is being done, with artificial deadlines, votes in the dead of night, bills cooked up behind closed doors with special deals jammed down the throats of the american people, who don't want it. i yield. a senator: mr. president? the presiding officer: the senator from south dakota. mr. thune: mr. president, i appreciate the comments of my colleague from texas and my colleague from wyoming prior to that. many have come down here as our colleagues on our side have, day after day, time after time, and continue to point out what we believe is wrong with the approach that's being taken by the majority and also pointing out the things where we would do things differently. now, remember, mr. president, this is -- this is the first bill, 2,100 pages long. $1.2 billion per page. $6.8 million actually per word.

and then yesterday, we got the manager's amendment. another 400 pages. and you add yet another amendment that's going to go on this stack and you're talking about 2,700 pages of bill language. now, what i think is interesting -- and i see a pattern emerging here almost every single day. it's like deja vu all over again. the other side comes down here, talks about the need for health care reform which we all can see. we all believe we need to reform health care in this country. we all hear from our small businesses. we all hear from individuals and families who are having a difficult time keeping up with the high cost of health care. and so that's something on which there is broad agreement on both sides, yet that seems to be the sort of m.o. for the other side, to come down here, talk about how we need to do health care reform, we agree with that. the other strategy is to come down here and attack republicans, attack republicans for not having their own ideas. we had several amendments

offered today. we asked unanimous consent to bring amendments up, to get them pending, to get them voted on. they were blocked by the other side. we were offering -- we have full alternatives to the current bill. senator burr, senator coburn have a comprehensive alternative they would like to offer being blocked by the other side. so the recurring pattern, the pattern that has emerged, mr. president, day after day in the debate here in the united states senate is democrats come down here, talk about how bad the current system is, point out examples of those who are falling through the cracks in the current system. exactly, we agree with that. they have acknowledged there was a problem. come down here and attack republicans. the senator from rhode island this afternoon essentially said that republicans have been coming down here and telling lies. now, the -- what the republicans have been doing day after day after day is coming down and talking about the bill and the impact the bill would have on health care delivery, the impact the bill would have on the

economy, the impact the bill would have on small businesses and their ability to create jobs. we have been talking about the congressional budget office report that describes the cost of the bill and goes into great detail about how it impacts individual families as well as the overall costs of health care in this country. we come down here day after day to talk about the c.m.s. actuary's report, the center for medicare services about the cost of the bill and how it would impact the cost of health care in this country. so we continue to come down here and talk about the bill. now, the other side, the one thing they don't do is they don't come down here and talk about the bill. i don't hear democrats coming down here and offering full-throated defenses for this bill because the bill, mr. president, is indefensible. it's 2,700 pages, and it doesn't do anything to lower the cost of health care, according to the congressional budget office.

so we come down here day after day, talk about the congressional budget office report, come down here, talk about the c.m.s. actuary report. they come down here and talk about how bad the current system is, say this is going to fix it, but then when they are challenged on the c.m.s. actuary report and the congressional budget office report, they don't -- they can't defend that. now, what they should be doing instead of accusing the republicans of telling lies and attacking republicans is accuse the c.m.s. actuary and the congressional budget office. they ought to be coming down and attacking them because all we're doing is pointing out the facts as they pertain to the current bill that's before the united states senate, this 2,700 pages right here. now, mr. president, what i would like to point out are some of the things, some of the promises that have been made by the president, by democrats with regard to this bill. the president made it very clear when he was running for president that he was going to -- you know, that this wasn't

going to be something, i would make this firm pledge he said. under my plan no family making less than 50,000 will see their taxes increase, not your payroll taxes, not your income taxes, not your capital gains taxes, not any of your taxes. yet the joint committee on taxation analysis -- by the way, that's another report. maybe they ought to be coming down here attacking that report rather than attacking republicans who are quoting from the report. the joint committee on taxation analysis shows 38% of people earning less than $200,000 a year will see a tax increase under the reid bill. even after you account for taxpayers who are going to receive the premium tax credit, 24% of tax returns under under $200,000 will on average see their taxes go up. thatthat is 42 million americano are going to see higher taxes who make less than $200,000 a year. so the no tax increase for the middle class, you have to say broken promise. second thing they said, it would lower health care costs. well, we all know and the president said this as recently

as june 23, i have said very clearly if any bill arrives from congress that is not controlling costs, that's not a bill i can support. it's going to have to control costs. it's going to have to be paid for, all right. so the last year the democrats have consistently shifted the benchmarks about what that means and what impact it's going to have on america's health care premiums. the president's first promise, going back to the campaign, mr. president, was that the typical family's premiums would go down by $2,500 per year. $2,500 per year reduction, according to the president, when he was campaigning, and that everybody would be covered. we all know even this bill, which is touted as expanding coverage, well, it does expand coverage. it puts 15 million more people on medicaid. that's one way that it expands coverage. but under this bill, there are still 23 million americans who don't get health insurance coverage. and so the president's promise that he was going to cover everybody and that he was going to lower health care costs,

again, you have to say is a broken promise, because i want to show you something, mr. president, of how this would impact a typical family's insurance cost. if you're a family that's paying paying $13,300 today and you're getting your insurance in the large employer market -- in other words, if you work for a large employer, get it in the large group market -- and you're looking at the year 2016, you're going to be paying over $20,000 a year for insurance. now, that doesn't lower health care costs. that increases health care costs. now, what they will say is well, this is -- you know, this is better than it would have been if we had done nothing. well, the honest truth is, mr. president, that if we do nothing, we still would have 5% to 6% increases year over year in the cost of health insurance for most americans. whether you get your insurance in the large group market or the small group market. you're still going to have 5% to 6% increase in the cost of your health insurance if this bill is passed. you don't see any improvement. the best you can hope for is the status quo which is year over

year increases that are twice the rate of inflation. that's the impact on an average family. so the whole notion, mr. president, that this is going to lower health care costs just doesn't pass the truth test, according to the congressional budget office. now, the next promise that was made, and i might say, it would bend the cost curve down. what's interesting about that, and this was the president in the joint session of congress on september 9 of this year. the plan i'm announcing tonight will slow the growth of health care costs for our families, our businesses, and our government. well, according to the congressional budget office again, mr. president, -- and if my colleagues want to attack us, let's have them attack the congressional budget office, the c.m.s. actuary, the joint tax committee because everything that i'm saying tonight i'm quoting from those reports. but according to the congressional budget office analysis of the reid amendment, the cost curve bends up, not down. in fact, in the first ten years, the net increase would be about about $200 billion a year in

overall health care costs in this country. now, this is an outdated chart, i have to say, because this is the chart that we used before this amendment was added. this is the manager's amendment, the 400-page amendment i alluded to earlier that was just added to the 2,100-page bill. in the 2,100-page bill, the congressional budget office said the cost of health care in this country is going to go up, not down, by $160 billion. so what's the cost of doing nothing? the blue line represents the cost of doing nothing. that's federal health care spending today and what it's projected to be into the future if we do nothing. the red line, mr. president, according to the congressional budget office, represents what health care costs would do if the reid bill passes. now, the ironic thing is that with the 400-page amendment that was added yesterday, this number gets bigger, not smaller. i said this is an outdated chart. this only represents represents $160 billion increase in the cost of health care,

according to the c.b.o. analysis on the amendment. it increases the cost of health care by hundred billion. now, the c.m.s. actuary came to a slightly different conclusion. they said that health care costs would go up in the next ten years by $234 billion. so you have got everybody, all the experts, the congressional budget office, the c.m.s. actuary all coming to the same conclusion, and that is health care costs go up, not down. and so you would have to say, mr. president, yet another broken promise. now, the other thing that has been said throughout the course of this debate is that you can keep the insurance that you have. the president said in his joint session of congress address on september 9, "nothing in our plan requires to you change what you have." well, interestingly enough, according, again, to the congressional budget office, between nine and ten million people who would be covered by an employment-based plan under current law would not have an

offer of such coverage under the proposal. the reid proposal. so you have got ten million people, according to the c.b.o., who are going to lose their employer-based coverage, and you also have the 11 million people who get medicare advantage which is being cut. they aren't going to be able to keep what they have. can you argue maybe their benefits are too rich today. that's been the argument that has been made by the other side, but you can't say they will be able to keep what they have. if you're going to cut cut $118 billion out of medicare advantage, the 11 million people in this country who get medicare advantage are going to see their benefits cut. they are not going to be able to keep what they have. in fact, the senator from pennsylvania, senator casey said recently on these medicare advantage cuts, and i quote -- "we're not going to be able to say if you like what you have you can keep it, and that basic commitment that a lot of us around here have made will be called into question." 11 million people who get medicare advantage aren't going to be able to keep what they have, nor are they 10 million

people according to the congressional budget office who are going to lose their employer-based coverage if this plan passes. another broken pumpkin. no cuts to medicare. we all know about that. we talked about that for about a week, mr. president, here, and offered amendments to get rid of the medicare cuts. the president said when he was running for office i want to assure you we're not talking about cutting medicare benefits. he reiterated that in his state of the union address. and yet this bill as we know cuts $470 billion out of medicare in the first ten years and when it's fully implemented, it cuts over a trillion dollars out of medicare. in the first ten years, years, $135 billion out of hospitals. $120 billion as i said earlier out of medicare advantage. $15 billion out of nursing homes. $40 billion out of home health agencies. $7 billion out of hospice care. these are all medicare cuts. these are all going to affect people in a very real way. whether you get medicare advantage or whether you're a provider. again, these are -- these are just the facts of this legislation, and i'm talking about the bill, mr. president.

i'm talking about the bill and i'm talking about what the experts have said about the bill. now, very quickly here -- so that you have to say was another broken promise. the last of two here, open and transparent process. we all know that the president campaigned. we will have the negotiations televised on c-span so that the people can see who is making arguments on behalf of their constituents and who are making arguments on behalf of the drug companies or insurance companies, and so that approach, i think, is what is going to allow people to stay involved in this process. that was what the president said when he was campaigning. we all know this bill almost in its entirety has been written behind closed doors. we just saw this 400-page amendment yesterday, and it was interesting earlier -- this was last week i guess in a discussion on the floor between senator mccain and senator durbin, senator durbin, the number two democrat in the leadership on the democrat side said i would say to the senator from arizona that i am in the dark almost as much as he is and i am in the leadership.

even the leaders, the leaders on the other side. there are three people, four people sitting in a room writing this bill, and what's most -- the most offensive thing about this came out yesterday when we found out is that the senator from nebraska had carved out a special sweetheart deal with a goody for his state that all the rest of the states get to pay for. he gets his medicaid paid for entirely by the taxpayers, and no other state gets that particular arrangement. so the federal taxpayers in every other state -- my state of south dakota. i don't know. nebraska borders south dakota. i think the people in our part of the country are going to say this really smells. this is the way they are doing business in washington, d.c.? this is business as usual, mr. president. and the final thing i will say and that is that the argument was that it won't add a dime to the deficit. well, here i would give the democrats a little bit of credit because they did raise taxes enough and cut medicare enough that they could actually raise quite a bit of revenue. but that's still saying it won't add a dime to the deficit assumes that there isn't going to be any payment to physicians

for the reimbursement -- what we call the physician fee fix which takes about 50 billion. that was completely cut out of here. they're going to have to fix that at some point. so you're not counting that. you're counting $72 billion from a program called the class act which the chairman of the senate budget committee, the democrat from north dakota kent conrad called a ponzi scheme of the first order, something that bernie madoff would be proud of, and there are others who have gone on to say. the congressional budget office says that the class act, the program would add the future budget deficits in large and growing fashion. even "the washington post" has editorialized about this, mr. president, and they came to the same conclusion. the class act is a gimmick designed to pretend that the government is paid for. these are not savings that can honestly be counted on the balance sheet of reform. then we all know you've got ten years of spending or ten years of revenue coming in with the tax increases but only six years

of spending in the first ten years. phony budgeting, gimmicks, all these things that are used to mask the true size of this program, $2.5 trillion over ten years when it's fully implemented. so, mr. president, if you don't use the gimmicks, if you don't use the class act, if you don't -- if you discount the doc fix and don't count that in there, you can make it look like it doesn't add to the deficit but the american people know better. they have come to the conclusion that this is going to add to the deficit. even david broder, the pulitzer prize winner for his commentary said while the c.b.o. said the house-passed bill as being budget neutral every expert i talk to says the public has it right. these bill as they stand are budget busters. that is why this bill needs to be voted down. we need to vote it down tonight. i'm hoping there is a courageous democrat or two who will join us and defeat this bad legislation and move forward with something

we can pass that will meaningfully lower health care costs for the american people. mr. president, i yield the floor. mr. brownback: mr. president? the presiding officer: the senator from kansas. mr. brownback: thank you very much. i appreciate the chance to hear my colleague from south dakota speak and talk about the bill. the statements he's made, i am in agreement with. this is a huge bill. the american public doesn't want, the gallop polling find 61% of the american public opposed to the democrat health care bill. i find in my state of kansas, widespread opposition. much higher than that. you look at these numbers and quickly see why. one of the pieces of it, the medicare cuts will hurt kansas, 63 pocket 7 -- 63.7% cut to medicare kansans. 1.5 billion in cuts to kansas hospitals.

many of our rural hospitals operating on the margins, on the edge. they get cuts. $239.8 million in cuts to home health agencies. this will put over 60% of them out of business in a ten-year time frame. they don't like th-fplt great christmas -- they don't like this. great christmas payment. 11.8% cut in hospice payments. $124.2 million in cuts to the skilled nursing facilities. all of those things being cut directly to kansas, directly to kansans, directly to people that benefit under current programs. and this all to start a new entitlement program on a program in medicare and in raising taxes, neither of which we can afford. medicare is already scheduled to go bankrupt, as we well know. this is like writing a big fat check on an overdrawn bank account and say we'll come up with the money. it isn't going to work.

it's going to take money from medicare. it's going to raise taxes on a weak economy. it's going to hurt overall. one of the issues that has come down to be one of the final pieces of this that the democrats have put forward is the issue of funding of abortion. we've had 30 years of agreement in this body and in this capital that the federal government wouldn't fund abortions other than cases of rape, incest and life of the mother. that was it. 30 years ago the hyde amendment was put in place that said we're not going to fund abortions. big debate in the country about abortion, but there's been no debate about funding of abortion. we said we're not going to fund it. taxpayers shouldn't be funding abortion. if people want to do that, that's their choice on elective abortion but we're not going to fund it n. this bill in the manager's amendment we break that agreement for the first time in 30 years. and what the president said in the joint session of congress is no longer true. this will not be true if this

passes in this bill. what the president said to the joint session of congress, one more misunderstanding i want to clear up. i was listening. under our plan no federal dollars will be used to fund abortion and federal conscious laws will remain in place. both of those, he say, look i want to clear up this misunderstanding, this is not the case. well, let's go through what's in the manager's amendment. we just got the manager's amendment recently, so this has been feverishly where we've had to go through what is actually in the manager's amendment. and what you will find is all the major pro-life groups are opposed to the manager's amendment because it does fund abortions. and i'll go through the specifics of th-fplt bart stupak -- specifics of this. bart stupak has been the lead guy on the house side to say we should continue with the hyde language. there's disputes about abortions. there is not disputes about

funding of it with taxpayer. bart stupak led a group of democrat members on the issue overall and said we're going to pull it out. it isn't in the house bill but now it's in the senate bill. here's what bart stupak says about the senate bill. not acceptable. a dramatic shift in federal policy that would allow the federal government to subsidize insurance policies with abortion coverage. that's what bart stupak says about it. what do some of the other pro-life groups say about what's in the manager's amendment? these are groups that, they track this stuff. this is the u.s. conference of catholic bishops which wants a health care bill. i think they're a pretty fair reviewer of this because they want a health care bill to go through but they are committed to life. they don't want taxpayer money to go to end a child's life. they are opposed to that, completely opposed to that on moral grounds. this is of the highest moral order that has to be protected. human life has to be protected. they say of this legislation:

the manager's amendment, this legislation should not move forward in its current form. it should be opposed unless and until such serious concerns have been addressed. this is on the abortion language. let's look at national right to life committee. national right to life committee, they are the gold standard reviewing this. they have been looking at this issue and tracking it since roe vs. wade was passed. they're committed to life at all stages and all places, that life is sacred, it's unique, it's beautiful and should be protected and the most vulnerable to everybody, it should be protected. what do they say about the manager's amendment? light-years removed from the stupak-sp*euts amendment that -- spitz amendment that passed in the house. bipartisan support in the house for hyde principles. the new abortion language solves none of the fundamental abortion problems with the senate bill and it actually creates some new abortion-related problems.

now let's go through the specifics because i think what we should do is go through the specifics of this bill and look at what are the specific concerned areas. many of the abortion changes that senator reid put in, smuggled into his manager's bill behind closed doors makes the bill worse than ever before, to hit a few of those, it violates the hyde amendment and the hyde principles set in precedent through all other federal administered health programs like medicare, medicaid tkapbd others. it preempts state laws and conflicts with some existing laws on abortion. third, this so-called fire wall. there is a fire wall provision between federal and private funds that's inconsistent with the hyde and the stupak-spitz am. you put the money in one pocket to pay for abortions in the other. it is still money that goes through the federal government to the federal government to pay for abortions. fourth, it departs from the way the federal employees health

benefit program is governed with respect to private plans covering abortions, so it changes that. fifth, it allows executive branch officials to require private health plans cover abortions simply by defining them as preventive care. we've debated this piece calling abortions preventive care in committee and on the floor, and both times we've tried to take that out and say preventive care does not include abortions, and we have not been able to get that definition in to the point where abortion can still be called preventive care. this is the mikulski amendment, it mandates all plans cover abortion by defining abortion as a preventive service. you define it as a preventive service, you can pay for it. sixth, it inserts text of the indian health reauthorization bill. that passed last year. it doesn't get signed into law, passed this body but does not contain the senate-passed vitter

amendment. seventh, basic conscious protections are not included in the senate version. there are other problems but these are seven of the most egregious. i can't imagine that people across the country, certainly people in my state or places like missouri, virginia, california, wisconsin will agree that the federal government should break with its longstapblgd policy against federally funding abortions. that is exactly what has happened and what is in this bill. abortion is not health care. why is it even in this bill at all? the president himself said that at the joint session of congress. at the end of the day the vote for cloture is an affirmative vote to the federal funding of abortion. there is no way around that fact. some people on the democrat side, particularly senator

nelson of nebraska, who i've been working with and closely on this, wants to keep abortion out of this bill. i believe there are huge flaws still in it. he has been fighting to keep abortion out of it. he said this: taxpayers shouldn't be required to pay for abortions. it's his statement on it. he says that. shouldn't be in there. and he's worked to try to get this out. i think there's still enormous flaws and holes in this. if we start the funding of abortions, the last time we did fund them, over 300,000 were paid for by the federal government in a one-year period of time through medicaid programs. 300,000 annually were funded 73-76. how many are you looking at now if you start down this road? we need one democrat in the united states senate will stand up and say this is not taking care of the unborn.

this is breaking the hyde language that many on the other side have supported for years, the hyde language saying that they're pro-choice but kwropbgts federal government should fund abortions. this breaks the hyde language. the seventh, it doesn't provide for conscious clause protection so somebody, maybe they are in a catholic hospital and they don't agree with providing abortion services, that would be their -- they would be required to do things in certain circumstances, maybe that's not one of them, but certain circumstances that they wouldn't agree to. this is a big part of this debate, and it's certainly elevated here. the american public doesn't want the abortion language in it, six in ten in a cnn survey said they don't want it in this bill. a quarter of the house democrats voted for the stupak-pitts

amendment, that is the authentic compromise on the hyde principle and said we will not fund this. the national right to life, i mentioned earlier, goes to some of the specifics on this language. i would just say, mr. president, all of this just seems so odd to me where we are right now. we're in the final days of advent season. we're here when we should be home with our families. i am missing a lot of the celebration in the, in the christmas season. this is the final days of advent. advent is the season of anticipating the birth of a child. it's the season of joy, season of happiness. you're looking forward to the day, the day of the birth of christ -- december 25. that's what season that we're in right now. it's a season of joy and how sad we might see the end of lives of

children in this bill, in this season of joy. it doesn't have to be that way. it shouldn't be that way. but now this is, i believe, the central issue in this health care debate. if this body passes this -- and i don't think it should -- it goes back to the house of representatives where congressman stupak and a group of others are saying they will not support the bill if it has this abortion language. it's now become, it's a central issue in the health care debate. is the issue of funding of abortion. it shouldn't be there. it's wrong. it's opposed by the american public. and i would just ask my colleagues on the other side: please, please, please, take this out. it doesn't belong here. it's not the thing to do. it's harmful. it's hurtful to the country, and it doesn't belong anywhere near a health care bill. mr. president, i yield the

floor. " " mr. cardin: mr. president? the presiding officer: the senator from maryland. mr. cardin: mr. president, in a few hours, we in the senate by our votes will be able to clear the way for the united states at long last to join every other industrial nation in the world and declare that health care is a right. i want to thank our leader, leader reid, for his extraordinary courage and leadership during these many weeks as we've been able to bring together the necessary votes in order to move this legislation forward. i want to thank senator baucus and senator dodd and many of my colleagues that have worked on

so many provisions that are in the managers' amendment and that are in the underlying bill. for 23 years, i've been in congress and for 23 years i have been supporting universal coverage. i believe that every american should have access to affordable, quality health insurance and health care. and by our votes later on this evening, we'll have a chance to take a giant step forward in accomplishing that goal. as i pointed out, the united states, although we spend more than any other nation in the world by far on health care, whether you want to do it on absolute dollars or per capita basis, we spend more than any other nation, yet we're the only industrialized nation in the world that does not provide universal insurance, universal care. so americans have to make a difficult choice. if someone happens to be walking on the ice tonight and doesn't have health insurance and falls and hurts herself, she has to make a decision whether her arm

or leg hurts badly enough to go see a doctor or perhaps to have an x-ray to see whether a bone has been broken because they don't really have the money in order to pay for that type of care. many people go without checkups because they can't afford the cost of seeing a doctor today. they don't have insurance or their insurance doesn't cover what they need. many people today who are on medications have to decide whether they can split their pills in order to make their dollars last a little bit longer because they literally are choosing between taking their medicines or having food on the table, in the united states of america in 2009, the wealthiest nation if the world. well, we have a chap -- the wealthiest nation in the world. well, we have a chance to change that. you can argue this on many grounds, and i have. you can argue the need to bring

down health care costs, and i certainly believe that, or you can argue that we need to provide more people with health insurance or we need to take on the health insurance industry. but, mr. president, i think the most persuasive argument for passing this legislation is the moral argument. it's the right thing to do. it's what america stands for. i met with some students this week and they -- and we were talking about the bill. these were high school students. said, well, it's the right thing to do. and they're right. this is the right thing for our nation to do, to make sure everybody has access to affordable health care. in maryland, this takes on a special note because i know my colleagues have heard me talk frequently about demonte driver, a 12-year-old who lived in prince george's county, maryland, just seven miles from here, whose mom tried to get him to a dentist because he had a toothache. didn't have insurance. no dentist would see him. and after many, many effort toso

try to get him to a dentist, he ultimately went to an emergency room. they operated on him because the tooth had become abscessed because of the delay in getting care. needed emergency surgery. went into his brain, and he lost his life. because in the united states of america we could not provide someone who was poor access to see a dentist. well, tonight we can change that by our votes on this bill. at long last, we have a chance to do something about that. in the last congress, i introduced a bill that provided universal care by saying each of us have a personal upo responsibility to make sure that we have health insurance. i did that because i think the first thing we need to do as a prerequisite to health care reform is make sure everyone is covered, everyone is in the system. well, this bill and the managers' amendment want only provides for universal coverage

but makes it affordable for every person in this country. we used the congressional budget office to -- as the objective score keeper here. everybody agrees to that, democrats, republicans. they're the professionals tell us whether our numbers add up or not. well, the congressional budget office tells us that the bill with the managers' amendment will mean 31 million more americans will have health coverage as a result of the enactment of this legislation. that will take our under 65 group from 83% coverage to 94% coverage. and for all americans, we will attain 98%. sure, we want to get to 100% but we're making a giant step forward for universal coverage. the congressional budget office tells us that for the overwhelming majority of americans, they'll either see no

increase in their health insurance premiums from what it would otherwise be or they'll see a decrease, a decline, a reduction in the cost of the health insurance premiums they would otherwise have to pay. and for all americans, they're going to have a better insurance product that's going to cover more, they're going to have less out-of-pocket costs than they would otherwise have. that's what the congressional budget office tells us. now, why is that true? well, the legislation provides for prevention and wellness. it provides that preventive services will be required to be covered in your insurance plan. we even do that for our government programs by providing an enhanced match for states that expand the medicaid program for our poor to cover the required preventive services. it covers oral headlight for our children -- it covers oral health for our children as part of a required

essential coverage package. it provides additional help to help people through education and demonstration programs. and i could give you many examples but let me give one that i've been involved with from the point of view of trying to expand preventive services and that's colon cancer. we know that if you have colon screenings, you actually can -- can discover a polyp before it becomes cancerous. you can avoid cancer. the test costs several hundred dollars, a couple hundred dollars. if you don't have the test and you have -- you have colon cancer and you need an operation, that costs tens of thousands of dollars. preventive services saves lives and saves money. prevention and wellness works. it brings down the growth rate of health care costs. it saves us money. this bill invests billions in prevention and wellness, directly and through required coverage in our private and public insurance programs.

we bring down the growth rate of health care costs by managing complex diseases. we know we spend most of our health care dollars because of major diseases. well, this bill helps us manage those diseases so that people can get the care that they need in a more cost-effective way. the legislation invests in health information technology so that we can reduce the costs, the administrative costs, of health care. i was surprised to find that maryland, like most states, if you go into an emergency room, it's very unlikely that they'll have your medical records. now, if they don't have your medical records because their information technology is not sophisticated enough to get those records, then surely they're going to do tests that they otherwise would not have to do. which ends up costing all of us more money. by using health information technology, we cannot only take better care of you, we can do it at a less costly way. by reducing the number of uninsured, dramatically we save money. how? because someone who's uninsured

who should see a doctor or go to a clinic, instead goes to an emergency room which is much more expensive. by the way, they sometimes don't pay their bills. mr. president, you and i -- each of our families, if you live in maryland, you have insurance. you pay an extra $1,100 a year on your health insurance because you're paying for the people who that don't have health insurance. and they access the system in a more costly way. that brings down the costsment and you brincostsment -- that brings down the costs. and you bring down the cost of health care because of competition. we believe in competition, market forces. that's what made america great. well, if you live in maryland and you have private insurance, 71% of marylanders are insured by only two companies. that's not competitive. i've talked to more and more business owners who tell me they have no choice. there's one plan that they can get. if they don't like that plan, there's no insurance they can get. that's not competition. this bill brings competition by -- by the exchanges that will invite more insurance companies

to participate in our states and by the program that's in the managers' package that allows us for the first time to be able to have plans available across state lines. that will be particularly helpful for a state like maryland, where many of our employers employ people that not only live in maryland but live in virginia, live in pennsylvania, live in delaware, live in west virginia. that will certainly help us. this legislation also reduces our federal budget deficit. now are that's a challenge. -- now, that's a challenge. let me tell you why it's a challenge, mr. president. because there's two different issues here: reducing health care cost growth and reducing federal spending are two different issues. because to get everybody insured, which will help us bring down health care costs, we need to provide subsidies so people can afford their health insurance, provide businesses some help. as more and more people become insured, they can use our -- our tax advantages and pay less income taxes by paying using

before-tax dollars rather than after-tax dollars. all that costs revenue to the federal treasury. so it's a challenge to bring this in without adding to the deficit, but we -- we knew we had to do that. and the congressional budget office, again, our objective score keeper, tells us that in the ten-year budget window, it will reduce the federal deficit by $132 billion. but in the next ten years, which all of us would admit is very difficult to predict, they tell us we can reduce federal spending by one-half a percent of our g.d.p., which can translate to over a trillion dollars. my point is that we are reducing the deficit while we are reducing the growth rate of health care costs. and, mr. president, the congressional budget office doesn't score us for a lot of the results from our prevention programs. they can't assume that less people will get cancer and, therefore, the preventive services will save us money.

i am convinced that the dollar savings will be a lot greater than that for health care costs, for our economy, and for the taxpayers of this country. this legislation protects consumers. that's why the consumer union supports moving this bill forward. the insurance reform that's in the underlying bill well-known. and i tell you, the people of maryland want that. i'm sure the people of massachusetts also. the insurance reform says, look, let's get rid of this preexisting conditions. let's not let insurance companies pick and choose who they want to insure. they should insure everyone. and the managers' package makes that available immediately for our children. we -- we eliminate the lifetime caps, put restrictions on the annual caps. we make immediately available coverage for children under the age of 26 and provide a reinsurance program for those between 55 and 64. we provide for an independent

appeal from an insurance company's decision on coverage. too many insurance companies have an internal mechanism to determine coverage which is stacked against the policyhold policyholder. the managers' amendment provides for loss ratios. loss ratios mean that a certain amount of the insurance dollar must go back to pay benefits. we know that a large amount is spent on advertising, spent on salaries, spent on profits. for the first time, the consumers will know how much of that is actually going to their benefits when we start to put into law that a certain amount must be returned to the policyholders in benefits, important consumer protection information. i'm particularly pleased that the patients' bill of rights, an amendment that i offered, is included in the managers' package, and i really want to thank the leader for including that. in the balanced budget act of 1997, a provision that i authored included a lot of the

patients' bill of rights in the medicare and medicaid programs. president clinton in 1998 by executive order extended it to all the government programs. and we've passed in the house and passed in the senate but never passed in both bodies and sent to the president the basic bill of rights for patients. well, we're making a giant step forward in the managers' package to cover those bill rights. let me just give you an example. access to emergency care that i've authored is now in this bill. there are insurance companies today that tell you you've got to get preauthorization before you can go to an emergency room. now, think about that. you're having chest pains or sweating, you try to find yourself insurance card to call your insurance company? that's not what a doctor tells you to do. you go to an emergency room. now, suppose the closest emergency room's not in your network. does that mean you're not going to get full coverage?

some insurance companies say that's the case. well, we put in the prudent layperson standard. if it's reasonable for you to go to an emergency room to get care, the insurance company must cover your bill. i can't tell you how many people i've talked to on both sides of this who've said, you know, i had chest pains, sweating, et cetera. i went to the emergency room, found out i didn't have a heart attack and almost had one when my insurance company refused to pay the bill. i -- i did what the doctor told me to do, and now they are not covering. this provision will make sure that that person's bill is covered. and tragically, we have had people who have delayed treatment, who should have gone to emergency rooms, whose circumstances have become much worse and some have actually died. we cover access to emergency care in the manager's package, an important consumer protection we also allow you as the -- as the subscriber to determine who you want your primary care provider to be. we give you protection as to the the -- you make your decision as

to who you want your primary care provider to be. and if you have a child, the pediatrician can be the primary care provider. if you're a woman, the ob/gyn can be your primary care provider. many insurance companies deny you that today. that protection is in this bill for everyone. i'm also pleased to join senator brown in a matter that i worked very closely when i was in the house for clinical trials. there are a lot of insurance companies today that will not cover the cost of clinical trials, even though it might be the best care option available for an individual. and by the way, it sometimes compromises the integrity of a clinical trial if they can't get a representative group to participate. well, we provide protection in this bill to cover you for clinical trials that your insurance company has to cover. so there's a lot in this bill for consumer protection, the bill of rights, and, mr. president, there is a long list of organizations that

support the patient's rights amendment that i offered to aarp, the consumer union, families u.s.a., national women's law center, american academy of all the different specialists. it's an important amendment, and i'm glad to see that it's in the manager's amendment. i'm proud of major new efforts that have been included in the manager's amendment. i want to talk about minority health for one moment, and i particularly want to thank a member of my staff, priscilla ross, who has been working on this issue for many years. she pointed out to me the vulnerability of minority populations in america. let me just give you a couple examples. the life expectancy for an african-american is 5.3 years less than someone who is white. minorities are two times more likely to have diabetes. african-americans or 33% have higher death rates for heart disease than the white population, and the list goes on and on and on. access to care in the minority communities is much less than in the general communities at

large. so we need to do something about this, and the amendment that i offered which is included in the manager's package elevates minority help -- minority health in our government agencies. it provides statutory authority for the office of minority health at the department of health and human services, codifies the network of minority health offices located within the centers for disease control and prevention, the centers for medicare and medicaid services, the food and drug administration, the substance abuse and mental health services administration, the health resources and services administration. mr. president, it elevates the office of minority health at the national institutes of health from a center to an institute. that's making a commitment to -- to attack this disparity that currently exists in health care in america. let me talk about one other issue that's in this bill. i'm very proud to work with

senator sanders about the community health centers and primary care. senator sanders is able to get get $10 billion in the manager's package so we could dramatically expand access to care. if you're latino in america, you're 35%, have no dependable source of health care, compared to 50% in the white community. we need more federally qualified health centers. you can universal health coverage, but if you don't have facilities, it would be difficult to get access to care. the community health center expansion will provide access in underserved areas, many areas of maryland need this help. and there is substantial investment in primary care in this legislation. this bill will help. it will help those who have good insurance coverage today by protecting that coverage and making sure it's available tomorrow and stop the erosion that's taking place today, with insurance companies cutting back on what's covered and employers putting more of the costs on the

employee. this legislation will help. it will help small business owners who today have very little choice as to what insurance plan they can get. they are paying 20% more on average than a large company pays for the same insurance pricks. -- same insurance protection. this will also offer tax credits to help small business, in order to make it easier for the small businesses which are the economic engine of america to be able to provide health benefits for their employees. it will help individuals who can't find insurance today by having large pools that they can enter without being discriminated against by the way the actuaries work and will provide subsidies for low wage workers so they can afford coverage. it will help our medicare population by starting to close the doughnut hole on prescription drugs. making prescription medicines much more affordable to our seniors, providing prevention services, including an annual physical to our seniors so that they could stay healthy and provide sustainability to the

medicare program. most importantly, this legislation reflects the values of our nation. affordable, quality health care for all americans. mr. president, i'm proud to support this legislation, the manager's package and the underlying bill, and i urge my colleagues to be on the right side of history. support moving forward with health care reform. with that, mr. president, i would yield the floor. mr. begich: mr. president? the presiding officer: the senator from alaska. mr. begich: mr. president, thank you very much for the opportunity to be here this evening. senator cardin, thank you for a great presentation on the real facts behind this bill. you know, being from alaska, we see a lot of winter storms. we saw a great blizzard here that just occurred and dropped a lot of snow. i see a lot of blizzards and storms in alaska, but i have to be honest with you, i've never seen a blizzard like i've seen here in washington of the misinformation about this bill.

hopefully in the next few minutes, i want to talk about the general bill and what it means for all americans, including alaskans, and then specifically about the effect and what it does for alaska. first, i want to walk through a couple things and some large issues. i know people who are watching hear this over and over again on this bill and the details of it, but i think it's important that we repeat it enough for people to be reminded of the positive impacts that this bill will have on americans and again from my state, on alaskans. it's not a perfect bill. there are pieces that i would like to have improved and i'm sure everyone in this chamber would, but it's a step in the right direction, a significant step. just on the financial end. in the first ten years, it reduces our deficit by by $130 billion. in the next ten years, with the manager's amendment, the improvement and what it did for the deficit reduction is now

now $1.2 trillion. a significant impact to the national debt. people ask me, they call my office and they say well, how does it reduce the debt, this type of legislation? i remind them that between medicare and medicaid and v.a. and indian health services and many other health care programs that we deliver, anything we do to improve the system will mean taxpayers save money. and so again, $10 billion in the first ten years, and the next ten years, $1.2 trillion in deficit reduction. the other issue -- and again, these are broad sweeps. there is now stronger medical loss ratios. once this bill is passed, a few months after implementation, health insurers will be required to spend more of their premiums, which really is your premiums on clinical services and quality activities, with less going to administration, advertising, profits, excessive pay packages,

and if they don't adhere to the new limits, they will have to pay rebates to the policyholders. these stricter limits will continue even after the exchange starts in 2011 and apply to all plans, including grandfather plans. this is a significant benefit to the individual, the person who has to pay the premium. accountability for he can assess assess -- accountability for excess rate increases. insurers that jack up their premiums before the exchange begins will be excluded. a powerful incentive to keep premiums affordable. an immediate ban on pre-existing conditions for children under the age of 18. this to me is unbelievable in the sense that this is now added into the manager's package. a family that struggles and sometimes the parent or the parents will forego their health care in order to make sure their

child is as healthy as possible. when a child has a pre-existing condition, just to get coverage for them is almost impossible. so this to make sure that no insurance company can ban or deny them access for health care with pre-existing conditions. ensuring access to needy care. the use of annual limits on benefits will be tightly restricted to the access and will be prohibited completely by 2014. but starting in 2010, new policies will eliminate the lifetime caps. also on the broader scheme, there will be innovation. medicare will be able to test new models. i can't tell you, every time i had a public hearing or a public meeting in alaska or i heard phone calls coming in what people asked me about. can't we do something different? how do we improve medicare? this creates some incentives to move forward on some innovation within our medicare system. when you look at the small business end of it, the package

improves -- improvements include starting the health insurance tax credit in 2010. almost $40 billion of tax credits and tax savings to small business will be available. transparency. new requirements will ensure that insurers and health care providers report on their performance, empowering patients to make the best possible choice. this one -- the next issue, multistate options. this is actually something during my campaign i talked a lot about. a program that we all have here in congress and so do almost four million federal employees have. when you include their dependents on, say, a million. how do we replicate that to give a benefit to the taxpayers of this country so if they wanted to access something similar? now we have the multistate option. health insurance carriers will offer plans under the supervision of the office of personnel management, people who manage our plan, the same entity

that oversees health plans for members of congress as well as federal employees. at least one has to be nonprofit and the plans will be available nationwide. this will truly promote competition in choice for individuals. another new idea which senator wyden had been sponsoring for many months and talked a lot about, and that's free choice options, giving more options to individuals with their money. as mentioned earlier -- it was the community health centers. it's estimated that this bill will now be able to put in place almost 10,000 community health centers throughout this country. providing, again, easy access and affordable access to folks. the small business end, i want to again just broadly sweep on this. the credits will be available on a sliding scale to small businesses. those small businesses with fewer than 25 employees and average annual wages of less than $50,000. this is truly a small business

benefit. but also if you're a small business with 50 or less employees, you will be exempt, but if you want to provide insurance to your employees and you're in a small group of 25 employees or under, there will be credits available for you. it also clarifies part time because we have so many part-time employees that work within the seasonal business in alaska, retail, fishing, tourism. it clarifies again to make sure that small businesses are not hampered by this legislation but enhanced. again, 96% of the small businesses will be exempt from this law unless you decide to provide health care and then you can get some benefits for tax credits, up to $40 billion available. i am a member of a group of freshmen that came in here to washington this -- this cycle. we came with all kinds of ideas of how we wanted to change washington in the short order. we sat down and on this bill as a group of freshmen, we put

together a cost containment package with many ideas. they are very technical in a lot of ways, but just in the broader sense, it creates administration simplification. helps ensure that we go after health care fraud enforcement, medicare system upgrades, making sure that as we develop new systems in medicare and for the providers, that we can do some performance testing which again will save individuals and medicare and save the medicare system over time. the cost containment package again that the freshmen put together, we spent many, many weeks on it. i want to give credit to senator warner for leading the charge with our freshmen, but everyone participated to try to make a difference and bring cost containment to the issue of health care. i want to just go through a quick list again on this -- on the broader perspective of this legislation, what happens now because you hear always on the other side that so many things are delayed way out. they're not going