will not do that. it will undermine that. and, finally, finally, senator lautenberg's amendment, which comes up after this, is the one that permits reimportation, but takes care of the safety issues that the f.d.a. has said is critical. we want to make sure when you buy that nexium that what you get is the substance and the quality and the quantity that you bought, not something less that can undermine your health. vote against the dorgan amendment. the presiding officer: the senator's time has spirted. the senator's time hats expired. -- the senator's time has expired. is there a sufficient second? there appears to be. the clerk will call the roll. vote:

vote:

the presiding officer: is there anyone wishing to vote or

wishing to change their vote? hearing none, on in vote the yeas are 51, the nays are 48. under the previous order requiring 60 votes for the adoption of this motion, the motion is withdrawn. under the previous order, there will now be two minutes of debate equally divided prior to a vote in relation to amendment number 3156, offered by the senator from new jersey, mr. lautenberg. the senate will be in order. a senator: madam president? the presiding officer: the senator from new jersey. mr. lautenberg: madam president, may we have order, please? thank you. madam president, this -- this is a simple solution to a complicated problem.

my amendment contains the dorgan amendment, the work that our friend from north dakota is significant. but what it did not have is a guarantee, as much as possible, that the product was safe, that there were no counterfeits, that there were no mixture of things that might not work -- well with other drugs. and it -- and it adds a simple requirement that imported drugs be certified as safe by the health and human services secretary. so i hope that we'll be able to pass this including the -- which will include the dorgan amendment and make sure that the products that get here, no matter what the price could be, if it's not safe, it's worthless, and we want to be sure that every product that reaches our shore is safe to take and -- and will operate at more reasonable costs. the presiding officer: the senator's time is expired.

a senator: mr. president? the presiding officer: who yields time in opposition? the senator from north dakota. mr. dorgan: the senate's not in order. the presiding officer: the senate will please be in order. please take your conversations outside. the senator from north dakota. mr. dorgan: madam president, we've all seen this movie before. we've had these votes before. all i say is this: the pharmaceutical industry flexes its muscle and defeats an amendment for fair prices, fair prescription drug prices for the american people so we can keep paying the highest prices in the world and there's another amendment offered that seems like something is being done, when, in fact, nothing is being done, nothing will change. do not vote for this amendment and say you've done something about the price of prescription drugs because constituents will know better. if you believe at the end of the

evening, we should do nothing, by all means, vote for it. don't count me in on that vote. a senator: i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the electric will call the roll. -- the clerk will call the - roll. vote:

the presiding officer: are there any senators wishing to vote or to change a vote? hearing none, on this vote the yeas are 56, the nays are 43. under the previous order requiring 60 votes for the adoption of this amendment, the amendment is withdrawn. the senator from texas. mrs. hutchison: mr. president, i have a motion at the desk and ask that it be brought forward. the presiding officer: the clerk will report the motion. the clerk: the senator from texas, mrs. hutchison, moves to commit the bill h.r. 3590 to the committee on finance, with instructions. mrs. hutchison: mr. president, i ask unanimous consent that the reading of the motion be dispensed with. the presiding officer: without objection, so ordered. mrs. hutchison: mr. president, this is a motion that senator thune and i are putting forward, and it's a very simple motion. i think a lot of people don't realize that the taxes in the

bill that we are discussing actually start in about three weeks. they start in january of 2010. but the effects of the bill, whatever the proposals are going to be in the bill, whatever programs are available, will really not come into play until 2014. so the taxes will start this next year, and they will be paid for four years before any of the programs that the bill is supposed to put forward will be there. so the amendment that senator thune and i are putting forward merely says that the taxes start being collected when the bill is implemented. so whatever programs are being offered to the people of america, whatever insurance programs, whatever kinds of

benefits that there might be in the bill would start at the same time as the taxes start, so you're not going to be paying taxes before you have any options that you would be able to take in this bill. so it's simple, it's clear. we believe that if you pay taxes for four years before you see any of the programs in this bill, that the american people can't really be sure that there will ever be a program because there will be intervening congresses and an intervening presidential election that will occur before this bill is designed to start. 2014. we have congressional elections in 2010. we have a presidential election plus congressional elections in 2012.

and two years following that, 2014, is when this bill will be implemented. so really, mr. president, i hope that everyone will look at this amendment and support the amendment that -- that we're putting forward. it's a motion to recommit the bill, to fix this issue, that america should not be looking at higher drug prices, higher medical device prices and higher costs of insurance, all of which are the first taxes that will take effect. let's walk through it. starting next year, in january, three weeks from today, there will be $22 billion in taxes on prescription drug manufacturers that will start.

$22 billion on drug manufacturers. so the price of prescription drugs, aspirin, anything that people take will go up because the drug manufacturers are going to start paying a tax. $19 billion in taxes on medical device manufacturers, so the medical devices that we use to -- hearing aids, that we use to treat ailments will start being taxed to the tune of of $19 billion next january. and $60 billion on insurance companies starting next month. so that's about $100 billion in taxes that start in about three weeks, so that the insurance companies have probably already priced in the goashz -- in the goations that they are having --

in the negligences now that they are having with people about their premiums, i'm sure they will be locked in for a year or two or three or four, and therefore these rises in insurance premiums are probably part of this bill that we're dealing with right now. $60 billion in taxes that will surely be passed to every person who has health care coverage right now. so mr. president, here we are, health care reform that is supposed to bring down the price of health care in this country so that more people can afford it, and what is the first thing that we do? it's not offer a plan, it's not to offer any kind of program that would help people who are struggling right now because they don't have insurance. it's certainly not going to help people who are struggling to pay

their prescription drug prices because we're going to raise the price by taxing the manufacturers of drugs, of medical devices and the companies that are giving insurance today. so i think it is time that we talk about the high taxes that are in this bill, and what we're going to talk about in the hutchison-thune proposal, the motion to recommit, is to just say at least, the very least that we could do is not ask people to pay taxes for four years when you're going to have three intervening congressional elections before this bill takes effect. so things could change mightily, so all these taxes that are going to go into place might never bring forward the proposals that are in the underlying bill.

in 2013, one year before this bill is to take effect, the taxes on high-benefit plans go into effect. now, what is a high-benefit plan? a high-benefit plan is one that is a really good plan. many unions have these and many people who work for big corporations have everything paid for. they have the -- all of the employer regular in the order that most companies do payments, but they also allow in these plans to have most of the deductibles also paid for. they're very good plans. this bill will excise for those plans $149 billion, just cut it

right out, and have an excise tax on those good plans. $149 billion, and that starts in 2013. that's one year before the bill takes effect. so "so in 2013, one year before there is any new plan put forward, those who have very good coverage, whether it be someone who works for a big company or whether it's a union member will start getting a 40% tax on that benefit. so all of the things that have been negotiated are going to have a big 40% tax. that starts in 2013. in addition, in 2013, one year before the bill takes effect, there is a limitation put on itemized deductions for medical expenses. now, today if you spend more

than 7.5% of your income on medical expenses, you get to deduct everything over that. so if you have a catastrophic accident or you have a very expensive disease to treat or you're in a clinical trial, something that's really expensive, if you go above 7.5% of your income, you can deduct that. in 2013, under the bill that is before us, you would have to spend 10% of your income before you could deduct those expenses. that is another $15 billion that will be collected in taxes that are not collected today. the new medicare payroll tax which impacts individuals who earn over $250,000 or couples who earn $125,000 each would take effect in 2013.

that's $54 billion in taxes. so these are all the taxes that take effect before the bill do does, before there's any plan offered. you would have the tax that starts next month on insurance companies, pharmaceutical companies, and medical device companies, and then in 2013 you would have the tax on high-benefit plans, 40% tax on that plan, and then in 2013, the itemized deductions will not be allowed until you've paid 10% of your salary in medical expenses. the medicare payroll tax, which is going to impact individuals, all of this before there is a program in place. then in 2014 when the bill does come forward so that there are plans to be offered to people,

then you start the mandates on employers and the taxes if people resident covered. so you have $28 billion in taxes on employs that start in 2014 and these are the employers that just can't afford to give health care to their employees or they don't give the right kind of health care to their employees. so it's not the right percenta percentage. and if it's not the right percentage, then the employer pays a fee of $750,000 to $3,000 per employee. that's their fine. and then there is the tax on individuals who don't have health insurance and that's $750 per adult. so my colleague from south dakota and i will certainly want to spend more time talking about this and hope very much that our

colleagues will look at this. and i don't think this is what the american people thought that they would be getting in health care reform. of course, what we would hope that the american people would get in health care reform would be lower cost options that don't require a big government plan. they wouldn't require big taxes, they wouldn't require big fees. if we just had a lowering of the cost by allowing small businesses to have bigger risk pools, that wouldn't cost anything. it just would allow bigger risk pools that would provide lower premiums and employers would be able to offer more to their employees. most employers want to offer health care to their employees. it's just a matter of the expense. and the bill that we're debating now is going to give more

expenses and burdens on employers at the time when we're asking them to hire more people to get us out of this recession. everywhere i go in texas, when i am on an airplane, when i am in a store, grocery store -- haven't been able to do any christmas shopping, i must admit, so i haven't been in a department store, but theless, i do -- but nevertheless, i do go to the grocery store -- so i will say that everyone i'm talking to is saying, i can't afford this, what are you all doing. and i'm saying, of course, well, we're trying to sthop becaus toe we agree with you, that small business can't afford this. i was a small business person. i know how hard it is because we don't have the margins of big business, and it is very, very hard to make ends meet when you have all the mandates and the

taxes and when you're trying to increase your business and hire people, which is what we want them to do, you can't do it if you are burdened with more and more expenses, as this bill will do. so what senator thune and i are doing is making a motion to commit this bill back with instructions to come back with the changes that will assure that the implementation of this bill starts and that will trigger whatever programs are in the bill at the same time as whatever taxes and fees are going to be in this bill. now, i would hope that there would be fewer taxes and fees, but whatever your view is on that issue, it is a matter of simple fairness that you wouldn't start the taxes before you start the implementation of

the program it would be like saying i want to buy a house and the realtor says, well, fine, you can start paying for the house right now and in four years, you'll be able to move in. the house might be stricken by lightning, it might fall apart, it might blow up, it might have a fire, and that's exactly what could happen in this bill. this bill may not make it for four years when people see what's in it. there will be elections. and i just cannot imagine that we would establish a policy of taxing people for four years, raising costs, leading down this path that will eventually go to a public plan, that will end up

doing what was originally introduced in this bill and that is to end up with one public plan. it will take a little longer the way the bill is being reconfigured, but it is going to end up in the same place unless we can stop it by showing people that the mandates and the taxes are not good for our economy and they're not good for the health care system that we know in this country. because we have choices in this country. we have the ability to decide who our doctor is and what insurance coverage we want, when we want a high deductible or a low deductible. and that's not a choice that should be taxed. we shouldn't have someone tell us what procedures we can have. we should have the option of deciding that for ourselves with our doctors.

and that's what we want in health care reform. but that's not what's in the bill before us, mr. president. so i hope we can discuss the hutchison-thune motion to commit. we're going to work to try to make sure that everyone knows we want fairness in this bill so that people know what's in it. and i hope we will get whatever the new version of the bill is very soon so that we will have a chance to -- to see, maybe there are some changes that are being made. but in the bill before us, the taxes start next month and the bill is implemented in 2014, and on its fair, that's fundamentally unfair. and i hope our amendment is adopted so we can change it. thank you, mr. president. and i yield the floor. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll.

quorum call:

quorum call:

a senator: mr. president? the presiding officer: the senator from arkansas. mr. pryor: i ask that the quorum be dispensed with. the presiding officer: without objection, so ordered. mr. pryor: mr. president, i ask unanimous consent that the majority leader be authorized to sign any duly enrolled bill and joint resolution today, december 15. the presiding officer: any objection? without objection, so ordered. mr. pryor: i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

mr. pryor: mr. president? the presiding officer: the senator from arkansas. mr. pryor: i want to ask that the quorum call be dispensed with. the presiding officer: without objection, so ordered. mr. pryor: i ask unanimous consent that the senate proceed to the immediate consideration of h.r. 4154, just received from the house and at the desk, that the baucus substitute amendment be considered and agreed to, the bill, as amended, be read three times, passed, and the motion to

reconsider be laid on the table, that any statements relating to the measure appear at the appropriate place in the record as if read, and without further intervening action or debate. but, mr. president, i understand that the republican leader will object, so i will withdraw this request. the presiding officer: the question is withdrawn. mr. pryor: mr. president, i ask unanimous consent the senate proceed to a period of morning business with the senators permitted to speak for up to 10 minutes each. the presiding officer: without objection. so ordered. mr. pryor: mr. president, i ask unanimous consent that when the senate completes its business today, it adjourn until 10:00 a.m. wednesday, december 16, that following the prayer and pledge, the journal of proceedings be approved to date, the morning hour be deemed expired, the time twor the for the two leaders be reserved for their use later in the day, and the senate resume consideration of h.r. 3590, the health care

reform legislation, with the first hour equally divided and controlled between the two leaders or their designees, with the majority leader controlling the first half and the republicans controlling the second half. the presiding officer: without objection, so ordered. mr. pryor: mr. president, we expect votes tomorrow in relation to the hutchison amendment to commit -- excuse me, the hutchison motion to commit regarding taxes and implementation and the sanders amendment regarding the national single-payer system. senators will be notified when any votes are scheduled. if there is no further business to come before the senate, i ask that it adjourn under the previous order. the presiding officer: the senate stands adjourned until 10:00 a.m. tomorrow. adjourn:

the health care bill. we will also hear from connecticut senator joe lieberman and about his opposition to the expansion of medicare. after that, and the date on health care from earlier, and then we will hear from groups opposed to the senate health care legislation.

president obama said earlier that he is consciously optimistic about efforts to pass health care legislation and praise the latest moves by senate democrats. the president is joined by senate democratic leaders. this is just under ten minutes. >> hello, everybody. we just had a very productive session about the final stages of health care reform in the senate, and from the discussions we had, it's clear that we are on the press of this of an achievement that is diluted congress and presidents for generations. an achievement that will touch the lives of nearly every american. there are still some differences that have to be worked on. this was not a role call. this was a broadbased discussion about how we move forward, but

whatever differences remain, there is broad consensus around reforms that will finally, per one, protect every american from, worst practices in the health insurance industry. no longer will these companies be able to deny coverage if you have a pre-existing illness or condition. no longer will they be able to drop you from coverage when you get sick. no longer will you have to pay unlimited amounts out of your pocket for the treatments you need. we are all in agreement on those reforms. we agree on reforms that will finally reduce the cost of health care. families will save on their premiums, businesses that will see their costs rise if we do nothing will save money now and in the future. this plan will strengthen medicare and extend the life of that program and because it gets rid of the waste and inefficiencies in the health care system this will be the largest deficit reduction plan and over a decade. i