bacchus, senator sanders, also for the republicans john cornyn, senator grassley, kay bailey hutchinson and mike johanns. all about it. now live senate coverage here on c-span2. the presiding officer: the senate will come to order. under the previous order, the senate will resume consideration of h.r. 3590, which the clerk will now report. the clerk: number 175, h.r. 3590, and act to amend the internal revenue code of 1986 to modify the first-time home buyers kret in the case of the armed forces and other employees

and for other purposes. the presiding officer: under the previous order, the time until 12:30 shall be equally divided and controlled between the two leaders or their designees. mr. durbin: mr. president? the presiding officer: the assistant democratic leader. mr. durbin: mr. president, we are continuing to run time postcloture on the managers' amendment. following any leader remarks, the time until 12:30 p.m. are divided between the two leaders or designees. senator reid asked me to serve as his designee on the democratic side. at 12:30 p.m. we will alternate one-hour blocks of time until 6:30 p.m. with the majority controlling the first hour. if all 30 hours postcloture is required, then the roll call vote on the managers' amendment will occur about 7:15 a.m. tomorrow, tuesday, morning in the -- and the cloture vote on the substitute will occur immediately after that.

so we expect two roll call votes early tuesday morning. hopefully votes will not be needed today to recess or adjourn this evening. and that is the state of play and business on the floor. mr. president, at this point i would ask to be recognized to speak pursuant to the unanimous consent request. let me withhold. i see that the majority leader's coming to the floor, and i want to give him a chance if he's seeking that opportunity to make any announcements that he believes would be timely and appropriate. the majority leader indicates that he's not going to make an announcement. so i'd like to make a comment about where we are at this moment. i can't imagine there are many people in america who have been following this day's session because it began at 12:01 a.m. when the senate was reconvened for a vote on the managers' amendment to health care reform

which took place a few minutes after 1:00 a.m. this morning. we recessed and now are returning for the balance of the legislative day. i think when the history of the united states senate is written, this vote will be included, because it is a historic vote. we considered many issues in the united states senate of great importance to individuals, groups, states and to our nation. but seldom do we address an issue of this magnitude or scope. this health care reform issue literally touches every person who is following this debate and many who are not even aware of it. what we're doing is addressing some of the fundamentals of our health care system in america that need to be changed. whenever you're suggesting change in america, there is resistance. there are people who are currently comfortable with the health care system as we have it and there are people who are benefiting from this system as we know it, particularly health

insurance companies, which enjoy great profits because of the current system of health care in america. but at the heart of the issue, we know that this system is unsustainable. as a result we have engaged in element a one-year effort to thoroughly investigate our health care system and to find ways to change it for the better. this is really called on so many of our colleagues to make extraordinary contributions to this search for reform. i want to commend, first, our majority leader, harry reid, who usually stands up at our caucus meetings and says, stop congratulating me, i'm just doing my job. i'm going to do it anyway. senator reid has worked tirelessly, and i have seen it firsthand to build a coalition for health care reform within the democratic caucus. we didn't have a single republican vote that was in support of reform in the early morning hours. i hope that changes.

as "time "time" passes. he -- as time passes. he had to build a caucus within, so we had 60 democratic members voting for health care reform. we're united in the belief that there are fundamental things that need to be changed in our health care system. first, it needs to be more affordable. people cannot afford the health care. 10 years ago health care for a family of four offered through their employer cost about $6,000 a year in premiums. that's $500 a month, instead of being paid to an employee as salary was taken from them as insurance. $500 a month. and now today that number has grown to $12,000 a year for an average family of four for health insurance through their employment. $1,000 a month that might

otherwise go to a family for basic necessities of life and savings and buying things that are important to their future. instead goes to pay for health insurance. that escalation, that 100% increase in health insurance premiums is troubling. but not nearly as troubling as the projection. that if we continue to see an escalation in cost of health insurance premiums based on what we've seen in the past, in another eight years it will double again. imagine eight years from now, in 2017, that you have to work and earn $2,000 a month just to pay for your health insurance. how many people will be able to do that? how many businesses will be able to afford? the answer is obvious. more and more people will be dropped. today 50 million americans have no health insurance. many of them go to work every single day, but their employers can't afford to -- afford health

insurance. so, in addition to dealing with the fundmental issue of health care reform, we're focusing on affordability, how to bend the cost curve or reduce the cost of health insurance premiums. i wouldn't say to the people in america with the passage of the bill that we're now considering, everyone's health insurance is going down. but i think i can say with some confidence the rate of increase is going to decline and that will give people a better chance of affordability. that is essential. secondly, what about those 50 million uninsured people? i've met them as the senator from west virginia has as well. these are not lazy, shiftless people who aren't trying. many of them are trying hard. but they don't have a chance for hish coverage for a variety of reasons. we're going to change that. of the 50 million currently uninsured, over 30 million will have insurance under this bill. those in the lower income

categories will qualify for what we call medicaid, which is a federal state health insurance program for the poor and disabled. most of those people, those making less than $15,000 a year won't pay any premiums because they can't. they don't have enough money. for those who are making slightly more, we provide in this bill tax credits that will help people pay for their premiums. so if your family is making up to $80,000 a year, the tax code will now help you pay for your monthly premium for health insurance. so we're going to expand coverage, 30 million people are going to have the security of health insurance coverage. enbending the cost curve so the increase in health insurance premiums is not as steep. making sure that more people are covered and then, equally important, we are changing the rules when it comes to health insurance companies. for too long these health insurance companies have ruled the roost since the early 1940's

they've been exempt from antitrust laws which allow them to collude and expire when they set prices. over half of the insurance markets in america are dominated by only two companies, and they are free, and it is legal under our law for those two companies to sit down and say, okay, how much are we going to charge? they don't compete with one another. they conspire with one another to set premium rates. if you think i'm a conspiracy theorist, what i'm stating to you is what the law says in the mccarren-ferguson act, something that i think should be repealed post haste. they can set premiums and allocate markets. they can say, you take over st. louis and those two companies will do chicago and these two companies are going to do wheeling, west virginia. they can setup the market structures there so there is little or no competition. how can that be good? if we truly believe in a true

market system, how can this be good for america? so we're what we're saying is we're going to change some of these rules. some of the most egregious abuses by the health insurance companies. first and foremost, preen, how many of us are -- preexisting condition, how many of us are so healthy that we don't have something in our family history or something in our own personal history and saying, well, we're either not going to cover you or charge you dramatically more. those days have to end. let me tell you what this bill does. it says immediately -- immediately children under the age of 18 with preexisting conditions cannot be discriminated against by health insurance companies. you can't deny them coverage because a child is born and develops diabetes. you can't be denied coverage because a child had cancer and is fighting that cancer. you cannot deny coverage because of the preexisting conditions. that is fundamentally fair. it gets to heart of what we should be doing as a nation.

senator tom harkin of iowa, stood at the podium last night, or early this morning, and said what this debate is about is whether health insurance is a right or privilege. it is -- if it is a privilege only for the wealthy in america, then we've loss our way as a nation. we have to understand that protection of our well-being of health through health insurance is something that every american is entitled to. we have to understand that we're the only nation on earth -- developed nation on earth where a person could literally die because they don't have health insurance. if you thinks that overly dramatic let me give you an illustration. man i met in illinois had a health insurance policy that wasn't very good. it had a $5,000 co-pay. now he had to take that co-pay so that his premiums would be low enough so he could afford it. that men went to a doctor who said, i see some indications that you need a colonoscopy.

you may be developing colon cancer. so the man priced a colonoscopy procedure and found out it was $3,000 that he would have to pay out-of-pocket and he said, i don't have it. so he didn't go through with the procedure that. is a risky thing, and it's something that no one should have to face. but that is the current system. what we are trying to do is change that system so that basically preexisting conditions are excluded from the discrimination of health insurance companies. that basic procedure that's are need for prevention and wellness are included in every health insurance policy. we're also making certain that these health insurance companies can't cut you off when you need them the most. can't cancel your policy when you face an accident or diagnosis where medical bills are going to pile up. that's one of the provisions of this bill as well. we also say that for families with young children who are off to college, and my wife and i

have been through this, that reach the point where you finally say, wait a minute, my daughter is graduating from college, i wonder if she's still under my family health insurance plan. today in most cases if your child reaches the age of 24, they're off the family plan. we extend that now so that those 24 and 25 will have the protection of the family health insurance plan while they finish school, look for their first job and have health insurance. that's going to be peace of mind for a lot of families across america. just those two years when young people are the most vulnerable and need the protection of their family health insurance plan. are these worth anything, these changes? i think they're worth a lot. i think that's why 60 democrats stood up proudly and voted for this. senator mcconnell, the republican leader turned to us in the midst of this dramatic debate early this morning and said to -- if one of you doesn't vote against it, all of you, democratic senators, will own

this. we know that. and we have pride in that ownership. because we know the alternative. those who voted against change are voting for a system that is unsustainable and morally indefensible. a system, which, frankly, today puts good, hard-working folks who follow the rules, americans who believe they're doing the very best for their country at a distinct disadvantage in one of the most basic things we expect in life, protection and good health care when we're facing illness and when we need a helping hand. this bill also is going to change the face of health care in america. i don't think i overstate it. our bill has $10 billion to be invested in community health clinics. senator bernie sanders of vermont has been a leader on this issue and deserves credit on it. he was dogged. some members looked to this bill for a variety of things, but senator sanders looked to this bill to provide a helping hand across america to the community

health clinics. as those clinics are expanded more and more towns in west virginia and illinois are going to have satellite clinics, where people regardless if they're wealthy or not as wealthy will have a chance to walk in the front door and see a medical professional. they won't be cueing up outside the emergency rooms of hospitals where the care is much more expensive. they'll be going to the community health clinics and meeting primary care physician who's will give them the basic help they need before their medical problems become much more serious. that's wha -- that's what this bill is fundamentally about. there are many other parts to it. parts i'm proud to be cosponsoring and proud to be supporting. giving a hand to small businesses, giving a hand to individuals to expand health insurance coverage. some might ask well, if you voted on it at 1:00 this morning, why are you still here? well, because the minority is exercising its right under the senate rules which require us now to wait 30 hours, under the senate rules, 30 hours before we

can vote again on this one section of the bill. and as i announced this morning, that means that in the early hours tomorrow morning, about 7:15 or 7:20, senators will be coming to the floor again for two votes to move this process forward. i understand it is the right of the minority to ask us to come in at 1:00 in the morning or early in the morning. they have that right. historically, we have usually reached some accommodation and agreement, and i hope we can here. the 60 votes that were there last night will be there again tomorrow morning, and they will be there every time needed until this bill is finally passed. those on the other side believe this bill is so bad that it's going to revitalize the republican party in the next election. i disagree with them. i think the american people as they come to understand this bill will view it in its historic context, one of the most dramatic steps forward to provide peace of mind and security to families and

businesses across america for an issue that we know needs to be addressed. there are some who came to the floor yesterday, there is one senator who i invited him to come in and explain his remarks, but he said people should say a prayer that someone would miss the vote at 1:00 a.m. well, i don't think we should be praying for misfortune for our senators, that they would be delayed or for some other reason couldn't make the vote. instead, we should be praying to overcome the misfortune of 30 million americans who won't have health insurance if this bill fails. that's the kind of misfortune i want to avoid in the future. i also think that we have one other item of business remaining, and that is the debt ceiling of america. it is something none of us want to face. it's almost like making your monthly payment for the mortgage, and that's what it is, the mortgage of america. we have to acknowledge the fact that as we fight a war and incur the costs, as we have the workings of government assessed

and we know their costs, it adds to the expense of our government and some of it is in debt, and that debt needs to be extended for a short period of time here as we move forward into the next year that begins in just a few days. so this debt ceiling issue is one that we need to come to grips with before we leave at the end of this month. there is a short-term extension which i hope the senate will consider. i want to also say that senator conrad of north dakota, chairman of the senate budget committee, has been a real leader in talking about coming to grips with this long-term debt. i've said to him that in the midst of a recession, with high unemployment, most economists believe it would be a mistake for us to pull back in terms of the safety net for families out of work, to pull back in terms of the investment ins from to put people to work, and senator conrad said he agrees, although he believes we need to be hon about the debt of america, he has said to me repeatedly that

he is not a hoover-ite, referring to that period in history when the great depression hit and president herbert hoover believed that the government should address the debt of america instead of the depression of america. he lost that election to franklin roosevelt in 1932 as a result of that point of view. many of us believe that debt is a serious issue to be grappled with, but at the current moment, we have to focus on the millions of americans out of work who need a helping hand, first with unemployment, cobra benefits for health insurance, food stamps, the basic necessities of life. we have to provide opportunities for education and training, and then we have to find a way to spark this economy and move it forward. senator reid has given to me and senator dorgan of north dakota the responsibility of looking at the senate job creation package. we have been working on that and we are close with our colleagues in the house. coming up with some ideas on how to expand employment. i hope we can have bipartisan

support for that. it would certainly make it a lot easier and it would be done more quickly so that we don't lose jobs in the next construction season coming up next year. that's the reality of the agenda we face when we return, but i can tell you most members of the senate now on both sides of the aisle are anxious to share the holiday season with their families. it's one of those special times of year. we now have a record vote, 60 members on this side, on health care reform. i hope we can get the agreement of the republican side to bring this matter to closure soon, to vote on the debt ceiling and to have at least a short adjournment for some time for us to return home to our states and home to our families. and, mr. president, if there is no one seeking recognition at this time, i am going to suggest the absence of a quorum and ask that time under the quorum call be assessed against both sides equally. the presiding officer: without objection, the clerk will call the roll. quorum call: number of senate l

will be speaking to reporters in about 50 minutes or so. 1:15 eastern in a news conference on capitol hill. we will have that for you on c-span.

quorum call:

a senator: mr. president? the presiding officer: the senator from montana.

mr. baucus: i ask that further proceedings under the quorum call be dispensed with. the presiding officer: without objection. under the previous order the time until 6:30 p.m. will be divided in one hour alternating blocks of time with the majority controlling the first block. mr. baucus: i thank the chair. mr. president, i ask consent that david barlava, an intern in senator dodd's office be granted floor privileges for the remainder of today's session. the presiding officer: without objection. mr. baucus: mr. president, i want to take a few moments to talk about a provision in this package about which i am particularly proud. it would finally follow through on the federal government's responsibility to provide screening and medical care to residents at super fund public health emergency sites. the term public health emergency is defined by the comprehensive liability act of 1980, otherwise

known as sfphe. it reserves the designation of public health emergency for the most hazardous superfund sites. this is where the potential release of a hazardous substance rises to a level of an emergency. when a public health emergency is declared, the law requires that the secretary of health and human services to provide screening and medical care services to people who have been exposed. to date the government has not created a mechanism to allow the secretary to deliver this screening and medical care required under current law. what the -- but the bill before us today finally provides that mechanism. first it authorizes a grant program for screening services. these screenings would determine if a medical condition is present, that is, attributable

to environmental exposure, and then it allows those individuals with a diagnosed medical condition due to the environmental exposure at the site to get the medicare services. it establishes a pilot program to provide additional medical care appropriate for the residents of the superfund site at libby, montana. this provision is important because it will provide vital medical services to americans who, through no fault of their own, have suffered horrible effects from their exposure to deadly poisons. it will provide the medical services that we woa under commitment under the prior legislation, that is the superfund act. and this provision is especially important to me for a very special reason. the environmental protection

agency currently has 1,270 sites designated where pollution and contamination present a danger to public health and well fare. throughout the history of the program, the e.p.a. has found one site where conditions are so severe and the contamination is so pervasive that it warranted the declaration of a public health emergency. that declaration occurred on june 17th of this year. the e.p.a. administration jackson found a public health emergency exists at the superfund site in libby, montana. libby, montana is a beautiful town, small town, surrounded by millions of akers of federal -- acres of land. it is an idyllic spot where families -- it is also a town

that's gone through lots of stress -- lots of economic difficulties of the -- the timber industry has virtually shut down, mining there is not quite what it used to be in years past. people have worked together, they love libby. it is almost isolated in the northeast of montana. most people have not been to libby, but they have a wonderful sense of community in their hometown. however, liberty is also a superfund site. it is the home after big mine. it is a place where hundreds of people have grown sick and have died. died due to the pervasive presence of asbestos spewed from the mine and operations of w.r. grace. gold miners discovered vermiculite.

in 1963w.r. grace bought the mining operations and made a lot of money, frankly, and the mine closed in 1990. the e.p.a. first visited libby in 1999. it was declared a superfund site. cleanup had begun. very pervasive. very difficult. very hard to get the trust between the e.p.a. and the people in the community. a lot of people in the community was doing the right job in the right way. i had to get involved in the right way to hold e.p.a.'s feet to the fire. they didn't know how clean clean was. they did not do a good job, mr. president. john was the first on site coordinator to convince e.p.a. what they needed to do. anyway, cleanup began in 2002 and we still have a long way to

go. for decades the w.r. grace operation belched 5,000 pounds of asbestos every day in and around libby. people used raw vermiculite to put on their highways, in little league ball fields, in their attics, it was used everywhere. someone said it is not right with all of this asbestos. it's hard to put your finger on it. one day i visited libby, i went up to the mine, i was stunned to see the miners come off the mine, into their buss, they were caked with dust. it added new meaning to dust bin. just caked with the stuff on their clothes and they get in the bus, they come home, and one

person i talked to and really got me interested in doing something about this, a guy name les, he told me when he got off the bus, he would go home, caked with dust and embrace his wife. the kids would jump in his lap. guess what, les is now dead from asbestos, his wife is ill and one of his children died as a consequence. think of the pain he has gone through. first, dying from asbestos and worse, he caused his wife to be ill and caused his son to die because of this disease. mine workers brought the dust home with them on their clothing. they contaminated their own families without knowing the dust was poison. we knew something was wrong, but we didn't know it was that wrong. i think the company knew exactly what it was doing. in fact, i might say, mr. president, the company has been

subject to a criminal action against the officers, allegations are that the officers knew that they were contaminating the people and didn't disclose it. the suit went on for a year. it's true that the officers were acquitted in my personal judgment because of allowsy prosecution, but just -- just a lousy prosecution. but not only did people thought that the officers were contaminating people, but the people in libby, montana. the asbestos was everywhere. and the w.r. grace company did not help matters. i might say this is the same company -- there is a book written about them in a movie called "civil action" where w.r. grace contaminated the water in massachusetts. they knew what they were doing. it's clear they knew what they were doing. as i recall a big civil judgment was granted against w.r. grace because it is clear what w.r.

grace is doing. they are now bankrupt. they shoved all of their assets to another location so though that the plaintiffs in the suit against w.r. grace could not attach their assets. and all the shenanigans this company undertook for their own benefit at the expense of the people in libby. when i say, expense, i mean dead, dying because of this asbestos. not regular asbestos. this is where the fibers are deeper, they're stronger and they get in your lungs an cause more damage and it takes longer to detect. it's that vicious. the effect on libby has been severe. today we know that nearly 300 residents of libby have died. 300. it's a small town. thousands more have become sick with asbestos-related disease. that's 291 deaths in a town of just over 2,600 people in a county of 18,000.

lincoln county, montana, home to libby, has the highest age-adjusted death rate due to asbestosis in the entire nation. libby is an isolated community with limited access to medical care. the median household income in 2007 was $30,000. when i say isolated community with limited access to medicare, what do i mean? there is not much there. and the company has reneged on their insurance policies. the company had mediocre insurance policies for folks, but as time goes on, the company just backs off, backs off. it's really what's happening a lot in health care reform here. they rescind, they renege their policies for one reason after another. so the poor folks, after they know they have asbestos-related cancer or other lung-related disease, they don't have the resources to go to get the medical attention. i have been at this for years. let me tell you, it is just so frustrating and so wrong what's happened to the people of libby,

montana. it is this combination of devastating characteristics that led the e.p.a. administrator in june to find the public health emergency does exist at libby, at the libby superfund site. this finding was based on years of work, having originally been recommended by the e.p.a. in 2001, and i might say i have read the transcripts between e.p.a. administrators and to o.m.b. back in those years, and it is -- and the e.p.a. administrator back then in the republican administration recommended this action be taken but squelched at the white house, squelched at the white house by o.m.b. the correspondence is clear this is exactly what happened back then in a previous administration. that is why e.p.a. has never used this authority. and the agency indicates that there are vently no sites under the national priorities list that come close to the conditions at libby. it's worth highlighting a few parts of the administrator's finding. let me indicate what they are.

the administrator has said the -- "libby asbestos site is unique with respect to the multiplicity of exposure routes, the cumulative exposures experienced by community members , and the adverse health effects from asbestos exposure already present and documented in the residents." going further, the e.p.a. administrator found -- "investigations performed by the agency for toxic substances and disease registry, atsdr, have found hundreds of cases of asbestos-related disease in this relatively small community. atsdr documented a december and death rate from asbestosis in the libby area significantly higher than the national average for the period from 1979-1998. the occurrence of disease are not limited to vermiculite facility workers or their families but are spread throughout the entire

population." not just the workers and their families but the entire population because as i mentioned this stuff is pervasive, has been used everywhere in the town. ball field, tracks, lawns. it's just awful. "medical care in libby has historically been limited due to libby's isolated location and economic situation, thus reducing the chance of early detection and treatment of asbestos-related disease." end quote. this piece bears repeating." medical care in libby has historically been limited, thus reducing the chance of early detection and treatment of asbestos-related disease." let me just refine that point, mr. president. for a long time, we would be talking to a lung specialist across the country about the libby tremulite asbestos. we got so-so responses about how dangerous it was. why? because virtually none of those doctors have experienced dealing with the per pernicious kind of

asbestos we have in libby, montana. it took a long time to get their attention, a long, long time. finally got some doctors to say yeah, this stuff in libby is wicked stuff. finally there is -- and that is why, frankly, the e.p.a. is starting to understand that this is how -- how bad this really is. essentially, the lack of access to health care services libby has -- i'll say it again -- has actually worsened the effects of this contamination. it's worked to their disadvantage. so the language before us today helps to solve this. it allows us to fulfill the commitment that we made to the people of libby when we passed the superfund act 30 years ago. and heaven forbid if in the future another superfund site like libby emerges, the bill before us today will allow the secretary to use the authorities in this provision to fulfill our commitment to provide health care services for those residents as well. but i can never talk about libby

without remembering my friend, les gramsted. i mentioned his name a few moments ago. i first met les in the year 2000 at the home of gayla benefeld. les was there, gayla was there, lots of other miners were there, pleading for help, some attention. we're dying. somebody pay attention to us. we're an isolated community up here in northeastern montana -- northwestern montana. please, someone pay attention to us. man, oh, man, did this get my attention. i was just stunned with the stories they told. and i -- talking to les over coffee and huckleberry pie. that's a real popular pie up in libby. les was watching me very closely, very closely as i said you bet i would help, i would help to do something about this. he was very, very wary. after his neighbors and friends had finished telling me their stories, i'll never forget, les came up to me, and he said

senator, a lot of people have come to libby. they have told us they would help. then they leave and nothing happens. and he told me that -- i remember thinking at that instant, you know in life sometimes you find four or five or six, seven instances that, man, oh man, whatever it takes, you're going to make sure they get justice, whatever it takes, whatever it takes, you have such a commitment, and that was one. i said to myself boy, i'm going to do whatever it takes to take care of this because these people of libby deserve justice, they have not received it. he said senator, he says i hear you say that, but i'll be watching. and i knew he would watch. i knew that would help. he didn't actually have to say it because i was going to do it anyway. so i accepted les' offer. nd -- and i have a big, nice photograph of les on my desk. les passed away a couple of three years ago. i spent a lot of time with him at the hospital and his wife and family.

just a wonderful picture of les gramsted on my desk. it reminds me of what we have to do for the people of libby and all the people in our state and our nation, help people like les gramsted. it means that much to me. but i have not forgotten les and i won't forget les, and that's why this provision is in here, and i think les right now up there, he would be smiling, says yep, we did not forget libby, we did not forget les, and that's what this provision is all about. mr. president, i yield the floor. mr. president, i might say there is a photograph behind me of les, les gramsted in libby, montana. he is at a cemetery there, lots of graves of lots of people of libby who have died. les played a pretty mean guitar. he was a great guy.

he still is and always will be. and i yield to my colleague from montana, senator tester. the presiding officer: the senator from montana. mr. tester: come snow or sunshine or dead of night, we're close to ceiling the deal to change our country for the better, to finally hold insurance companies accountable and to make health care affordable for folks in this country. right now, we are all paying far too much for our health insurance. many of us can't get the health insurance at all, and even worse insurance companies don't always live up to their end of the bargain. sure, a lot of folks are happy with the health care they have. our doctors and our nurses and our hospitals and medical research are some of the best in the world. but when you add it all up, many are paying too much for it, some are paying nothing for it, and

overall too many lives are lost, too much money is wasted, and too many folks are falling through the cracks. they're calling out for help. we have all heard their voices. now i want you to hear their stories. they are ordinary folks who stand to lose everything unless we reform our health care system. i support this health care reform bill because it saves lives and it saves money, it saves medicare. it's tough on insurance companies, taking them to task to ensure affordable and fair coverage. mr. president, i have a perspective somewhat different than most of my friends here in the senate. i am and always will be a third generation montana farmer. my wife, charla and myself, still operate our farm. a farmer knows that we have some good years and we have some bad

years. i've had my share of bad years, and, in fact, many years ago, not long after our first child was born, charla and i had to give up health insurance to make ends meet. we had no other choice but to hope and pray for our health and safety and for the health and safety of our child. thank god our prayers were answered. now i have the honor of serving montana in the united states senate, but my story is one of thousands of real montana families that have been forced to wing it rather than depend on a health care system that works and that holds insurance companies accountable. i know a woman from montana who cannot afford health insurance because of her pre-existing condition. she and her husband got letters from their insurance company telling them their premiums were going up $500, $600, $700 per

month through -- per month. through no fault of their own, their insurance became too expensive so they gave up. this legislation will prevent that sort of nonsense in the insurance industry from happening. with this bill and health insurance's participation in the exchanges will depend on its performance. insurers that jack up their premiums before the exchanges begin will not be included in those exchanges. that's a powerful incentive to keep premiums affordable. mr. president, we all have friends and relatives who aren't fortunate enough to have a job where health insurance is part of the deal, so they do what millions of others are forced to do. they hope and they pray that they stay healthy. we have got a problem in this country. it's time for a solution using common sense and fiscal responsibility, and that's why i'm going to vote for this health care reform bill. so we can save lives and save

money, so we can save medicare, so we can hold insurance companies accountable. and so they don't drop people when they are sick or drive families into bankruptcy. because of fax credits, this bill is good for small businesses. it gives eligible small businesses access for up to six years of tax credits. that would help small businesses buy health insurance for their employees. because of tough new rules in the insurance industry, it's good for families and it's good for our kids, and because of commonsense ideas like cross cross-state insurance markets, more competition and more choices, it's good for millions of americans who until now had to rely on luck, hope, and prayer. if we don't pass this bill, our entire country could fall apart apart -- i'm sorry. if we don't pass this bill, our entire economy could fall beyond repair. mr. president, right now we're working hard to rebuild our

economy, and it's working. we're creating jobs and investing in basic infrastructure needed to get our economy back out of the ditch. fixing our broken health care system is part of that job. over the past few years, i have heard from thousands of montanans telling me about the need to fix health care. one of them is a lady named roxy burly. roxy owns a hair salon in billings, montana. she just bought a home. as all small business owners, she worked hard, but she -- she works hard but she can't afford health insurance, so she says she is walking a tightrope. her home and business on one side, and her health care is on the other side. if roxy gets sick, she worries she will lose her home and her business. in montana, our economy relies on people like roxy burly, small business folks. we can't afford to have our economy walking a tightrope.

in this bill, roxy will be protected from losing her home and business. her annual out-of-pocket expenses are capped at no more than $5,950 per year. mr. president, i want to share another story. it's about mindy renfro. she lives in missoula, montana. mindy got breast cancer not ones, not three times, but four times. and these were four different types of breast cancer. mr. president, the same cancer didn't come back every time. she got a different cancer each time. the first two times mindy's insurance paid for her treatments. the third time the insurance company called her and said, we're sorry, but we're not going to pay. the underwriter, she says, determined her chances of survival were just too slim. so, instead, they offered to

send a hospice nurse. well, mindy was a single mom in her early 40's and she was simply not ready to checkout. she asked about her options. she was told if she wanted to start chemo, she would have to come up with more than $100,000 in cash. her only option was to sell her home. so mindy, and her children, sold their home. they packed up and moved out of their home so they could sell it and so she could start treatment that she needed to stay alive. after many years of trying to repay that debt, mindy recently declared bankruptcy. i've heard many stories from folks in montana that are in the same boat that mindy is in. this isn't good business. this needs to stop.

and it's why i support this health care reform bill. i support it because under this bill, mindy and people like her, wouldn't have had to declare bankruptcy. she would have had the insurance despite her preexisting condition of being a cancer survivor and her annual out-of-pocket expenses would have been capped at no more th than $950 per year, not th the $100,000 in cash what that she needed to start her cancer treatment. this bill is strong and decisive and tough on insurance companies so they cannot say, sorry, but, no, when you get sick. so they cannot say sorry, but, no, if you have a preexisting condition. another story, mr. president, is about former ranchers pam and pat deshan. dan and pass used to own a cattle ranch in northwestern montana. they used to own a ranch in northwestern montana. the ranch had been in their

family for four generations. dan and pat couldn't afford health insurance. and then dan was diagnosed with cancer. to pay the bills, they had to make the painful decision to sell off their ranch. now, i'm going to tell you when a piece of land has been in the family for four generations, you get an attachment to that piece of land. but, nonetheless, dan got cancer, they had to pay the bills, they sold the family ranch. under this bill, the deshans would have had access to subsidies so they would have had health insurance in the first place. they never would have had to sell the ranch to pay the doctors' bills. i want to read what pat wrote me about that experience. she wrote -- quote -- "cancer ravaged dan's body, but selling our ranch to pay for the medical costs broke his spirit.

" dan deshan lost his battle to cancer two years ago. all his bills were paid, but the ranch that had been in the family for four generations was gone as well as dan. after that, pat still cannot afford health insurance today. under this health care reform bill getting sick won't force folks like dan and pat deshaun that has been in their family for generations. that's because it limits the amount of money that you would have to pay out-of-pocket on a rate that you can afford based on how much you earn. that means that no one will have to sell their homes or family ranchs to pay the medical bills. i know a lot of folks already have health insurance and they're wondering how is this going to affect me? let me be clear. if you like your plan, you get to keep it. if you don't, you can look for a more affordable plan that works best for you and your family. every will have access to

affordable health insurance. right now, those with health insurance are subsidizing those without it. the other day i struck up a conversation with a trucker back in montana who told me, i don't need insurance. i don't want insurance. because i don't get sick. i asked, what happens if you get into an accident, being a trucker, that's always a possibility. he said, all i have to do is go to the emergency room where they take care of me. no questions asked. that's exactly the problem, mr. president. when everybody is insured, costs will go down because no one will be paying extra to cover the folks who rely on the emergency room for health care that they eventually never pay for. it's just common sense. it saves lives, and it saves money. mr. president, i've been on the phone with tens of thousands of montanans over the past few weeks answering questions about health care. a lot of them want to know how we're going to pay this bill and how much it will increase the

debt. it won't increase the debt one thin dime. in fact, it will lower our deficits by hundreds of billions of dollars. $132 billion over the next 10 years alone. it reduces the deficit even more in the decade after that. in fact, this bill saves money is pretty important to me. it doesn't add to the deficit. it cuts billions of dollars in government waste. it requires a bigger chunk of your premiums to go directly to better health care instead of administrative costs an profits and it saves money for families by lowering costs for everyone and by limiting amount of money that you have to pay out-of-pocket for health care. and by emphasizing wellness and prevention by lowering -- and by holding insurance companies accountable so that we don't pay more than our fair share for the health care that we need. mr. president, when you turn on the tv these days or open a newspaper, you see all sorts of spin about the health care

reform and medicare. it amazes me how distorted the facts have become. i've read the bill. the plain fact is that it makes medicare stronger. all guaranteed medicare benefits stay just as they are. they're guaranteed. seniors are guaranteed to keep the benefits like hop stays, access to -- hospital stays, access to doctors, nursing homes, and prescription drugs. how do we make medicare stronger? we make it stronger by getting rid of wasteful spending and by spending your money smarter. without this bill medicare will be on the rocks within a matter of months. if we don't fix it now, it will go broke. leaving entire generations in the lurch. millions of americans have worked hard all their lives for medicare benefits. they've earned it. that's why we're making medicare better, not worse. that's common sense.

the same goes for v.a. health care. this bill does not affect v.a. health care or tricare. i serve on the v.a. committee. over the past three years we've made good progress in living up to the promises made to our veterans. we still have a lot of work to do. but this health care reform legislation takes us forward even further for america's veterans. finally, this bill preserves some of the most important parts of quality health care. the relationship between you and your doctor. and the freedom of choice you have as a patient. in montana, as in many parts of this country, we don't tolerate the government snooping around our private lives or making personal decisions for us. health care is no exception. this health care reform bill not only saves lives, it saves money, it saves medicare. it keeps the government out of the exam room and the waiting room. mr. president, i go home to montana just about every weekend to visit with the folks and hear

what's on their minds. i meet with doctors and nurses, hospital administration -- damian straightors and regular -- administrators an regular folks to hear about their concerns. everywhere i go, medicare is the number one issue. the worst option is to do nothing at all. if that happens, insurance companies won't be held accountable and people who need treatment to stay alive won't get. it -- won't get it. i know a fellow farmer who works land back in montana. when he got sick, he had to sell off entire chunks of his family farm to pay the bills piece by piece. piece by piece we watched as he made painful sacrifices for his health care. piece by piece his lively hood was broken a-- livelihood was broken apart. no one deserves that. people are calling for help because a lot of folks are

falling through the cracks. i say to them, we're listening. we hear you and we're doing something about it. that's why this is a good bill. it's a bill that i support it will allow americans to get the health insurance that they have needed and the insurance will be affordable. it is a result of a lot of hard work and working together to do what's right for this country. for america's rural families, seniors, small businesses, family farms and ranches. the people in this country deserve no less. mr. president, i yield the floor. mr. sanders: mr. president? the presiding officer: the senator from vermont. mr. sanders: thank you very much. mr. president, i was proud last night to have voted for the health care bill. and the reason is, as senator tester just indicated, this bill accomplishes a whole lot.

and before i go on to talk about what i really want to focus on this afternoon, i do want to say that there are a number of provisions in the senate bill that i don't support and that i hope we can improve in the conference committee by adopting house language. one is the issue of public options for which, mr. president, you have been so strongly involved with. at the end of the day, it seems to me the american people have been very clear is that if they are not happy with their private insurance, they want the option of a medicare-type public option. and i think we should give them that. and, furthermore, as we look at the soaring cost of health care in this country, we understand that one important mechanism to control escalating health care costs is a public option which provides real competition to provide insurance companies who are only concerned about making as much money as possible.

and i know, mr. president, you have worked very hard in that effort. and i hope we can in that regard take the house language with -- which includes a public option. and the other area, mr. president, where i disagree with the senate and agree with the house, is on the issue of taxing health benefits for middle-income workers. in the house provision, they raise substantial funding by putting a surtax on the very wealthiest people in this country. people who have received huge tax breaks during the bush years, and that makes a lot more sense to me than taxing the health benefits of middle-income workers. having said that, mr. president, i want to focus this afternoon on one new provision that was placed in the health care reform bill by majority leader reid. and i want to thank him very much for his strong support for this concept, and i also want to thank dick durbin, chuck schumer, patty murray, you, and the entire democratic leadership

for their support. and that provision, very simply, provides $10 billion over a five-year period to the federally qualified health center program and the national health service corps. in my view, these two programs are some of the best and most effective public health care programs in the united states of america. and they enjoy widespread -- widespread tripartisan support. president bush was a supporter. john mccain, when he ran for president, was a supporter of community health centers. many of the republicans have spoken very positively of community health centers, as have virtually all of the democrats. the reality, however, is that both community health centers and the national health service corps have been starved for funding for many, many years, and we are finally in this bill doing right by them. i should mention importantly that while we have place

placed $10 billion in the senate bill, in the house bill there is $14 billion. and my strong hope and expectation and belief -- and i talked to the white house about this and the senate leadership and the house leadership -- my strong hope is that when this bill is finally passed, we will adopt the house language which calls for $14 billion. and let me tell you why this money is so terribly important. mr. president, in a few days the senate will be voting on final passage of a historic health care reform bill that will insure an additional 31 million americans who have no health insurance at all. and that is a huge, huge accomplishment. about half of the new people to get health insurance will be enrolled in an expanded medicaid program. while this reduction in the number of uninsured is an essential step in achieving

reform, we have got to ask a very simple question: if 15 million more people go into medicaid, where are they going to access the health care that they need? it is no secret that today medicare is a strange program. which some of my -- when some of my republican friends make that point, i have to say they're right. it is a strained program. that is why expanding community health centers and the national health service corps is so important. you know, mr. president, we talk about the number of people uninsured, very important number, 46 million. but we don't talk about the number of people who every day do not have access to a physician or a dentist on a regular basis, and that number is close to 60 million. these are people when they get sick can't find a doctor. where do they go? well, several things happen. they may end up going to the emergency room, which is the

most expensive form of primary health care that we have. that's where they go. or even worse, they don't go to any doctor at all. and what happens is they get sicker and sicker. then they go stumbling into a doctor's office, and the doctor says why didn't you come in here six months ago, and the person says i didn't have any health insurance, couldn't afford it, and then they go to the hospital, and we spend tens and tens of dollars treating somebody who is now suffering in a way they should not have suffered at greater expense to the system that should have been the case. but what sense does that make? and let me tell you the worst case scenario. the worst case scenario is they walk into the doctor's office and the doctor says it's too late, can't help you anymore. you should have been in here six months ago. i have talked to physicians who told me about that, i suspect you have as well. that is why this year we're going to see 45,000 of our fellow americans die because they don't have health insurance and they don't get to the doctor when they should.

now, one of the advantages of the community health care program is that it is an enormously cost-effective program. one study recently reported that that $20 billion is wasted every year in this country in unnecessary and inappropriate use of hospital emergency rooms but not emergency care. now, when you walk into an emergency room -- i don't know about west virginia, but in vermont, it's about $600. if you get that similar care for a nonemergency type ailment, the cost is $100. so think about all of the money that we save, we save when we have community health centers expanding all over the country. now, one of the issues that we have not focused on enough in my view in this whole health care debate is the very serious crisis in primary health care in general. the american college of

physicians, in a recent report, warned that the nation's primary care work force, which it called, quote -- "the backbone of our health care system is in its own words on the verge of collapse. that is the american college of physicians. over the past eight years, for example, the number of family practice residents fell 22%, while the overall number of medical residents rose 10%. currently -- and this is an extraordinary -- extraordinarily frightening statistic -- only 2% of medical students interested in internal medicine intend to pursue primary care as their specialty, 2%. this growing crisis was recently underscored in a report by the association of academic health centers which warned that the country is rapidly running, quote -- "out of time to address what is out of order in our health work force." end of quote. now, the good news is that

20 million of those people live in medically underserved areas, are fortunate to live where there are federally qualified community health centers. and let me explain a bit. what is a federally qualified health center which exists in all of our states, 50 states? it is a center which says that if you have no health insurance, you can walk in. and you know what? you will pay not only for primary health care but for dental care, which is a huge problem all over this country. for mental health counseling, you will get the lowest cost prescription drugs available in america. and if you don't have any health insurance, you get it on a sliding scale basis. if you have got medicaid, you are welcome. if you have medicare, you're welcome. if you have private insurance, you are health care into these centers. crerntly, these centers serve 20 million americans in all of our 50 states. conceived in 1965 as a bold new

experiment in the delivery of preventative and primary health care services to our nation's most vulnerable people and communities, community health centers are an enduring model of primary care for the country and are designed to empower communities to create locally solutions that improve access to care and the areas they serve. west virginia centers will be different than vermont centers, will be different than california centers because they are designed and locally controlled to serve the needs of the local population. my -- by mission and mandate, community health center must see all those who seek their care, regardless of health status, income level, or insurance status. if you're rich, if you're poor, you will gain access to these community centers. nobody is tossed away. today, these health centers are america's health care home to one out of every four low-income uninsured individuals, one out of every six rural americans, as well as one out of every seven

medicaid beneficiaries and one in four low-income people. we need to guarantee that as we expand coverage, we expand community health centers as well. they are the one primary care provider who will see those on medicaid without restrictions. furthermore, community health centers already employ so many of the features of what we seek in the medical home model. they provide integrated health care, which is what we're talking about. a study recently by george washington university -- you know, we're talking about spending money. what is so exciting about this whole concept is you are going to create more health care opportunities for people and you save money, save money by keeping them out of the emergency room and out of the hospital. a study by george washington university found that patients using health centers of annual overall medical care costs that are more than $1,000 lower than

those who do not use a health center, $1,000. that translated to more than than $24 billion in savings for the health care system last year alone. we are keeping people out of the emergency room. we are keeping people out of hospitals, and we're keeping them from getting sicker than they otherwise would have. and, mr. president, that is why i'm so pleased that majority leader reid has looked at this track record and concurred that we will guarantee, guarantee the funding of health centers over the next five years in order to provide health care to more people and to save money at the same time. now, let me tell you in concrete terms what $14 billion, the amount of money that's in the house, what this will mean to the american people. what it will do, what it will do is will increase the number of people who access -- who have access to community health centers from the current 20 million to 45 million over a

five-year period. 20 million to 45 million. we are more than doubling the number of people who will be able to walk into a clinic. health care, dental care, low cost prescription drugs, primary health care. in five years, going from 20 million to 45 million people. mr. president, this funding would create new or expanded health centers in an additional 10,000 communities. 10,000 communities from one end of our country to the other. in some cases, entirely new federally qualified health centers would be established. in other cases, new satellite centers would be created. in vermont, for example, we have eight community health centers. we have 40 total sites. and that is true all over this country. but, mr. president, can you

imagine that in the united states of america, within a five-year period, 10,000 new community health centers in this country would be established? people would not have to go 50 or 100 miles to find access to health care. it would be there in their own community. it would be in urban areas, in rural areas. this is extraordinary. now, these community health centers and the growth of these community health centers don't mean much unless we have the medical personnel to adequately staff them, and as i mentioned a moment ago, everybody concludes we have a real crisis in terms of access to primary health care in this country and the number of physicians and dentists and nurses that serve in the primary care area. what this language does that we have just added is it would, if we adopt the house numbers, triple funding in a five-year period for the national health service corps which provides

loan repayments and scholarships to medical students. in the university of vermont medical school, my memory is correct, and this is fairly typical for america, the average medical school student graduates with $150,000 in debt. if you graduate with $150,000 in debt, what are you going to do? you're not going to do primary care. you're going to go into a fancy specialty, start making a loft money to pay off that debt. but what the national health service corps will be able to do is provide debt forgiveness and scholarships for an additional 20,000, an additional 20,000 primary care doctors, dentists, and nurses. that is a lot of new medical personnel that's going to get out into underserved areas all over america. and that is just a very, very exciting thought. mr. president, in short, when we

more than double in five years the number of people who have access to community health centers, and within that same period of time we add an additional 20,000 primary health care doctors, dentists, and nurses, we are talking about nothing less than a revolution in primary health care in america, something which we have needed for a long, long time. so let me conclude, mr. president, by just saying this: i want to again thank the majority leader, senator reid. i want to thank senator durbin, senator schumer, senator murray, and thank you and the democratic leadership for your support of this concept. as you know, this idea developed back in the 1960's with senator ted kennedy who developed this concept in the first place. it has expanded, and now we are going to take it a giant step forward, and in the process i

think we're going to make a difference, a real difference in improving the lives and the well-being and the health care access of tens of millions of americans. mr. president, thank you very much. and with that, i yield the floor and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

mr. grassley: mr. president? the presiding officer: the senator from iowa. mr. grassley: i ask that the calling of the quorum be dispensed with. the presiding officer: it is so ordered. mr. grassley: i would call the attention of the leadership of the majority party that i have a unanimous consent request i want to make. i'm going to be visiting with my colleagues about the issue of taxes on medical devices so my -- unanimous consent is in regard to that. and i would hope that people

would observe that if there's an effort to block this motion i'm going to make, i think it's an endorsement of the tax on devices like berlin hart and hundreds of other children across this country rely on. so with that in mind, i ask consent to set aside the pending amendment in order to offer my motion to commit. the presiding officer: is there objection? mr. durbin: with regret, i object. the presiding officer: objection is heard. mr. grassley: well, this is disappointing for those of us on this side of the aisle to not being permitted to consider an amendment that is important like this. so i'll go ahead, mr. president, with my remarks. this is another major problem in the reid bill. of the many taxes in this bill, i'm especially worried about the

excise tax on medical devices. medical device technology is responsible for saving many lives and extending the overall life expectancy of people in the united states. in the united states over 6,000 companies are in business of developing lifesaving medical products. the majority of these companies are very small business and small business we tend to measure around here with less than 500 employees. so what will happen when the reid amendment imposes a tax hike of $20 billion on these innovative medical devices? i think that's something we ought to consider if we're considering about quality of life in america and quality health care to preserve that life and extend life expectancy. during the markup of the finance committee bill, i asked the question to the nonpartisan congressional budget office and

the nonpartisan committee on taxation. let me emphasize nonpartisan. these folks are professionals. they don't care about republicans or democrats. they care about giving the best judgment of what something will cost or how a tax will raise or decrease revenue. so both of these organizations, the congressional budget office, the committee on taxation both said that these excise taxes will be passed on to consumers in the form of higher prices and higher insurance premiums. and to emphasize this, it's right here out of a statement that those organizations have made. also i want to emphasize the chart that's up. talks about a statement of the chief actuary of the h.h.s. the

congressional budget office, joint committee on taxation, and the chief actuary all say the tax just gets passed on to consumers. who are the consumers of these devices? who's going to bear the cost of the new medical device excise tax? well, it's quite a burden. so i'm going to give you some real-life stories here. so i'll start by telling the story of the tillman family. a family that would bear the burden of this new medical device tax. at only 5 months old, tiana tillman had her life saved by a medical device. this story received a lot of attention because tiana's father is a professional football player for the chicago bears. however, lifesaving stories like this happen all across the country regularly. when charles tillman reported to training camp in 2008, it wasn't

long before his coach told him that his 5-month-old daughter, tiana, had been rushed to the hospital. when charles got to the hospital, tiana's heart rate was over 200 beats per minute. that doctor told charles and his wife jackie that tiana might not make it through the night. tiana survived that night and after a series of tests, she was diagnosed with cardiomiopothe, an enlarged heart that is unable to operate properly. without a heart transplant, she would find it hard to survive. finding pediatric donors is difficult, and many do not survive the wait time. so tiana was put on an ecomode,

a device that would help the function of the heart while tiana waited for a heart transplan. however, exmo -- survivors can only -- can only survive for weeks while waiting for a heart. echmo also requires that the patient take a paralitic medication which prevents the patient have moving and at the same time that weakens the body. the tillmans waited for one of two outcomes. either tiana would receive the transplant or would die waiting on echmo, but then the doctors told the tillmans about a new device called the berlin heart. it is an external device that performs the function of heart and lung. it is designed for a long-term

support to keep infants and young children alive for up to 421 days while they wait for the donor heart. obviously a lot longer than the three weeks on an echmo. so the till mans decided to move forward with the br lynn heart. after -- berlin heart. after 13 days of being on echomo, tiana underwent surgery to connect the berlin heart. we have devices here to show what this is like. these two photos are of tiana with the berlin heart. you can see that this device is run by a laptop at the foot of the hospital bed. it pumps the blood through her body. a job that her heart could not perform on its own. unlike echomo, the berlin heart and its support capability, allow the tillmans some peace of

mind while they waited for that donor. doctors said that the berlin heart helped tiana regain her strength because she was off the paralitic medication and finally able to move. not long after tiana was connected to the berlin heart, a donor was found and tiana underwent an eight-hour surgery. the surgery was a success. usually it takes some time for the new heart to start working. but doctors said that due to tiana's strength, her new heart started working immediately. so i want to talk about the tax on devices like this. because you have right here holding a football, that's tiana today. and you shouldn't be surprised about her love for football considering that her father's a professional football player, at

least at that time. she enjoys playing on her swing set, watchlin watching her dad y football there are many people responsible for the successful effort to save tiana's life. but without the berlin heart to keep her alive and help her keeper strength, they may not have had that opportunity. what does this legislation have to do with this story about tiana? well, the reid bill would increase costs for families like the tillmans. in fact, the reid bill would tax every pediatric medical device. pediatric devices aren't the only devices affected by the tax on medical devices in the reid bill. the reid bill also taxes one of the most important modern

technologies, automatic, external defribillators. this defribillator isn't used to save people from sudden -- is used to save people from sudden cardiac arrest, and that's the leading cause of death in this country. each year nearly 325,000 people die from sudden regardal arrest -- sudden cardiac arrest. that is nearly 1,000 deaths a day. sudden cardiac arrest occurs when the heart's electrical system malfunctions and the heart stops beating abruptly and without warning. when this happens, the heart is no longer able to pump blood to the rest of the body. and for about 95% of the victims, death occurs. once cardiac arrest occurs, the clock starts ticking and the

victim's proximity to a defribillator could mean the difference between living an dying. as many as 30% to 50% of the victims could be survived if such a device is used within five minutes of sudden cardiac arrest. so here -- here we have the story, then, of marie ann werda. maryanne is a constituent of the county i lived my 75 years in -- now 76 years. she is also a survivor of a sudden cardiac arrest, thanks to the prompt response of the hampton police department, the availablity of a defribillator. on july 26, 2002, maryanne

pulled up to a stoplight in hampton, iowa, without warning, maryanne experienced cardiac arrest. as she slumped over the steering wheel, her car drifted across the road and came to rest against a tree. she was only minutes away from brain damage and death. at 11:38 a.m., the police station dispatched officer chad elness who arrived at the scene two minutings later, when the officer arrived, maryanne was as blue as his uniform, according to his own report. officer elness attached the defribillator to maryanne sending 200 jewels of electricity to her heart. that was one of the two shocks that maryanne required. between the shocks, the defribillator prompted the

officer to perform c.p.r. twice he almost lost maryanne. but by 11:50 a.m. maryanne had a pulse and her color was improving. at 11:52, 11 minutes after the defribillator was turned on, it had saved her life and was turned off. maryanne then was taken by helicopter to mercy hospital in mason city, iowa, where she received care. one week later -- just one week later, she was back home with no permanent damage. the defribillators are only effective if they're used within minutes of cardiac arrest, which means that in order to save more lives, there needs to be more of these devices. but, you know what this bill would do about all of that? it would increase the cost? meaning that there would then be

fewer defib lators. you understand the laws -- defribillators. you understand the laws of economics, if you lower the price you'll get more of it, if you raise it, you'll get less of it. you raise the price, it would make it difficult for police departments, schools and other public places to purchase defribillators to have one and if you have to be within five minutes of their use, you understand why they have to be in police departments, schools, libraries, and a lot of other places. and you know what is this only one-third of the police departments are equipped with defib lators. however, maryanne was lucky that the hampton police department already purchased the device. according, increasing the cost of defib lators will make it more difficult for communities to make this lifesaving investment. we already have 62 defribillator

stations throughout the capitol. the three senate office buildings have one. so you and i are protected. probably protected more than we need to be protected with 62 of them being throughout the capitol. so we're going to put a tax on them so the people in the rest of the country. you know, it seems like around here we have got one set of morals and ethics for chill and -- for capitol hill and another set of morals and ethics for the rest of the country. so clearly -- congress clearly understand by having so many of these devices the importance of them. and having them on hand to protect us and to protect our staffs and the million visitors that come to the capitol. so i made a motion that was --

that was objected to, so i can't go through with that amendment, but my motion would have stopped this new federal tax from increasing the cost of defibrillators and hurting the chance of placing the devices where they need to be, hopefully within five minutes of people that need them. this is a disappointment that my colleagues on the other side of the aisle would not allow that motion to go through. it is a sad state of affairs when the majority is not only blocking the offering of amendments that will improve the bill but also trying to ram through a bill before the american people even know what's in it. yesterday, so often we heard these things about republicans haven't offered amendments. there is 214 amendments at the desk. you would think we would have a chance to offer more than the

dozen or so -- i doubt it's even a dozen at this point on a bill that's going to change the -- the -- restructure 1/6 of the economy. i yield the floor. mrs. hutchison: mr. president? the presiding officer: the senator from texas. mrs. hutchison: mr. president, may i ask what? is it ten minutes or what is the procedural position as of now? the presiding officer: the minority party controls the time until 2:30, and there are no individual limits. mrs. hutchison: thank you. thank you, mr. president. mr. president, for weeks, we have been debating legislation that will dramatically and permanently reform our health care industry. it will impact the life of every

american and it will add to our growing national debt. on saturday, the majority leader filed an amendment increasing the size of this bill. early this morning at 1:00 a.m., we had a vote to proceed to the revised bill that makes really a mockery of transparency in public policy. yet even though the majority took the opportunity to amend the bill, it is clear that the concerns of the american people were not heard by my friends on the other side of the aisle. i was astounded to see that this revised bill still contains half a trillion dollars in new taxes, half a trillion dollars in medicare cuts, and mandates and penalties on businesses and individuals throughout our country in a time when business is struggling, unemployment is up, and families are trying to

make ends meet. i want to talk about the taxes. the revised bill has an additional $25 billion in taxes than the bill as introduced. we have been hearing for weeks about families that are struggling to pay their mortgage, struggling to find a job, struggling to pay their utility bills, and yet, what do we find in this new bill? more taxes and more mandates. the american people overwhelmingly oppose this bill, and just when we thought the final product couldn't get any worse, it does. under the revised bill, the taxes collected from individuals that cannot afford health insurance has been raised from from $8 billion to $15 billion, almost double. why? because the penalty for not purchasing insurance has become more severe. now if you cannot afford

insurance, the tax is either either $750 or 2% of your taxable income, whichever is higher. there are still taxes that begin next month, less than two weeks from now. less than two weeks from now in this bill, $60 billion in taxes on insurance companies will start, except for companies in two particular states. now, that doesn't seem fair. fortunately, the constitution's equal protection clause may have something to say about this gross situation. this will not stand the test of the constitution, i hope, because the deals that have been made to get votes from specific states' senators cannot be considered equal protection under the law.

and if it does stand up and the taxes start next -- two weeks from now -- the people who have insurance are going to pay higher premiums, even higher than what has been projected already. in 2011, then we see the taxes on prescription drug manufacturers and medical device manufacturers, so the public can expect to see higher prices for medicines and devices, thermometers, blood sugar machines, canes, walkers, the things that people need to stay healthy. that's another $40 billion in taxes. and then there is another round of taxes in 2013. $149 billion in taxes on high-benefit plans. a 40% excise tax on the amount by which premiums exceed $8,500

for individuals and $23,000 for families. $87 billion collected from a medicare payroll tax. this tax is actually $33 billion higher than in the prior bill. individuals earning more than than $200,000 and couples earning more than $250,000 are now assessed at a tax rate of 2.35% for a new medicare payroll tax rather than 1.45%. so if you are a couple earning earning $125,000 each, you have another tax increase. in addition to possibly a tax on not having insurance or a high benefit plan. $15 billion will be raised by raising the threshold for the medical deduction. to receive the medical deduction, you must now spend 10% of your income on medical

expenses rather than 7.5%. this tax will impact those who have high medical costs or are suffering from a catastrophic or chronic illness. this bill taxes those who have insurance and those who don't. all of these taxes are collected. all of the taxes that i had mentioned will be collected before there would be the option that is the purpose of this bill. whatever the option becomes, it takes effect on 2014. all the taxes that i had mentioned start before 2014. senator thune and hi a motion that would have -- and i had a motion that would have sent this bill back to the committee and required that everything in this bill start at the same time, so if the program starts in 2014, the taxes would start in 2014.

under our motion, not one dime in taxes would be paid before americans are offered the insurance option in the bill. the motion was defeated. now the democrats have revised their bill and the taxes collected are even higher than the previous bill. let's don't forget the penalties to business, business that can't afford to offer health insurance to their employees. a tax of $750 per employee is assessed. now, this is a time when unemployment has reached double digits. we should be encouraging employers to hire more workers, and yet this bill imposes imposes $28 billion in new taxes on employers. what will these taxes do to small businesses which create 70% of the new jobs in our

country? in a letter sent to the majority leader yesterday, the small business coalition for affordable health care stated with its new taxes, mandates, growth in government programs and overall price tag, the patient protection and affordable care act, the bill that we are discussing costs too much and delivers too little. any potential savings from those reforms are more than outweighed by the new taxes, new mandates, and expensive new government programs included in this bill. that letter is signed in addition to the small business coalition by associations such as the farm bureau, associated builders and contractors, associated general contractors of america, the national association of home builders, the national association of manufacturers, the national automobile dealers association,

the national retail federation, and more. the national federation of independent business, which is the voice of small business, sent a letter expressing their strong concerns over this bill. it says the current bill does not do enough to reduce costs for small business owners and their employees. despite the inclusion of insurance market reforms in the small group and individual marketplaces, the savings that may materialize are too small for too few, and the increase in premium costs are too great for too many. that's the tax situation. how about the half a trillion dollars in medicare cuts? they are still there. they were in the first bill, and they are there now. $120 billion in cuts to medicare advantage, which we know reduces choices for seniors.

in my state of texas, over 500,000 currently enrolled enjoy the benefits of medicare advantage. that's just in my state alone. millions across the country like medicare advantage, but many seniors without a doubt are going to lose this option. now, oddly enough, once again, one of the points in the new bill is that there were optouts for certain states on medicare advantage's cuts, so some states are going to have the medicare advantage cuts while other states will not. the individual fixes for certain states, presumably to get the votes for certain senators, really, mr. president, does not pass the test of transparency if you put it in the nicest way. it just doesn't pass the test

for fairness, for due process and equal treatment under the law, and it certainly doesn't pass the test for what is the right way for us to pass comprehensive reform legislation. the other health care cuts in medicare would be $186 billion in cuts to nursing homes, home health care, and hospice providers. and then there are the cuts to hospitals. approximately $135 billion in cuts to hospitals. the texas hospital association has estimated that hospitals in my state will suffer almost almost $10 billion in reduced payments. i have a letter from the texas hospital association that outlines their concerns with these cuts and this bill, and they are very concerned. here's one of the quotes from their letter.

the texas hospital association says -- "with a significant reduction in payments, hospitals may be forced to reduce medical services. hospitals may be forced to close or merge with another hospital or severely reduce the services they provide to their communities. essential services such asthma ternity care, emergency services, medical-surgical services or wellness programs may be reduced or eliminated entirely." mr. president, i know so many -- i've talked to so many hospital administrators and people on hospital boards, and they are very concerned about the cuts in this bill because they are on very thin margins, most of them, they're struggling, and especially in our rural areas, and they are very worried that there are going to be shutdowns of hospitals throughout our state and certainly our country.

but our aging population is growing, so cutting the payments to providers who treat those, whether it is in hospitals or health care providers, doesn't seem to be a way to reform medicare. cuts in medicare and especially payments for treating low-income seniors will disproportionately impact rural hospitals, the safety net for health care outside of the metropolitan areas. the texas organization of rural and community hospitals which represents 150 rural hospitals in texas said in a letter, "we fear the medicare cuts as proposed could disproportionately hurt rural hospitals, which are the health care safety net for more than 2 million rural texans. because of lower financial

margins and higher percentage of medicare patients, rural hospitals will be impacted more than urban hospitals by any reductionness reimbursement. these proposed medicare cuts could have a devastating effect that could lead to curtailing of certain services, and the closure of some of these hospitals in texas is a real possibility. how could anyone support a reform bill that will result in seniors having to drive 30, 60 and 90 miles and more to get the care they need, care that was accessible in their own community before this bill took effect." mr. president, what we have here is a bill heavy with tax cuts -- tax hikes, medicare cuts and government intrusion. this bill is being forced through congress the week of christmas because everyone knows that this is not the reform that americans want.

the polls are showing that. we all know that polls can have margins of error, and maybe they're not completely accurate. but the trend in the polls is clear. it has gone from people thinking that health care reform is a good thing and supporting it in majorities to going down now to the point where the trend is clear. the american people now do not support this bill. they would rather have nothing according to latest polls and have congress start all over and do what they hoped it would do, and that is bring down the cost of health care, not have this big government increase in debt, cuts to medicare and increases on taxes to small business and families, especially at this time in our country's economic

period. my republican colleagues and i have tried to offer fiscally responsible alternatives to reform. allowing small businesses to pool together, increase the size of their risk pools will bring premiums down. if you have the change with the risk pools that are increased, it would be fine unless you have so many mandates like we see in this bill that are going to cause the prices to stay up. and even get bigger because of all the taxes on the underlying companies that are providing the health care. creating an online marketplace free from mandates and government interference would be a republican proposal, something that i think would be a point at which we could start having health care reform that would be truly effective for america.

if you didn't have the mandates that would drive up the cost. offering tax credits to individuals and families that purchase insurance on their own, that's a bill that we have put forward. $5,000 per family would cut the cost and make it affordable without any government intervention that would be necessary. and, of course, medical malpractice reform could take $100 billion out of the cost of health care by stopping the frivolous lawsuits or at least limiting them. yet, republicans were really not at the table. the bill was written in a room, no transparency, no c-span cameras, and no republicans. we did not have input into this bill. that's why it is a partisan bill. that's why the vote last night or this morning at 1:00 a.m. was

completely 100% partisan. because why would a republican vote for a bill that goes against every principle that we have: higher taxes, higher mandates and cuts in medicare, and in which we had not one amendment pass. we offered amendments, but there were hundreds of amendments left on the table that we were closed out of offering because of the rush to pass this bill before christmas. mr. president, americans asked for reform. they deserve it. this bill is not the reform americans hoped to get from a congress that would have acted responsibly but did not. thank you, mr. president, and i yield the floor. a senator: mr. president? the presiding officer: the senator from texas.

mr. cornyn: thank you, mr. president. mr. president, like my colleagues on this side of the aisle, i voted against the reid health care bill last night because it cuts $470 billion from medicare to create a brand-new entitlement program that will cost $2.5 trillion roughly over the next ten years, a price we cannot afford. it increases premiums for american families that currently have health insurance and who are struggling to make ends meet during tough economic times. and it increases taxes on small businesses and individuals, which is a terrible idea, particularly at a time when our economy is struggling and our job creators are struggling to be able to keep people on their payroll and possibly expand their payroll and hire people back and bring down the unemployment rate. but i want to talk about the way this bill came to pass, at least

the cloture vote this morning at 1:00 a.m. i want to talk about the process. i recall that when senator obama was running for president of the united states, he talked about wanting to change the politics as usual in washington, d.c. but i have to tell you, the majority in this administration have in many ways confirmed people's worse suspicions about washington politics as usual, and they've taken it to a new level. that's not a higher level. it's a lower level. as a matter of fact, the bartering for votes for cloture, the special sweetheart deals with drug industries, with senators in order to get the 60 votes last night is nothing more, nothing worse than confirming the worst fears, the cynicism that the american people have about the way washington works. we know this bill is a direct

result of many special deals with interest groups and their lobbyists. we heard the president say when he ran that he wanted to have a transparent process, that this would take place in front of c-span at a round table so people can see who's making arguments on behalf of the drug companies and the insurance companies. but that rhetoric conflicts with the reality, where the drug companies and the insurance companies and others were negotiating behind closed doors for sweetheart deals that ultimately ended up getting 60 votes. and so it turned out that it was the obama administration that cynically said one thing during the campaign and then when it comes to actually passing legislation, does completely the opposite. this is tragic, in my view, mr. president. the american people want to believe in their government. they want to believe in their elected leaders who are trying to do their best on behalf of

the american people, but this process confirms their worst suspicions. no wonder public opinion of congress is in the toilet. rather than listening to the american people, the creators of this bill started cutting deals with special interest groups first and cut those deals early. the white house struck a deal with the pharmaceutical industry, as you know, which produced in part, as "the new york times" reported, about $150 million in television advertising supporting this bill. and this deal got 24 democrats when we were debating the issue of drug re-importation, to switch their votes from their previous position against drug re-importation earlier this month. we know the insurance industry, not withstanding all the rhetoric about insurance

companies and -- that basically this is a sweetheart deal with insurance companies because insurance companies will get $476 billion of your tax dollars and my tax dollars to pay for the subsidies in the insurance that is provided in this bill. the hospital industry cut a special deal that provided them an exemption from the payment advisory board. and then there were groups like aarp that purport to serve seniors as a public interest, but as we know primarily pockets money as a result of sale of insurance policies, insurance policies that are going to be necessary because of cuts in medicare advantage or 11 million seniors, just to name one example th-fplt bill was the result of back room deals with specific senators, persuading them to vote for cloture, what has caused some people to call on the blogs and on the

internet, "cash for cloture." in order to get 60 votes for cloture we know one of the first deals for that was the so-called louisiana purchase. charles krauthammer said it well. "after watching louisiana get $100 million and what some called the louisiana purchase, she ought to ask for $500 million instead. that's because obama said he would end business as usual in washington, so it's a new kind of business as usual." in other words, i guess the price has gone up. one business leader points out that not withstanding the special sweetheart deal for the state of louisiana directing $300 million to the state, that the medicare expansion alone here results in the taxpayers and the people of louisiana being a net loser. we also know that in order to get 60 votes, the majority leader had to cut a deal with the senator from nebraska, the senior senator from nebraska, in order to get the vote for cloture. it's been widely reported that

that meeting with the senior senator of nebraska took place for 13 hours behind closed doors, after which they negotiated some language which purportedly no longer allowed the use of tax dollars to pay for abortions but which, according to conference of catholic bishops and other pro-life groups, is completely ineffectual and which restores or actually produces a taxpayer paid-for abortions for the first time in three decades. what else did the senior senator from nebraska get? well, the state of nebraska purportedly got a free ride from washington's new unfunded mandates on the state. of course we know every other state ends up paying for that sweetheart deal that the senior senator got for nebraska. what do nebraskans think about it? well, just ask the governor who said yesterday he had nothing to

do with that tk-l deal and called -- with that deal and called the overhaul deal bad news for nebraska and bad news for america. he said nebraskans did not ask for a special deal, only a fair deal. then we know in order to get 60 votes, the majority leader had to cut a special deal with the senators from vermont. one senator from vermont threatened to vote against the deal, but lo and behold the manager's package included $600 million benefitting only that one state. the senator who threptened to vote -- who threatened to vote no decided to vote yes after that special deal was included. "the new york times" lists several other sweetheart deals that produced this monstrosity of a piece of legislation. the intended beneficiaries, though, in many instances were identified in a vague and sort of cryptic way. individuals exposed to environmental health hazards recognized as a public health

emergency in a declaration issued by the federal government on june 17. well, there's only one state that would qualify for that, not withstanding this sort of vague description designed to hide the ball and obscure what was actually happening through another sweetheart deal as part of this bill. another item in the package would increase medicare payments to doctors and hospitals and any statements where at least 50% of the counties are -- quote -- "frontier counties," the finest of those having a population density of less than six people per square mile. we know there was another $100 million sweetheart deal for an unnamed health care facility affiliated with an academic health center at a public research university in a state where there is only one public medical and dental school. the associated press reports the state that qualifies for that special deal is the state of connecticut, where the senior senator currently is in a tough

reelection fight. now, mr. axelrod, who is the architect of the campaign strategy for this administration, to bring change to washington, when asked about these special deals in the manager's amendment, his response was pretty telling. he said "that's the way it has been. that's the way it will always be." well, maybe in chicago, but not in my state, and not in the heartland and the vast expanse in this great country where the american people want us to come an represent our constituents an vote for what is right and not what sweetheart deals we can eek out at the expense of the rest of the american people. the very thing that's happening with this health care bill demonstrates why washington takeovers are such a terrible idea. because instead of health care decisions being made between patients and doctors, health care decisions are overcome

through a political process where elected officials choose winners an losers. -- and losers. politics has become a dirty word outside the beltway and, certainly, we can understand why this process is reconfirmed in the minds of many people that what we're doing here is not the people's business, but protecting special interest and special sweetheart deals. rather than making decisions about what's best for the american people, this deal has been driven by deals with special interest groups and lobbyists and rather than listen to constituents, individual senators have decided that their votes should be traded for tax dollars and other sweetheart benefits that go to their states. but make no doubt about it, this bill takes the power from individual americans to make their own health care decisions and transfers that to washington, d.c., and this new

low-level of politics as usual. mr. president, according to one recent poll that occurred today, or was reported today in rasmussen for one state that i won't mention by name, where only 30% of the respondents to this poll favor this health care bill and 64% are opposed, the senators from those state voted for the bill where only 30% of their constituents support the bill and that's not the only example. you can only ask yourself why in the world would senators vote for a bill when two-thirds of their constituents are opposed to it? who must they be listening to? are they listening to the people they represent and who sthenlt here to washington to represent them or are they listening to the special interests -- or have they decided somehow that they've become miraculously

smarter than their constituents and they know better what's for their constituents than their constituents themselves. there is still a chance to vote against this bill. as senator mcconnell said last night, any single senator on the other side of the aisle can stop this bill or everyone who votes for it will own it. i yield the floor. a senator: mr. president? the presiding officer: the senator from nebraska. mr. johanns: mr. president, let me start my comments today by complimenting the gentleman from texas. i thought he did an excellent job of shining the light on something that is now gathering a lot of attention because the managers' amendment is out. and we can read the words and we can start to understand the special deals that were cut to

get the votes to make this happen. so i applaud you for standing here so courageously. mr. president, my state, the great state of nebraska, has been pulled into this debate. and i want to start out today by saying here on this senate floor that i am enormously proud of my state. probably like all united states senators in reference to their state. i'm enormously proud of the people of nebraska. i've gotten to know them well. i was their governor and on a more localized basis, i was also the mayor of lincoln and i did my -- date my time back in public service to when i was lancaster county commissioner. these are good, decent, and honorable people who are always looking to try and figure out

the right way of doing things. and i stand here today to acknowledge that and to tell all nebraskans how proud i am to be here today. but, mr. president, i rise today to share with my colleagues the reactions of nebraskans to the special deal that got cut for nebraska that came to light over the weekend as the managers' amendment was released and analyzed. less than 24 hours at announcement of the special for nebraska with virtually no warning, no preparation to speak up, 2,000 people gathered in omaha, nebraska. nebraskans who in one voice cried foul. nebraskans are frustrated and angry that our beloved state has

been thrust into the same pot with all of the other special deals that get cut here. in fact, mr. president, they're outraged that a backroom deal for our state might have been what puts this bill across the finish line. you see, mr. president, i fundamentally believe that if this health care bill is so good, it should stand on its own merits. there should be no special deals, for anyone in this health care bill. not for states. not for states. not for insurance companies. and not for individual senators. you know, i stand here today and i find it enormously ironic that advocates for this bill who worked overtime to vilify

insurance companies in the last hours of putting this bill together struck a special deal with two insurance companies in omaha, nebraska, that they would be carved out of their responsibility in this bill to pay taxes. i find it painful to even acknowledge that that happened. i said at the beginning of this debate that changes of this magnitude affecting one-sixth of our economy must be fair and they must be believed to be fair by the people. the special deal for nevada was was wrong. i said that. in fact, one of the six reform principles i publicly outlined and took out to town hall meetings i stand by today and it simply said, no special deals. a special deal for nevada was

wrong and is the carve out for louisiana. and statement applies for the backroom deal that was struck for my state, the great state of nebraska. all of this special -- all of the special deals should be removed from this legislation. if this bill cannot pass without the carve outs and the special deals, what further evidence could we possibly need to draw the conclusion that this is just enormously bad policy? if you literally had to sit down in the last hours of negotiations and strike a special deal, do we need any other argument about how bad the policy of this bill is for my state and the citizens of nebraska? our governor said it well, nebraskans don't want a special deal. you see, i went around the state for months doing town halls and listening to nebraskans. they don't want a special deal.

no nebraskan came up to me and said, mike, give me a special deal. you see, their request is simple. they want to be able to see the doctor of their choice and to keep the current plan that they have. they want our job creators, our small businesses to get our economy moving and create jobs in our communities from large to small free of the half trfd trin dollars of taxes and fees that this bill will heap on our employers. the managers' amendment does nothing to change the core problems with this bill. the nearly $500 billion in medicare cuts will be devastating to nebraska. and no special deal with an insurance company is going to make nebraskans feel better about that.

no special deal to make the state budget look better is going to make nebraskans feel any better about the medicare cuts and the impacts on our hospitals, our nursing homes, our home health care industry, our hospice industry. nationally governors, republican and democrat, have stepped forward to say that they can't afford the unfunded mandates that come from washington and drive their budgets into the red. the special deal struck on abortion is enormously tragic and insufficient. it breaks my heart. this is a far cry from the 30 years of policy by this united states government. you see, when this is done and over, what we will be reporting to our citizens is that taxpayer funds will fund abortions if

this bill passes. you see no watered-down accounting gimmick will convince the pro-life community in my state or otherwise. in fact, they have publicly said they feel betrayed. i'll wrap-up with this, this bad deal is not sealed. there is time for truly pro-life senators to stand tall and say no. there is still time for principled senators to reject the carve outs and to cast aside the bad, backroom deals. there's still time for senators to listen to the people and reject reckless federal policy. fair treatment isn't too much to ask of washington. i know in my state that's what they're asking for. i will firmly stand behind any senator who has the courage to stop this train wreck. i'll be the first to lead the

applause. and i'm confident the standing ovation for that courageous senator will extend all the way back to nebraska and it will be deafening. thank you, mr. president. i yield the floor. a senator: mr. president? the presiding officer: two 1/2 minutes. -- 2 1/2 minutes. mr. grassley: i would think that one of the things that we would have seen from the majority at this point is a list of what the last two senators were talking about, all of the earmarks that are in this bill. because i ask for a

parliamentary inquiry yesterday, i'm not going to ask for that again. but, as we said yesterday, rule 44 was adopted as part of a major ethics and reform legislation adopted in 2007. it was part of the honest leadership and open government act. the democratic leadership made it the first bill to be introduced when they took the majority in 2007, taking control of congress for the first time for a long period of time. and this bill passed by unanimous consent when -- when -- when rule 44 was passed, the theory behind it was, that we ought to have total transparency on earmarks. it applies to floor amendments like the pending reid bill. it requires a sponsor of the

amendment to provide a list of refeearmarks in that amendment. earmarks are provisions that provide limited tax benefits. and those are words -- limited tax benefits, words out of the rule. and another substitute language for limited tax benefits, congressionally direct spending items or earmarks, as they're generally referred to by the public at-large. giving -- given what a priority the new rule passed in 2007 was given and the importance of it, one would expect that the majority leader would be making every effort to comply with it. one would think that he would be willing to set a good example in complying with a -- with a rule and it slows these earmarks. in order to ensure transparency

of these very narrow provisions, like what the -- what senator johanns just referred to get the votes of specific members of the majority party that probably would not have voted for this bill, you would think that -- that that ought to be made public. that's what rule 44 is about. and, of course, that burden under that rule is on the sponsor to provide the list. so once again, i'm going to ask the democratic leadership to comply with the honest leadership and open government act. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i ask unanimous consent that the senate receive en bloc the following bills -- calendar number 235-242, that the bills be read a third time and passed

en bloc, the motion to reconsider be laid upon the table with no intervening action or debate, and that any statements relating to this matter be printed in the record at the appropriate place. the presiding officer: is there objection? mr. grassley: i object because i don't know what it's all about. has this been cleared with our side? mr. baucus: it's my understanding, senator, yes. these are post office bills. mr. grassley: then i withdraw my objection. the presiding officer: hearing no objection, it is so ordered. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i now yield 20 minutes to the chairman of the health committee, senator harkin, and then 18 minutes to the senator from colorado, senator bennet. the presiding officer: the senator from iowa. mr. harkin: mr. president, i guess we -- i can say we passed the rubicon last night at 1:00,

and reading some of the press reports, of course, most of the newspapers didn't have it because it occurred at 1:00 a.m., but some of the different reports have been online this morning, and it occurred to me that a lot of people are missing really the overall importance of what happened last night, the overall importance. oh, we can get into the fine tuning and the nit-picking and the -- sort of the fear and the anger that i hear from the other side. every time i listen to speeches over there with the exception of the last speaker, but almost all the speeches i hear from the other side, it's fear. be afraid, be afraid. it's some built-up anger over there. but i think what happened last night is we really crossed a demarcation line, a demarcation line of which on one side health

care is a privilege. we have been on that side of the line for a long time. on the other side of that line is health care as a right, and we stepped across that line last night. we are now in the process of saying health care is a right, an inalienable right of every american citizen. is that what so upsets my friends on the republican side? well, i don't know. something is upsetting them because this is a momentous change that we're doing. as i said last night, i -- i keep hearing from the republicans they want us to deal in a bipartisan way. well, we tried all last -- all this year, both in the "help" committee and senator baucus in the finance committee bent over backwards to accommodate, but at every turn, the republicans said

no, no, no, no, no, all year long. but how can you be bipartisan when the other side has nothing to offer? there is no bill on the republican side. well, there is a bill. it's got about nine cosponsors. senator coburn and i think senator burr, maybe seven others, but not every republican is on that. i hear bits and pieces of this and that every time i hear these speeches around here, most of us just attacking what we have done. i hear nothing positive from their side. it's very hard to deal with a party that is in total disarray as the republicans are. they had a bill that they were supporting and that was supported by all of them, like the bill that we have here which is supported by 60 democrats. i think then you could find some

reason for meeting and -- and working things out. but since there is no one on that side that has a comprehensive proposal, it's very hard to do that, and so we have had to kind of plow ahead as best we can. now, we have not done this just alone in our committee. we met for 13 days. we had 54 hours of markup. no amendment, no amendment was denied. republicans offered over 200 amendments. we adopted 161 of them. that's pretty good. and yet in the end, every republican voted against it. so it's not as if we didn't try and we didn't hold out the olive branch and work with people to get -- to get a bill that was truly bipartisan. we did in our committees, both the finance committee and the "help" committee. but now it's come down to fear

and anger on the other side and some nit-picking. now, my -- my friend from iowa -- and he is truly my friend -- was talking about some provision that is were put in the bill for special reasons and stuff. well, i admit fully and openly that i was part of that, that i put something in the bill that was sort of particular to my state of iowa? yes, i did. but it doesn't -- but it isn't just iowa. there are a few other states and several states in which we have these hospitals. they are not as big as the big hospitals with the volume. they are not so small that they are these low volume hospitals that get help. they are kind of in between, and they call them tweener hospitals. we have eight of them in iowa, at grenelle, kiakut, muscatine,

newton, fort madison, and the great lakes regional hospital at spirit lake. now, there are a number of these in the united states. i forget the total number, but but -- not a large number, but they just fall in a place where they are in between the big and -- they are too small for the big and too big for the small. and as a result, they have been getting a bad deal from medicare reimbursement, and there is a fix in this bill that will allow them to get adequate reimbursement. i don't know. i don't see anything wrong with that. it's fixing a specific problem that the bureaucracy just can't seem to quite get fixed. so that's in the bill. i -- i make no bones about having put that in there. but i think it's a good deal. i think it's something that's going to help a lot of

hospitals, not just in iowa but a few other states. mr. president, one of the things i wanted to talk about today is something that i have been on for many, many years, and that is the huge amount in this bill on prevention and wellness. it's not been written about a lot. you get focused on public options and the abortion issue and a few other things like that, but perhaps i -- i'm one of the most -- on one of the most profound parts of this bill and the one that i feel will do more to bend the cost curve as they say than any other single thing are the provisions dealing with prevention and wellness in this bill. now, in the past, i have said many times that we don't have a health care system in america. we have a sick care system. when you think about it, if you get sick, you get care, but

precious little is spent out there to keep you healthy in the first place. and so people get sick, they go to the doctor, they go to the hospital, and we patch and fix and mend and try to make them well. well, your mother was right, you know. prevention is worth a pound of cure. and we have fallen far short of that in -- in this country. there is a remarkable array of provisions in this bill that promote wellness, disease prevention and public health, and together they'll move us from a sick care society into a genuine wellness society, into a true health care system, not just sick care. what better way to reform our health care system than to restrain health care costs by helping americans to prevent chronic diseases? stay healthy, stay out of the hospital in the first place. right now, as we have heard so

many times here, in this country we spend more than $2 trillion, than $2 trillion, $2 trillion each year on sick care, but just four cents of every dollar is invested in prevention in public health. four cents of every dollar, prevention and health. i submit that this is a major reason why americans spend twice as much per capita on health care as european countries, but were twice as sick with chronic disease. get that. we spend twice as much as europe on health care, but we're twice as sick with chronic diseases. well, the good news is by ramping up our emphasis on wellness and prevention, we have tremendous opportunities, both to improve the health of the american people and to restrain health care spending. that is the aim of this bill,

which makes these significant new investments in prevention. for example, our bill will ensure that seniors have access to free annual wellness visits and personalized prevention plans under medicare. we have never had that. for the first time, seniors will have access to free annual wellness visits and personalized prevention plans under medicare. that's a big deal. so many seniors today just you get sick, they go to the doctor, get more pills, they get sick, they go to the doctor, get more pills. now they will be able to go in, have their annualized checkup, see what's wrong, and have a personalized prevention plan for each person under medicare. they will also encourage states to improve coverage and access to recommended preventative services and i amizations under

medicaid. at a minimum, states will provide medicaid coverage for comprehensive tobacco cessation services for pregnant women. now, that's just at the start, right away. at a minimum, they have to do that. in addition, the bill requires insurance companies to cover recommended preventative services with no co-payments or deductibles. now, this is critical because we know that all too often, people forgo their yearly checkups or essential screenings because either their insurance companies don't cover them or because they have high co-pays and deductibles. another critical element in the bill is -- it's essential i think to a sustainable push for wellness, is the creation of a prevention and public health trust fund. prevention of public health fund. typically, prevention and public health initiatives are subject to unpredictable and unstable funding. this means that important

interventions, things like education about nutrition and assistance for smokers who want to quit often go unfunded from one year to the next. they get funded a little bit one year, cut the next, funded a little bit the next year, cut the next. the prevention in public health fund in this bill will provide an expanded and sustained national investment in programs that promote physical activity, improve nutrition, and reduce tobacco use. now, we all appreciate that checkups and i amizations and other clinic -- and immunizations and other clinical services are important, but this bill also recognizes that where americans live and work and go to school also has a profound impact on our health. that's why a number of provisions in this bill focus on creating healthier communities with better access to nutritious foods as well, as well as safe places to engage in physical

activity. a 2007 study by the trust for america's health found major savings from community-based prevention programs designed to increase levels of physical activity, improve nutrition, and reduce smoking rates. this study conclude thad a national investment of $10 per person per year, $10 per person per year in these kinds of community-based programs could yield net savings of more than than $2.8 billion annually in health care costs in the first one and two years. more than $16 billion savings within five years, and nearly nearly $18 billion savings annually within 10-20 years. $10 per person per year. more generally, this bill aims to give americans the tools and information they need to take charge of their own health.

for example, it requires large chain restaurants to post basic nutrition information on the menu so consumers can make healthy choices. that's in this bill, and it will start next year. the bill also focuses on prevention and public health needs of a number of generally overlooked populations, including children, individuals with disabilities, americans living in rural communities, and certain ethnic minorities. for many months, mr. president, i made the case that it's not enough to talk about how to expand insurance coverage, how to pay the bills -- those are important -- but it makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective and broken. we have to change the health care system itself.

beginning with a sharp new emphasis on prevention and public health. we also have to realize that wellness and prevention must be truly comprehensive. it's not only about what just goes on in the doctor's office. it also encompasses community-wide wellness programs about which i just spoke, things like building bike paths, walking trails, getting junk food out of our schools, out of the vending machines, making our school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more. some of this is going to be addressed in other bills. for example, next year in the agriculture committee, we will be reauthorizing the child nutrition bill. that deals with school lunches and school breakfasts. and we need a major effort there to make our lunches and our breakfasts more nutritious for our kids in school. next year in the committee i

chair, the "help" committee, we're going to reauthorize the elementary and secondary education act, the so-called no child left behind act. there's a lot of things we're going to be doing on that. i see one of our committee members, the senator from colorado, senator bennet here, former superintendent of schools, is going to play a key role in helping us get that elementary and secondary education act through and refined and brought up to date and make some changes. but there's one other part of that bill that we have to focus on, and that is the amount of physical activity that kids get in school. i talked many times both to secretary duncan, and before him to secretary spellings about this idea of no child left behind. if we're not going to leave kids behind in terms of their reading and their math and their english, how about not leaving them behind in terms of their health. and yet, recess is gone.

i saw a statistic the other -- this year that said that 80% of elementary schoolkids in america today get less than one hour of physical exercise a week in school. 80% get less than one hour a week. mr. president, i don't know about you, but i remember when i was in school, in elementary school we had an hour a day. we had 15 minutes in the morning, 15 minutes in the afternoon and a half-hour at lunch. that was one hour every day. and we had to go out and do stuff. we couldn't sit around and play with game boys and things like that. we had an hour a day of physical exercise. we need to reinvigorate our schools to make sure that they get that physical exercise. so, now we've done a lot in this bill to move this paradigm towards a health care society rather than a sick care society. there's more to do, as i said, in both the education bill next

year and in the agriculture committee in terms of the child nutrition reauthorization. but in this bill we made a great start. we laid a great foundation. i'm just thrilled that so many of the wellness and prevention initiatives that i've championed for so many years are included in this bill. included in this bill. as i look forward to going to conference, we look forward to working with the house to strengthen it even more and to put more emphasis on wellness and prevention. just a few moments ago, just about an hour or so ago, mr. president, we had a press conference with the president elect of the american medical association, dr. wilson. and i'm proud of the fact that the american medical association has now endorsed our bill. as i said at the time, i said the doctors of america have examined this bill and they've

made the right prescription: pass it. pass the health reform bill. but dr. wilson in his statements made particular note of the wellness and prevention programs that we have in in bill. he didn't say this, but i was thinking when he was talking that it made sense. i mean, doctors want to keep people healthy. they don't want to see people go to the hospital. they'd rather be working with their patients one on one. how can they structure a patient's profile so the patient stays healthy, doesn't get sick so often? that's what dr. wilson was talking about. he's letting doctors practice medicine in a way that focuses on a person's health and keeping them healthy. as president obama said in his speech to congress earlier this year -- and i quote -- "it's

time to make the largest investment ever in preventive care because that's one of the best ways to keep our people healthy and our costs under control." the president of the united states in his state of the union message. president obama's got it right. it's one of the best ways to keep our people healthy and our costs under control, and that is a big part of this bill. i don't know -- i mean, i haven't listened to every speech made by a republican on the other side, but i hardly ever hear them talk about this but it's a very important part of the bill. mr. president, we are changing the par tkaoeufplt we're going to extend quality care, we're going to transform ourselves into a genuine wellness society and give our citizens access to a 21st century health care system, one that's focused on helping residents live healthy and happy and healthy lives.

mr. president, i yield the floor. mr. bennet: mr. president? the presiding officer: the senator from colorado. mr. bennet: i'd like to thank the senator from iowa for his leadership over many years, especially on prevention and wellness. i thank you for that. mr. president, a number of years ago i left a rewarding job and business because i had a chance to lend a hand to my community during a very difficult time in denver. the economy was slow, and the city was face ago record budget deficit. our mayor asked me to come be his chief of staff. it was not a glamorous job but it was rewarding because it got results not by seeking out to divide the people of denver going through a rough time but through reaching out to what the mayor called our line of self-interest. i had the fortune of becoming superintendent of public schools and serve our children and the people who work so hard every

day to support them. i came away from that experience believing that much of the republican and democratic orthodoxies relating to public education are essentially useless to our children, and maybe worse and that washington as a whole has absolutely no clear about what's going on in america's classrooms. it's fair to say, mr. president, i didn't come to washington with a partisan ax to grind. as is probably 0 object kwrus to everyone, i am not a career politician. i didn't come here to win political points so someone else could lose. i'm not interested in that. i'm here as the father of three little concerns with an abiding concern that we are at risk of being the first generation of americans to leave less opportunity to our kids and our grandkids than our parents and grandparents left us. that prospect is shameful. mr. president, we are not the only americans who have been working weekends and late into the night recently.

there are people in small towns and big cities all across america doing jobs much harder than ours who are taking an extra shift before christmas so they can afford that extra gift beneath the tree, americans who are unemployed in this savage economy and still trying to make sure the kids know santa remembered them. these same people are reading their papers and watching their televisions, wondering what in the world they're doing in washington. all they see are talking heads, needless are theship paralyzing their government. and even people praying that senators won't be able to make votes. i'm not naive about politics but i expected more. i will vote for health care reform because it's a step in the right direction. but i will not go home and defend the actions of a washington that's out of touch arcs washington that is more interested in scoring political points, more interested in the

278 health care lobbyists who used to work for members of congress than it is in what our constituents have to say. a washington that is more concerned with the millions being spent by big insurance companies. columnists opposed to reform criticized me by saying i'm willing to lose my seat to enact meaningful health care reform. now i'm being asked why i didn't negotiate a special deal with leadership. in fact, there was a report this morning criticizing me because the national republican campaign committee was rejoicing that i didn't ask for special favors. only in washington would someone be attacked for not negotiating a backroom deal. and just because others choose to engage in the same tired washington rituals doesn't mean that i have to. so i have a message for the columnists, the political professionals and those back home: i'm not happy about the backroom deals. i'm not happy that the public option was held hostage by people in our own party.

i do not support rewarding delay with special deals. i'll let others justify their vote and their tactics. as for me, i'm voting to provide coverage to 840,000 uninsured coloradoans, voting to extend medicare for seniors and provide free preventive care for everyone, voting to close the prescription drug loophole and provide tax cuts to small business, voting to make health care more affordable and eliminate exclusions based on preexisting conditions, voting for health care reform that is fully paid for. the people in my state and in our country deserve better than a politics that cares more about lobbyists and talk show hosts than the people we represent. i am committed to delivering on that despite what the political experts have to say. and in the end when the dust is settles and the stories focus more on substance and process, i'm confident that coloradoans will see it the same way. i also commit to the people of colorado and the people of this

chamber that i will do everything i can to make sure this bill really is fully paid for. it's why i introduced an amendment that will ensure that health care will pay down the deficit by forcing congress to make adjustments if reform doesn't meet the cost estimates we have projected. i urge my colleagues and the leadership in the senate to see to it that this amendment is included in the conference report. if not, i will fight to get it passed on its own. i believe so strongly in this because everyone here knows that keeping things the way they are is no longer accept afpblt when i first started in the senate, 800,000 coloradoans were without health insurance. that number has grown by 40,000 in the months we have debated this bill. on average, 111 coloradoans have lost their health insurance every single day. this number will only get worse if we do nothing. our state has spent $600 million in the last year alone on

uncompensated care. colorado working families suffered double digit health care increases year after year for the last decade. many families have made terrible sacrifices, no longer investing in their children's future, saving for a home or carrying crushing credit card balances all to pay for health care. small businesses pay 20% more for health insurance than large businesses do just because they're small. i think back to the coloradoans who shared their stories with me during this debate. i remember bob and debra montoya, torn between providing health care for their small business employees and keeping their business afloat. last year their business paid out $36,000 to cover two families and one employee. they couldn't afford to give their other 12 employees health care or they would be literally forced out of business, so they dropped coverage for the 12 employees to keep their doors open. carlos sporent owns a small

business and told me about her daughter who graduateed from colorado state university in 2004 and found a job in new york with a large company. her daughter's company made her wait a year before she was eligible for health insurance, and during that time abbey was diagnosed with ovarian cancer. carla took out a second mortgage to pay for her daughter's bills and told me -- quote -- "this experience brought to light all too clearly how close we all are to losing everything due to a health issue." i've spoken about a young boy named alex lang. alex's parents insurance company reap fuseed to cover alex because he was four months old and 17 pounds. they said he had a preexisting condition of obesity. there was two-year-old acelin pwa*euts whose parents insurance company denied her coverage because she was underweight. one child too big, the other too small. today in america you have to be just right to get insurance.

there was peggy robinson of golden colorado, who was told she couldn't receive coverage unless she was sterilized, mr. president. she came and bravely testified in washington about the need for reform. matthew temmy of castle rock who couldn't receive coverage because his wife was pregnant even though she had her own health insurance. the sad thing is there's nothing unusual about these stories. none of these people were trying to cheap or game the system. they were trying to gain some peace of mind, some stability in their life instead they fought against the bureaucracy and mounting bills. mr. president, we have debated health care reform for over a year. some have been working on these issues for decades. killing health care reform under the guise of starting over is not an option. we can't wait until the next election, we can't wait until our economy recovers or until we come home from afganistan to deal with our broken health care

system. now standing so close to the finish line, it's completely understandable that some americans doubt whether this bill will improve their situation. they understand that we cannot live with the current system. but they're also deeply concerned about our compass toy make it worse -- capacity to make it worse. the special interests are using tried and true tactics that have been employed over and over again across the decades to prevent reform. phone calls to scare seniors, direct mail to scare those already covered, television ads to scare almost everybody out. reforms in this body are trying every delay tactics. now amidst all of this there is a reason to hope. after almost a century of trying, the senate is close to finally passing a meaningful health care reform bill. a piece of legislation while not perfect represents a substantial step forward. we have a bill that does three

important things, it saves money, it saves lives and it gives families a fighting chance in their relentless struggle with health insurance companies. this bill will save money and reduces the deficit by is is is 130 billion over the first 10 years according to the congressional budget office and projected to reduce the deficit by 10 times that, up t to $1.3 trillion in the second deck kaismed we will vif -- decade. we will save half a trillion dollars by the way that we deliver services to seniors. these savings will prevent medicare from going broke. this bill will save lives, extend health insurance coverage to 31 million americans who don't have it today. over 90% of americans will have health insurance coverage. the highest percentage in the history of the united states. for colorado, that means over 840,000 people who don't have insurance will now have access and another 300,000 people who have insurance in the unstable

individual market will be able to get affordable coverage through the new health insurance exchange. the senate bill makes preventive services like breast cancer and colorectal screenings available without co-payments. now mammograms which can cost up to $200 to $750 -- half of my seniors. this means catching diseases earlier, promoting wellness and saving millions of lives and for our nation's working families, this bill will rein in the worst practices of private insurance companies. they'll have to commit to covering patients instead of gouging them for excessive profits an overhead and starting in 2011, if an insurance company doesn't give you value for your dollar, they will have to refund you back for the difference. they won't be able to impose arbitrary lifetime limits on consumers who punish you for just getting sick or deny you insurance because of a

preexisting condition. the new senate bill does more to detain costs and transparency from insurance companies and nor give consume areas better choice. from my home state in particular i'm glad that the bill addresses other critical areas this reform does more for small business and small business workers than ever before. small business tax credits will begin next year, giving eligible businesses a tax credit for six years to purchase health insurance for their employees. we have extended tax credits for small businesses, allowing more than 68,000 small businesses in colorado to buy health insurance. this bill makes a significant investment in medicaid payments to rural armies when i first joined the senate, mr. president, my first piece of legislation called for a deficit-neutral reserve to address the differences in medicaid payments between urban andle rural -- and rural areas, this bill recognizes the difference between urban and rural areas and makes sure that

those who pay higher costs receive higher medicaid payments. this bill delivers on its promise to seniors. it does not cut guaranteed benefits. that's why in the first day of the health care reform debate i introduced an amendment to make sure that seniors will still see their guaranteed benefits like hospital stays an prescription drug coverage. no matter what changes we made in health reform. it was the most bipartisan piece of legislation we have had this year with 100 senators agreeing that health reform would not take away guaranteed medicare benefits for seniors. for colorado ma means half a million beneficiaries will have their benefits protected. i'm very pleased that majority leader reid included a piece of legislation that i wrote based on the work in mesa county, colorado, home of grand junction. currently one out of five

medicare patients released from the hospital in this country winds up back in the hospital in the same month they were released. but not in mesa county they reduced the readmission rates at the hospital to about 2% compared to the national average at 20%. that's 12 million patients who aren't receiving the care they need. in mesa county they lowered readmissions by creating a transitional model that makes sure what patients leave the hospital, they do so with a coach, that coach goes with them to the primary care provider, the mental health provider making sure they get the care they need over period of time. making sure they don't forget their prescriptions and making sure they have the guidance they need to take responsibility for their owner care. i'm pleased that the senate bill compensates an reimburses hospitals and providers that setup models like the one in mesa county that actually saves money. on another note i want to thank the president, i want to flank my fellow freshmen.

together we worked hard to produce the package of amendments to further contain costs and make our system more efficient. as i travel throughout colorado on the august break, i heard from doctors and nurses who told me repeatedly all they wanted to do was work with patients while all the government was doing was making them fill out one form after another. when i came back, i was determined to do something to help cut the red tape in bureaucracy for these people so they could spend more time with their patients. as part of the freshman package, i introduced an end to multiple forms, confusing codes and unnecessary paperwork. if they don't follow the rules they will suffer financial penalties. our health care workers deserve better, this gives them time to spend with their patients. our freshman package rewards and emphasizes efficient, one form to fill out, not 10, fewer

bureaucrats, thank to your leadership, mr. president, that package was endorsed by the business roundtable, the afl-cio and the consumers union. proof that at least off this floor there are still people from all different points of view who are willing to tworkt. this -- to work together. this bill makes progress in the area of tort reform, it include language i worked on with senators baucus, carper, and lincoln to create a state grant program for states to implement and evaluate alternatives to tort litigation to medical malpractice claims. the purpose is to limit litigation while promoting strategys to reduce medical errors. mr. president, i know many in this chamber take issue with one particular part of this will bill or another. i have my own issues with the bill. i am one of many who have expressed their strong preference for a public option. but i urge you to consider how much good this bill can for the american people. those with skyrocketing health care costs.

small businesses forced with the impossible choice of helping workers keep their choice or maintaining their business. to have the nonpartisan experts at the congressional budget office validate that in the second decade we will have cut health care costs b by $1.3 trillion and reduce the rise in cost of medicare from 8% in the next two decades to 6% in the next two decades while covering 31 million insured americans is truly groundbreaking. we know one more time lapse -- means for colorado's working families and small business, it means more double-digit premium increases, less time to fix medicare before it goes bankrupt in 2017 and more names added to the rolls of the uninsured. it means another big win for the special interest. more people denied coverage for preexisting conditions and more small business employers who will have to make impossible decisions about covering their workers who are keeping their doors open.

so let's reject business as usual. let's look at the promise of this senate bill as a control. let's put the pettiness, scare tactics an obstruction aside. reform is what's needed to control costs, give people more choice and provide support for our small businesses. this package will reduce our deficit and it does so by reforming the way we provide health care. mr. president, we have much to do. even before we were in the worst recession since the great depression, during the last period of economic recovery, working families' incomes in this country actually declined. the first time in the history of the united states. the first time that our economy grew and left the middle class behind. at the same time in my state of colorado an all states across the country, the cost of health insurance rose by 97%, the cost of higher education in my state rose by 50%. because of short-term politics practiced around here we have a deficit and long-term debt that

is cheating our children. we have a lot to do to live up to the legacy that our parents and grandparents have left us and it has taken me less than a year that washington still doesn't get it. i know we can do better. despite so much evidence to the contrary, i believe we will. i believe we will in the end because the national creed that each generation of americans has fought for and fulfilled, the idea expressed in our constitution that our responsibility lies not just to ourselves but to our pros territoriy did shall -- prosperity is much more than. so many of the charges and countercharges that rick share around this building -- ric rict around this building. mr. president, i yield the floor. a senator: mr. president mr. president? the presiding officer: the senator from minnesota. ms. klobuchar: mr. president, i ask to yield myself 10 minutes.

the presiding officer: the senator's recognized. ms. klobuchar: mr. president, late last night, as you're aware, the senate took the important step to move forward on health care reform. after all of the work, the debate that's gone on for this entire year, we owe the american people a vote on this issue. we can't afford to ignore this situation any more. and i know some of my colleagues on the other side of the aisle have been talking about a lack of debate. i think anyone that's turned on c-span for the last few months will tell you there has been a lot of debate. and not only that, a number of the republican amendments were actually included in the original bill, the "help" committee bill that came out. i believe it was something like 130 amendments that were included that came off of their side. the finance committee as well. i remember the first bipartisan meeting we had on health care reform was something called ready to launch, that the finance committee put together. i remember senator whitehouse and i were there.

it was literally a year and a half ago and so many of the ideas that are now incorporated in this bill that senator bennet of colorado just so eloquently went through are in this bill. so many of the bipartisan ideas to really kick off cost reform, to start rewarding high-quality care. to start bringing down those costs in a way that gives you the high-quality care. now, we all know that rising costs are not sustainable the if we don't act, these costs are going to continue to skyrocket. so what was the vote last night about? well, the vote last night was to say we're not going to put our heads in the sand anymore. we're not going to let these costs go up. 10 years ago the average family was paying $6,000 a year for their health insurance, now they're paying $12,000 a year. 10 years from now if we don't do anything about this, they're going to be paying $24,000 to $36,000 a year for theirish 0 health insurance. look at these numbers.

in 1999, a single person was paying about $2,100 for their health care. and they were paying about for a family $5,790 for their health care. well, where are we now? last year, 2008, single person was paying $4,070 for their health care, and then a family was paying $12,680. emduring this difficult economic time wages haven't been going up, people have been losing their jobs, cutting back on their hours, look at the health care costs. it has been a higher and higher percentage of their family budget. a higher and higher percentage. at the same time health care expenditures going up and up and up. look at this, 1995, we're spending something like $12 billion. now it's way up to $2.5 trillion. this is the kind of money we're talking about when we look at why we have to do something to bend the cost curve. when people at home hear this number -- this name cost curve

and they don't know what it means, well this is exactly what it is. the cost curve has been going up and up and up for health care in america. one out of every $6 spent in our economy is on health care. over 20% of our economy by 2018, they believe, will be spent on health care. and the american families just can no longer afford it. who's been taking it worse? well, small businesses. they're paying 20% more than large businesses for their health care. in a recent survey, nearly three-quarters of small businesses that did not offer benefits cited high premiums as the reason. these are little companies like granite gear up in northern minnesota and two harbors. i went up and visited them. thriving little company. they now have 15 employees. they're making backpacks for our nation's soldiers because they make such high-quality backpacks. you know what the man that started that company told city in he said if he would have known what his health care would

cost for his family of four when he started it? he wouldn't have started it. he's paying $4,000 a year in two harbors, minnesota, for a family of four. this is what it really means when you look at the numbers, mr. president. i want nation usually raises the costs of most goods and services between 2% and 3% a year. what have health care premiums been doing? health care premiums have been going up close to 8% a year, and that's an increase that americans simply can't afford. so what does this bill do? well, the first thing -- and i was listening to some of the commentary and taking part in it myself over the weekend. there seems to have been a lot of talk about these delayed benefits. well, why don't we talk about the benefits that are taking place right when the president signs this bill, within the first year of this bill. well, the first thing is that if a kid -- if your kid loses their coverage because something goes wrong, if they get diabetes, if they have some childhood disease, guess what? they're going to be able to get health care. there's no longer a ban on preexisting condition for kids

immediately and then in the later years, that applies for adults as well. but immediately for kids. immediately, and by 2011, within the first year of the bill, our seniors are going to be covered in that doughnut hole for their prescription drugs. so many of them for so long -- i know my own mother would complain about it, that this doughnut hole, where they kind of fall off a cliff and aren't able to pay for their drugs because they don't have enough money. that will be covered. a number of the small business tax credits taking effect by 2011. these are real benefits for the people of this country. real benefits. now, the thing that i cared most about in this bill which senator bennett discussed with this idea of getting our money's worth for our health care dollars. what does this bill do? well, this new bill that just -- we've just taken a lot of the good from the original bill and made things even better -- $132 billion off the deficit in the first 10 years. in the next 10 years, $1.

$1.3 trillion off the deficit. that was the most important thing for people in my state when i went around. they said, look, we want to get rid of these preexisting conditions, we want to make things better so that we've got better health care. but what we really want to do is make sure we start doing something about the deficit, start doing something about costs. minnesota, as you know, mr. president, is a mecca for health care. we have one of the highest-quality, cost-efficient, low-cost states in the country. and, in fact, when you look at some of the numbers, one of my favorite ones -- and maybe this will be the last time i'll say this before the end of the yea year -- mayo clinic. they did a study out at dartmouth and they looked at what mayo did with chronically ill patients. and what they found was this. if the other hospitals in the country simply used that high-quality care that mayo uses, where they bring the family in, they talk to them about what -- what the care should be for the patient, they talk to the patient, and then they figure out what's the best course here, and they work as a team, like a quarterback with a

team, working with that quarterback. they don't have 20 specialists falling all over each other. they work as a team. well, what this study showed was this kind of health care for that subset of chronically ill patients in the last four years of their lives, that the quality ratings were sky-high for the mayo clinic. the family felt good about how their loved one was being treated. and guess what? what dartmouth found was that if all the hospitals across the country followed this same protocol, we would save for this subset alone, mr. president, $50 billion every five years. $50 billion every five years in taxpayer money, giving patients that mayo health care, giving them the high-quality health care. and i think it's counterintuitive to people. you know, they look at it and they think if you go in a hotel and they pay for the most, you're going to get the best room with the best view. well, that hasn't been the same in american health care. in fact, there's an inverse relationship. i see my friend from ohio over there with the cleveland clinic, with guyinger. those -- with guisinger.

those places that offer the high-quality care often tend to have the lower costs. and those are the incentives we're putting in this bill. incentives for accountable care organizations. incentives for that integrated care that i talked about, where instead of having people running around with x-rays to 20 specialists, getting charged every single time but then the specialists don't know what the other specialist said and they don't know what kind of drugs you're allergic to when you go in for surgery because there's no communication, no integration. this bill promotes that integrated care where you put the patient in the driver's seat so they've got their pick of a doctor who works with a team of specialists. that's what we want. bundling of payments so you start rewarding outcomes instead of just the number of tests and the number of procedures. my favorite example of this really came out of guisinger clinic in pennsylvania where they said, yo you know, we're nt that happy with how we're treating our diabetes patients. so instead of having everyone wait and wait and wait to see an endocrinologist, to see a doctor, we're going to have some of the routine cases see nurses and then the nurses will report up to the doctors and the

patients will be happier because they'll be able to see a nurse more often and the more difficult cases will be treated by endocrinologists. so they did this for about a year and they looked to see what the results were. well, guess what? the patients were so much happier because they were able to communicate one-on-one with the nurse. the doctors were able to handle those more difficult cases and monitor the other cases. they saved $200 a month per patient with this kind of a system. higher-quality care, better patient outcomes. guess what? what does medicare do, what does our system do when they see this kind of smart, cost-effective result for the -- for the doctors and for the system and for the taxpayers? they actually are told, well, guess what? you get punished for this under our system. you're going to get a lot less money if do you something like this. that's what i'm talking about, mr. president. hospital readmissions, $18 billion a year we could save. if you go in the hospital and you are treated, you want to go home, you don't want to go back into the hospital because someone made a mistake or they gave you an infection.

let's put incentives -- and that's what this bill does -- so we reduce those hospital readmissions, make life better for the patient and at the same time reduce taxpayer money. that's what this bill is about. fraud -- right now, $60 billion -- i don't think anyone would believe this, a senior who just depends on medicare, right? guess what? we got to tell our seniors today that $60 billion a year is wasted on medicare fraud, going to com men, going to people that just set up storefronts and then they get fake checks and they're not even real. that's why the money is going right now, down the tubes, siphoned off by fraudsters. what this bill does, it gives the tools to improve that situation so that won't happen anymore. that's what we're doing with this bill, mr. president. it's about reducing costs. it's about raising quality, and it's about saving medicare so it doesn't go in the red by 2017, giving it 10 more years and beyond because of the delivery system changes. mr. president, i'm proud to

support this bill. we continue to work for reform. as you know, this is not just an end, this is a beginning, and there will be more work to do in the future. but we can't put our heads in the sand. we have to vote on this bill. we have to get this done. thank you, mr. president. i yield the floor. the presiding officer: the senator from ohio. mr. brown: thank you, mr. president. it's been that said a cynic knows the price of everything and the value of nothing. i spent, as we all have, the last -- as the senator from minnesota has, as the presiding officer has, spent the last three weeks listening to my colleagues come to the senate floor to describe health reform legislation that bears no resemblance to what is actually before us. they take liberties with the cost of the bill. they seem to have no concept of the value of health care to a family that has it and to a family that doesn't have it. i guess they believe it isn't important for us to get this done, that it isn't important for other americans to have affordable health insurance. after all, they aren't -- my colleagues aren't at risk of losing their coverage. they can afford the health care

that they and their families need. so what's it to them if another 14,000 americans lose their insurance every day? what's it to them if 390 people every single day in my state lose their insurance? what's it to them if people with preexisting conditions can't get coverage, if women are overcharged for insurance, if the self-employed can't afford the outrageous premiums they're charged, if american small businesses pay more for health coverage too often than they earn in profits? what's it to them? i've listened as republican senators have come to the senate floor day after day to telltales about -- to tell tales about health reform and to try and manipulate public opinion by any means possible. i hear them mostly stalling. slow down, not yet. they've done it since the gang of six in the finance committee met since june. no, actually they've begun to stall even before that when the finance committee and the "help" committee began our

deliberations, sort informal deliberate raising. but what they forget, or what they don't to want think about, perhaps, is that every day they stall, 390 people from galion to gallipolis, from buckeye lake to avon lake, from ashtabula to cincinnati, 390 people in my state lose their insurance every day. every day they stall. 14,000 americans -- 14,000 americans lose their insurance every day. 1,000 americans every week die because they don't have health insuranchaveinsurance. a thousand americans every week die because they don't have insurance, and on the other side of the aisle, they say slow down, what's the rush, why do we have to move into this. they forget, or maybe they just don't want to hear, that a woman with breast cancer is 40% more likely to die if she's uninsured than if she has insurance. a woman with breast cancer, 40% more likely to die if she's uninsured than if she has insurance. yet they continue to say, slow

down, slow down. you know, mr. president, i wis wish -- i wish that my friends on the other side of the aisle would -- would actually meet some of these people that don't have insurance. and let me -- let me put a human face on this, if i can, let me share three letters from ohioans. i've come to the floor since july day after day reading letters from people who are directly affected by -- by this health insurance situation, if you will. and in mo cases, these are people that were happy with their -- and in most cases, these are people that were happy with their health insurance a year ago, and then something happened in their lives. they got laid off, lost their insurance, they had a child with a preexisting condition whom they couldn't get insurance for, maybe they got sick and the cost of their insurance -- their health care was so high that the insurance industry cut them off, simply eliminated their coverage. but let me read a couple of these. marie from hancock county, finley, ohio, "my husband and i both have preexisting conditions. we're paying $1,300 a month for health insurance. he's been out of work two years. we're living off the money that

we got when we sold our house. we're afraid to go without insurance. we're in a fix in our late middle age and find ourselves watching our retirement savings go down the drain. please fight for us and for others like us." think about that. think. does anyone in this chamber, does anyone who comes to work as a united states senator or down the hall as a congressman, can any of us really understand what this couple's all about. this couple, rural, small town ohio, paying $1,300 a month for health insurance. how are they paying the dollars 1,300? they sold their house so they could pay for their health insurance. they're in their late middle age. i'm guessing they're not -- they're in probably their late 50's, early 60's. they're not yet eligible for medicare. and so many people say to me through these letters and through my meetings and discussions, and when i'm traveling around my state, so many people say to me, i'm 63, i only have two more years so i can get on medicare because i trust medicare, it's stable, it's predictable, it will be there for me and it will help.

instead, republicans in this body, all 40 of whom not even voted against the bill last night, 40 of them said stop, don't even move forward on this bill. do any of them, do any of my -- do any of those 40 really understand people like marie from hancock county? do any of them understand, do any of them understand that 390 people are losing their insurance every day in just one state? do any of them understand that a thousand people a week are dying in this -- in this country because they don't have insurance? do any of them understand, any of the members of congress, the house of representatives or the senators, it is 40 senators that saithat -- the 40 senators that said no and stall and stall and stall and said not yet, can't do this yet, have to slow it down, do any of them understand that a woman with breast cancer 40% more likely to die if she doesn't have insurance than if she does? charles from can i yoga county, the cleveland area, writes me, "the hands-off health care

people claim that many americans are very satisfied with their own health insurance. i'm one of those. i have medicare but i don't believe their implication that health care reform isn't needed. i think if you were to really ask those lucky people who are satisfied with their plan, a great majority would support -- would say they support reform that would benefit everyone." charles understands. he's on medicare. he understands the stability and the predictability of the medicare system. i might add parenthetically, mr. president, that my -- my republican friends, all 40 of whom said last night, stop, slow down, stop, slow down. all 40 of them understand that their party overwhelmingly opposed the creation of medica medicare. when they had a chance, they tried to privatize it, cut it and privatize it in the 1990's. then when newt gingrich became -- when president bush was sworn in with republican leadership in the house and senate, they moved forward on their giveaway to the drug companies and the insurance companies in their attempts to privatize med carol. now they say they're all -- privatize medicare. now they say they're all for

medicare. but understand, charles knows what this bill is going to do. it's going to strengthen medicare, it's going to lengthen its life expect circumstance the life span of medicare. it's going to give free physicals, once-a-year checkups and colonoscopies and mammograms for people in medicare and it's going to close the doughnut hole so more -- so fewer people will have to pay so much out of pocket. last letter, mr. president, raymond from delaware county, my wife and i had to drop our coverage because it costs $30,000 a year. the country needs reform that bars insurance companies from denying coverage or charging higher premiums on the basis of preexisting conditions. health reform is the right solution for the people of ohio. raymond from central ohio. okay, thank you, mr. president. a senator: mr. president? the presiding officer: the senator from wyoming. mr. barrasso: mr. president, i just heard my colleague, the senator from ohio, said "i wish

some of my colleagues on the other side of the aisle would understand families that don't have insurance." mr. president, i practiced medicine for 25 years taking care of families in the state of wyoming. mr. president, during that time i took care of all patients, regardless of ability to pay. and i will tell you, i believe that as a physician who's practiced medicine for 25 years and someone who the obama administration has decided to completely ignore as he did to the other senator from this chamber who is also a physician, because we know specifically and personally about what happens to families who lose their insurance and because we specifically know what happens to families who are on medicaid, a health care program which my colleague who is now leaving the chamber after asking if anyone in this body understands people without insurance but not staying to hear the discussion

for the next hour, making statements and then leaving, i will tell you, mr. president, i understand those families. i understand the families on medicare. i understand the families on medicaid. i understand the families without insurance. i understand the families worried about losing their insurance. i understand about the families worried about disease. and then he said do people understand women with breast cancer? mr. president, my wife -- a senator: would the senator from wyoming yield? mr. barrasso: regular order, mr. president. mr. brown: i wanted to inform the member that i'm still in the senate. mr. barrasso: my wife is a breast cancer survivor. her breast cancer was discovered in her 40's by a screening mammogram. it was that screening mammogram that saved her life because the cancer had already spread, had already spread to a lymph node. she had three operations, two bouts of chemotherapy,

radiation, 35 treatments, all because the screening mammogram saved her life. yet this bill that was brought to the senate floor with the government's knowing better than the rest of america, knowing what health care ought to be given and shouldn't be given, all of a sudden what we see is government knows best, people don't know. her life would have been lost because she's one of those 1,900. so i understand having practiced medicine, lived that life as a physician taking care of people without health insurance and on medicare and on medicaid and those worried about losing their insurance when they lose their job. i understand the implications of this. i took care of all of them as did all of my partners. we dealt with all of these people, each and every one of them regardless of their ability. it's why we need health reform in this country that actually works on availability of care, affordability of care, access to care and quality care.

this bill that i voted against last night doesn't address those needs of the country. it fails time and time again. the president, mr. president, made a number of promises, a number of promises to the people of this country. he said people would see their insurance premiums drop by $2,50o. instead the budget officers say no, it's going to go up $2,100 per family. has are the president not read the bill, not read the responses that have come from the congressional budget office? does he not see the difference there of $4,600 per family? the president said this wouldn't add a dime to the deficit. well, it's going to add a lot of dimes to the deficit. this is going to add $1 trillion to the deficit. they say it won't at all. yet, they didn't do the the

doctor fix, the medicare doctor fix. now the speaker of the house says we'll handle that in january or february. for $250 billion they're not going to pay for. the president says taxes won't go up on anybody making under $250,000 per family. there are dozens of taxes that are going to be passed on to american people. now any teenager that goes to a tanning salon, they're going to be taxed 10%. i don't think any of those kids are making over $250,000 a piece. the president said people won't lose their coverage. oh, they're going to lose their coverage, mr. president. many will lose the coverage they have that they like because they've cut 11 million people on medicare advantage, a program people like, a program my patients like, people i've taken care of like -- they like it because there is actually an advantage to the program. it's a program that deals specifically with preventive care, coordinating care. that's what happens when

medicare advantage. they'll lose their coverage. the president said we wouldn't see cuts to medicare. the bill says $500 billion of cuts to medicare, to the seniors who depend upon medicare. the president said in open debate, the president said in honest debate, the president said c-span would be there covering the debates. those of us with the most experience -- the two physicians, 50 years, 50 years of practice in medicine in this country, taking care of families in this country, completely excluded, completely excluded even though we offered to go to the white house and read the bill with the president. so where do we have it? what's the verdict of the american people on the vote that was taken in the dark of night, 1:00 in the morning, 1:00 in the morning on a monday morning, a vote that was taken at 1:00 in the morning so the people,

hopefully the democrats said, be asleep and not see what they were doing to the american people. the verdict is the american people are overwhelmingly opposed. opposed, mr. president, to the bill that the senate last night on a cloture vote of 60-40 decided to move ahead. and the deals in that bill are absolutely astonishing. $100 million for a hospital in a state that we can't still identify, no one's claiming. pay off to one state, a pay off to another state. and the cuts in medicare, the cuts in medicare for our seniors who depend on medicare, a program that's going to go broke in the year 2017, not to save medicare, not to save medicare but instead -- instead of saving medicare to start a whole new government program. i see my colleague from the state of tennessee is standing. he has worked closely with

people on medicare in his home state, worked with those people, is familiar with that and with medicaid, knows how difficult it is for patients to get to see a doctor. with the cuts in medicare it is going to make it harder, for those hospitals to stay alive and open in your community, for patients to get the kind of care that they need. skilled my friend from tennessee, are there concerns that you have about the cuts to medicare and how they're going to impact on the care of people in your home state? mr. alexander: i thank the senator from wyoming and appreciate his leadership on this bill. it's of tremendous value to have within our body two practicing medical doctors to help us interpret the effect of this bill which affects all 300 million americans and so dramatically. we find when we discuss it with our colleagues on the other side of the aisle that we sometimes becomes exasperated with one another because it seems like they're talking about one set of

facts and we're talking about another set of facts. what i'd like to do is take just a moment and talk about medicare. and then i see the assistant republican leader, the whip, on the floor. i know he may have a number of things he wants to talk about. but i have a question i want to propound to him in just a moment. let's take medicare just a moment. to anyone watching our debate, you hear the democrats say "we're saving medicare." that's one of the three things they have been trained to say. we're saving medicare, werl extending its debaters we're extending its length. you hear the democrats say we're cutting it. who's right? medicare, of course, is the program that -- it's a government program. 40 million -- 40 million --

seniors, maybe closer to 45 million now depend on it. we all pay into it and then when we get to be of a certain age in our 60's, we depend on it for our medical care. for many americans, it's very, very important. and it was established with broad bipartisan support in the 1960's. now what are the proposals that have to do with medicare? well, basically half this health care bill is paid for by reductions in the growth of federal spending for medicare. those are medicare cuts. now who says they are? well, the president of the united states, for one, says we'll have no deficit. and so the way we're going to do that for this bill, which the congressional budget office figures show us, will cost $2.5 trillion over ten years when fully implemented is basically

paid for one half by medicare cuts and one half by new taxes, give the democrats credit for that. that helps to avoid a large part of the deficit. and the rest is done bill sending a huge bill to states to help pay for another big government program called medicaid. i'll leave that to the side for a moment. the medicare cuts, the reductions in the spending for medicare, are $466 billion over the first ten years. really six. and over a fully implemented ten years it's about $1 trillion in medicare cuts. that's money coming out of the medicare program and going somewhere. now where does it go? well, it goes to start a new program. what's wrong with that? well, one thing wrong with it is

the trustees of medicare. these aren't republican trustees or the democratic trustees. these are the men and women whose job it is to report to the nation on the condition of this program that takes care of 40 million people and their medicare, the trustees say that there is already more money coming out of medicare than is being paid in by those of us who pay in. by the year 2015 or 2017, it will be insolvent. that means going broke *fplt and already we -- that means going broke. already we see the medicare program is under some stress. the doctors, for example, who serve medicare are only paid about 83% or 84% as much as doctors who serve patients with private health care. and as a result of that, we have to come along year after year and appropriate more money for the doctors to reimburse doctors who serve medicare patients. if we do not, they won't be

serving medicare patients and medicare will become like medicaid, the program for low-income americans, where ab50% of doctors -- where about 50% of doctors won't take a new medicaid patient. it's like giving somebody a ticket to a bus line where the bus to the bus line only runs by every five minutes. what the republicans are saying is by taking $1 trillion out of medicare -- and there is no dispute about that amount of money, none whatsoever, and spending it to pay for this new program, not for medicare, that somehow that's good for medicare and the seniors who depend on it. they're suggesting that we believe if you take $135 billion from hospitals and $120 billion from the 11 million seniors who participate in medicare advantage and $15 billion from nursing homes and $40 billion from home health agencies and $7

billion from hospices that somehow that's good for seniors. perhaps it could be if all that money were put back into medicare, if the money were taken from grandma and spent on grandma. but, no, this money is taken out and spent on a new program. and director of the congressional budget office -- not a republican, not a democrat, the nonpartisan director said for the 11 million medicare advantage patients, that's one-fourth of everybody in medicare, he said one half of their benefits will be diminished. that's what he said about these cuts. and even when it's all said and done -- and i'm about through in explaining this -- when it's all said and done we completely leave out the quarter of a trillion dollars we need to appropriate to pay physicians

who serve medicare patients. if we don't their payments are going to be cut by 21% next year and fewer of them will be medicare patients. we already heard that the mayo clinic is beginning to restrict some patients on medicare because they lost $840 million serving medicare patients hrafpt year. that's just one thing wrong with this bill. but when you hear the other side say they're helping medicare and when you listen to what i just said about how can you take $1 trillion out of the medicare program which is going broke, when it's fully implemented over ten years and claim that you're helping medicare by starting a new program. i don't think that's possible, mr. president. and that's the source of the great concern on our side of the aisle on, about this bill on that one issue. i seat assistant republican leader, the whip, and i've heard a number of people say -- and i'll propound this question and then i'll yield the floor if i

may, to the senator from, but hearing them say why are you republicans keeping everybody in here this week? we want to go home and see our families. we all want to see our families, mr. president. but, there is a reason why this bill was suddenly presented to us in the middle of the greatest snowstorm in the history of washington on one day and we were asked to start voting on it in the middle of the night on the same day and to finish the work by christmas. if i'm not mistaken -- and this is my question to the distinguished assistant republican leader, who's been here a number of years, who's in the leadership and whose job is to help manage the floor -- is it not entirely the prerogative of the majority leader of the senate to schedule what comes up on the floor? is that not his job? isn't it true that if senator reid wanted to say, let's take this bill down, let's go home, let's let the people hear about it, let's come back and vote on it after christmas, after new

year, after valentine's day? could he not do that and isn't that peculiarly -- particularly his power and not our power? mr. kyl: mr. president, i would say to my colleague that as a general rule, that's correct. the majority leader has two great powers that to one else in the senate has. one is the right of first recognition by the presiding officer and the other is the power to set the schedule. now, that power is limited by senate rules and it can be altered by unanimous consent. and i could go on and explain a little bit to folks who are wondering why we would be in this predicament of voting on christmas eve based upon the majority leader's decision, and if i can just proceed, then i'll do that. all of these rather odd times for debates -- 1:00 in the morning, 7:20 a.m. in the morning, and so on -- are a result of the majority leader's decision to make sure that this bill is completed by christmas. that -- that's the precipitating

cause for everything else that follows. because once he says the bill has to be followed -- has to be completed by christmas, then he has to, in effect, count backward on how long it takes to do the various things that the senate rules say that we have to do. so if there are three cloture petitions filed, which is what the majority leader did, filed three cloture petitions simultaneously, under senate rules, certain time frames then attach. you have to take the vote with one day intervening between the filing of the cloture petition and the vote. if cloture's invoked, then 30 hours for debate is permitted, after which there can be additional action by the. so when the majority leader takes all of that into account, he finds that he's got to vote at 1:00 in the morning, 7:20 a.m., and so on. now, he could change that, of course. he could change that by saying, we don't actually have to have the whole thing completed by

christmas. that's strictly an arbitrary date that he set there. have been whset. there have been some who said, why don't we have a unanimous consent request and try to debate the -- finish the debate a couple of days earlier. and some say, you're telling us on the one hand that the majority leader is saying we have to have this completed by christmas, but since that's kind of tough on all of us, now you're saying let's move that up a couple of days. and republicans are saying we've had barely enough time to consider this bill as it is. we're not going to agree to move it up any more than that. we don't like voting on christmas eve any better than you do. but the answer to it is not to make the time even shorter but, rather, to take our time, do it right. as the senator from -- from maine has pointed out, let's go home for the christmas recess, stop and listen to what our constituents are telling us that they'd like to have us do and then come back and complete t. that could all be done by unanimous consent. but my colleague is correct, that once the majority leader

made the decision that this has to be done by christmas, then the time is pretty well set by the senate rules absent a unanimous consent by the body that would either extend the time or shorten that amount of time. if -- i -- i would like to make another point off that subject, if i could, but if my colleague has another question in that regard, i'm happy to try to respond to it. mr. alexander: no, i thank the president. i would yield the floor. mr. kyl: thank you. i talked to the senator from wyoming, and, of course, arizona is a state that has a lot of medicare patients and our state is hurt as much as any by the cuts to medicare and particularly the medicare advantage cuts. we don't have the benefit that was extended to residents of other states, primarily the state of florida, by a special provision that was inserted into the bill. and as a result. our constituents are going to suffer more than those of some other states. but the more we read this bill,

and one of the reasons that republicans have not been willing to truncate this debate, is that the more reread it -- the more we read it, the more we find in it that is troublesome. we found yesterday that the congressional budget office -- actually, the congressional budget office brought to our attention the fact that they had made a little mistake. it was i think a quarter of a percent in one of their calculations. that quarter of a percent amounted to $600 billion. so a small error by the congressional budget office can make a huge difference to the people of america. so that's $600,000. we also saw that there were special provisions in the bill for residents of one particular state and that's gotten quite a bit of attention lately. there's also been a -- a dental-vision clinic in a state that's benefited. i'm still not sure we've figured out exactly what that state is. but i understand the senator

from connecticut was taking credit for it. i don't know that to be true. that's hearsay. if that's not true, i stand to be corrected. but the more we hear about it, the more rerealize that support for it was not on the merits but on the basis of special faifs done to certain members. and my staff has indicated that there's yet another one of these in the bill and it has to do with so-called specialty hospitals or, as they're referred to in the legislation, physician self-referral hospitals that have physician ownership. now, just a little bit of background on this. the hospital association that's primarily representative of the community hospitals has been pleading for a long time that they're not adequately reimbursed and that we need to try to help them. and i've been an advocate for that. i've tried to help them in, for example, reimbursement for the care provided to illegal immigrants, and we were successful in that. but one area where i departed from that is when they concluded that the best way to help themselves was to hurt their competition. at that point, i said no, the

competition -- their competition are these physician-owned, self-referral hospitals. these are generally specialty hospitals in a community that provide very good care. and while they do in one sense provide competition to the community hospitals, they're all in the same boat in terms of the kind of reimbursement that congress provides. what i've said is, you shouldn't solve your problem by hurting your competition but having congress solve the problems that affect you both. and i've been willing to try to help on that. but in this legislation, what they've done, they struck a deal with the hospital association to stop the competitors, the physician self-referred hospitals, from building any more hospitals. you have to be under construction by a certain date unde.under the bill, it's febru0 of the year 2010. you have to have a provider agreement in operation. that's the technical term. or else you can't go any further with your new physician self-referred hospital. and that's going to hurt a lot of communities.

it turns out that some of the communities hurt were in a particular state, the state of nebraska. now, again, i have an affinity for nebraska because i was born there and i know a lot of people there. and the senator from nebraska, senator johanns, a little bit earlier today said that he didn't think that the special deals that were created for the state of nebraska were really appreciated by nebraskans who really stand more on principle and have the view that if something is bad for nebraskans and it's bad for the folks in other states, that, therefore, it ought to be solved for all of the states, not just the state of nebraska. and it turns out that that's the case with this particular provision on page 332 of the reid so-called managers' amendment. which would extend the date on which a hospital would have physician investment and a provider agreement in place for the purpose of being grandfathered. that date was extended until august 1, 2010. and it turns out that that helps

helps, at least according to staff, at least three hospitals in the state of nebraska, one in omaha, one in carnie and well in bellview. in fact, i'll just quote briefly from an article that robert pear of the "new york times" did on this. and i'll just quote this briefly. "the senate health bill would impose tough restrictions to referrals of medicare patients by doctors to hospitals in which the doctor haves a financial -- doctors have a financial interest. the package assembled by mr. reid would provide exemptions to a small number of such hospitals, including one in nebraska." and he goes on to describe this. and then quotes a molly sandvig, executive director of physician hospitals of america, which represents doctor-owned hospitals, who said the change would benefit bellview medical center scheduled to open next year in bellview, nebraska. under the proposal, miss sandvig said, "doctor owners can continue to refer medicare patients to the hospital in eastern nebraska." "senator nelson has always been a friend to our industry," she said. "doctor-owned hospitals in other

states were not so fortunate. they would not meet the august 1 deadline." end of quotation. now, i'd like to help all the physician-owned hospitals. i agree that all of them should have the same kind of support that was gained by the senator from nebraska for three specific hospitals in nebraska. i understand, by the way, that three or four hospitals in arizona would also benefit from that. and i think that's a great thing. but instead of just benefiting the hospitals in a few states by moving the date back to where you catch the ones in the state of nebraska, we now eliminate this requirement altogether. because what you're going to do is prevent more competition from very, you know, high-quality hospitals and communities that can provide a real service to constituents in all of our states, not just one state. it's just one more example, i would say to my friend from tennessee, that the more we read the bill and learn what's in it, the more we find that it was --

that the 60 votes for it were obtained i think less by persuasion and on the merits of the bill than by special provisions that were inserted to assist folks in particular states. and as i said, i think that if something is good for one state, it ought to be good for all states. and if it's not good for one state, then it ought to not be a requirement on the other states as well. mr. barrasso: well, mr. president, what you're hearing is -- what we're noticing is republicans taking a look at a bill. you know, i saw the majority whip come on to the floor a few minutes ago and yesterday he was on the floor and said the republicans haven't offered amendments. haven't offered amendments to this bill. so i brought four amendments yesterday and the chairman of the finance committee objected. one had to do with letting people on medicare keep their own doctors or choose who they wanted to go to see for a doct doctor. and the purpose of this was

called medicare patient freedom to contract. allows medicare patients the right to privately contract for medical services with the physician of their choice. so i would ask my friend from tennessee, who has just spoken about medicare, wouldn't you think that patients who have been promised that they can keep the health care that they want should be able, or at least the senate ought to be able to debate an amendment about allowing medicare patients the right to privately contract for medical services with the physician of their choice. wouldn't that seem fair? mr. alexander: mr. president, i agree with the senator from wyoming. of course under the procedure that we're following -- and i think it's important for the american people to know this -- the bill, the 400-page bill that was added to the underlying bill was brought up over the weekend and is being presented to us in a way that it can't be amended. and so something that affects a

sixth of the economy, which you've had a day and a half to read, which is part of an overall bill that will raise taxes, cut medicare, send big bills to states, has many questions, could be improved with amendments, can't be amended. mr. barrasso: another amendment -- and i see my colleague from south dakota is here -- an amendment that i offered on the floor of the senate yesterday to protect individuals from skyrocketing insurance premiums. because you recall that the president of the united states said that premiums, families in wyoming and in other states, families across the country, health insurance premiums would go down $2,500 per family. yet, what i read and study and as i look at this, it says to me it looks like premiums will go up instead of going down. instead of going down $2,500, will go up $2,100. and for i think 90% of the

families in this country, their insurance premiums will either stay the same or go up more because the bill is passed than if we did nothing. so i'd ask my friend from south dakota -- and i know you've been bringing forth this information. i know you put a chart together on it. wouldn't there be some value in allowing the senate to discuss an amendment, because this amendment basically said let the state insurance commissioners, because he every state has an insurance commissioner. let the state insurance commissioner take a look at what happens to insurance premiums in their state. and if the insurance commissioner finds that the premiums have gone up faster than the consumer price index, then in that state where those premiums have gone up faster than the consumer price index, then all of these laws and regulations and rules would no longer apply.

the mandates, the rating rules, benefit mandates, all those included in the reid bill would not apphraoeufplt wouldn't that make sense? i ask my colleague from south dakota, what is your understanding of all of this? and shouldn't we be allowed to discuss and debate that as a united states senate when we've been promised as citizens of this country that premiums would go down. mr. thune: the senator from wyoming is correct. of course we would like to offer amendments. i know that the senator from wyoming has deep experience in this field, being a practicing physician, and someone who brings great knowledge and background to the debate and obviously has some great insights about how this 2,100 page bill could be improved upon and be made better. but i want to point out again, madam president, what we got here. we've got 2,100 pages that we started with. and this is, represents one-sixth of our entire economy. what we're talking about is restructuring or reordering one-sixth of our entire economy.

saturday we received the amendment, 400 page amendment, which nobody until saturday had seen. in fact, many of the democrats hadn't seen it either, including members of the democrat leadership. there was a discussion that occurred on the floor last week between senator mccain and senator durbin from illinois in which senator mccain said they're writing this amendment behind closed doors. we don't have any idea what's in it. and the senator from illinois, senator durbin, the number-two person in the democrat leadership in the senate said i'm in the dark just like you are. you had a handful of people that were adding 400 pages of content to the 2,000 pages that we already have. in addition there is another amendment that adds another 300. you're talking about 2,700 pages here that will reorder and restructure literally one-sixth of the entire american economy. right now what we're being told, as the senator from wyoming has pointed out, is we're not going to be allowed to offer amendments to that humongous

piece of legislation. and what happens when you get this much legislation coming at you and receiving this on saturday and now having the opportunity to read it for the first time and why we're saying we need to push this back and not jam it through before the christmas holiday is you find all kinds of things in these bills. sometimes people take credit for those being in there, sometimes they don't. we had a debate over the weekend about some of the provisions that benefit specifically nebraska. you've got this medicaid provision that requires the taxpayers of the other 49 states to basically subsidize and pay the medicaid matching share for the state of nebraska which will cost millions and millions and millions of dollars. the senator from arizona mentioned this late ad that we saw, this $100 million item for construction of a university hospital which, again, is being reported, was inserted by the senator from connecticut. and so you have all these sort of deals that get made to try and get this, that elusive

60th vote that are now coming to light. it seems to me that the american people have a right to know. and, frankly, members of the united states senate who have to vote on this have a right to know what is in this, these volumes of pages. 2,700 pages that's going to spend $2.5 trillion. the original 2,100 page bill spent $6.8 million per word, creates 70 new government programs. this is a massive overhaul of health care delivery system in this country. what it ought to be about, it ought to be about driving down the cost of health care for people in this country. in fact, we heard a lot of discussion here in the chamber from the other side about how this drives down the cost of health care, this bends the cost curve down. they can say that, but the experts that we rely on, the referees and upl nicer this debate say -- umpires say otherwise. in fact, what the congressional budget office has shade is that

the cost curve -- has said is that the cost curve would be bent up by this bill. the blue line represents the increasing health care costs year over year if we do nothing. the blue line represents what we'd be looking at if we continue on the current course, which everybody here acknowledges is unacceptable. we all want to see the cost curve bent down and see the overall health care costs for americans to go down. but the ironic thing is, according to the congressional budget office, the red line represents what happens if the bill that's being proposed by the democrat majority here in the senate and that we're debating actually becomes law, the cost curve is bent up. we will actually spend more on health care in this country than we're spending today even the year-by-year, twice the rate of inflation increase that is we're seeing in health care premiums today. so the senator from wyoming is absolutely right to be offering amendments to address the issue of premiums, because this bill does not do anything to reduce premiums for most americans.

there are about 10% of americans, we think, because of the subsidies in the bill, would get their premium costs reduced. but 90% of americans we're told by the congressional budget office would see their premiums stay the same or go up. when i say stay the same, it means go up at the current rate of twice the rate of inflation. the worst-case scenario, if you're buying your insurance in the individual marketplace is you're going to see your insurance go up above and beyond this by 10% to 13%. health care costs for people in this country, for 90% of americans, the best they can hope for is the status quo, year over year increases over twice the rate of inflation. if you buy your insurance in the individual marketplace your premiums go up by another 10% to 13%. what the whole purpose this have 2,700 pages ought to be about, it ought to be about driving down health care costs and getting premiums under control. the overall cost, as i said, of health care in this country represents about one-sixth of our entire economy.

if this bill passes according to the congressional budget office, according to the actuary of the center for medicare services, health care spending in this country will no longer be just one-sixth of our economy. it will be more than one-fifth. because if this bill passes, health care spending in this country will go up to just about 21% of our gross domestic product. tell me, madam president, i would say to my colleague from wyoming, what does that do, what does this bill do then to get costs under control? if we're driving up the cost of health care for individuals in this country in the form of higher premiums, if we're driving up the overall cost of health care as a percentage of our entire economy in this country, why would we be pushing jamming this thing through before the christmas holiday, these 2,700 pages, spending $2.5 trillion of taxpayer moneys, raising taxes on small businesses, which small businesses obviously have weighed in on this and the national federation of independent business which represents a lot of small businesses around the country

has said if enacted, this bill would cost us 1.6 million jobs because of the new taxes it imposes. you're raising taxes when fully implemented by about $1 trillion. you're cutting medicare as the senator from wyoming and the senator from tennessee pointed out by about $1 trillion. after all that, what do you have? you have the same or worse insurance premiums for 90% of americans. i would argue, madam president, that is a bad deal for the american people. and i would also say again coming back to these special deals, this is not the way to legislate, to carve out these deals, to go and try and find or buy or however you want to characterize it, that extra, that 60th vote is essentially what we're talking about. these are special goodies that were packed into this bill essentially because the majority decided that rather than try and include republicans and pass this with republican votes, they had to pass it with all democrats which meant that every one of the democrats on their side had tremendous leverage and

clearly they decided to use it because there are lots of carveouts, lots of special deals, lots of goodies in this that cost the american taxpayers hundreds of millions of dollars in additional spending in this bill simply because they want to get this done, an artificial deadline before kph-s and wanted to do it with all democrat votes. i would say to my colleague from wyoming and my colleague from tennessee who is here that, this process itself, i think when the american people find out particularly this latest deal just smells. and i don't think they're going -- a senator: mr. president, i would say to my colleague from south dakota, i try to stay in close touch. so i've had telephone town hall meetings and i know that the senator from tennessee has done the same. there's a little way when you do that where people can push a button in favor or against, and 93% of the people of wyoming are

opposed to the bill the democrats are trying to jam through in the middle of the night. and i know that the senator from tennessee has recently had telephone town hall meetings with his constituents at home because he wasn't able to be home personally with them. and i know maybe you want to share with us some of the experiences that you've had and some of the messages that you've heard from the fine folks in tennessee. mr. alexander: i thank the senator from wyoming. the telephone town halls are very interesting. this is the 21st consecutive day and the third weekend that we've been debating this health care bill. and one would think we could probably do a better job of it if we were going back home every weekend to hear what people had thought about what we were doing. but maybe the strategy has been keep us here talking to each other, bring the bill up in a snowstorm, pass in the middle of night and go home for christmas and the people won't find out what we're doing until it's too

late. halls.ne -- one way to find out i was skeptical of these until i did one. it is an interesting way to stay in touch with people. you get on a telephone and an automated system calls thousands of people and say that the senator from wyoming, illinois or tennessee wants to talk to you about health care. and so people can either stay on the phone when they get the call or they can hang up. and what normally happens is that a surprisingly large number of people on this issue, health care, stay on. and the other night, four or five nights ago, i did it between 7:30 and 8:30. i called into about 18 west tennessee counties, including shelby county, which is memphis. and about 30,000 people were on the telephone, so it was reported to me by the -- by the

service, sometime during that hour. with a maximum number of 3,016 at any one time. someone might pick up the phone and say that senator barrasso is on the phone and threat might tune in for 15 -- and they might tune in for 15 or 20 minutes, maybe they have to cook dinner or have something to do or maybe the ballgame comes an and they -- comes on and they have to hang up. i took a number of questions and after it was over 563 e-mails from my constituents were sent to my website. it's interesting to me, people who know my history a little bit, to be elected governor 30 years ago, i walked across tennessee. instead of going to a rotary meeting, you see different places when you go to bars. it took me six months and i'd

see 1,000 people a day. these random phone calls reminded me of that. it was as if the people were randomly selected. they weren't on a republican list or democratic list or list of doctors or patients. they were just in the phonebook and they talked and acted like they were normal citizens who i interrupted after dinner, probably, it was 6:30 to 7:30 in that part of tennessee. but i was able to ask those citizens three questions. now, i'm not about to say this is a gallup poll of tennessee. because i know that surveys like that have to be done in a scientific way. but they're straws in the wind for someone here 21 straight days not able to go home because we're debating this bill. the first one, do you believe the senate should rush to pass the health care bill before christmas? this was last week. 943 people responded to the

question by pushing a button. they said no. that's 83%. 108 said yes. that's 9%. second question, do you support the health care bill moving through the senate? 1,496 said no, that's 5%. 352 said, i don't know. that's 18%. yes, 154. that's 8%. the number leigh: do you a-- number three: do you believe congress doesn't do legislative well -- 1,285 said yes, that's 80%, 7% said disagree. i've often 4erd our friends -- often heard our friends on the other side say where's the bill. our response has been day after day if you're looking forward to seeing the republican leader roll a wheelbarrow in here with a 2,700 page republican comprehensive bill, you're going

to be waiting forever because we have a different approach. our approach is to set a clear goal, reducing costs. the bill that we're voting on increases costs. and find five or six steps to go in the direction to reducing costs, without going into detail, although the senator from south dakota or wyoming may want to, we focused on five or six steps that would clearly reduce health care costs. by that i mean your premium, the cost of your government. once we do those five or six, we could go on. we could do that without taxes, without mandates, without running up the debt, without a big bill with lots of surprises. just to take one example, and then i'll yield to my friends from wyoming or south dakota, one of those examples was the small business health care plan. the current bill, the democratic bill has in it a credit for small businesses, but we would argue the by the time small business men and women get through paying the mandates and

taxes the bill also imposes it's not going to be much help to them. what we have is a bill that would allow small businesses to pool their resources. in other words, if you're a small business man or woman and you've got 60 employees and two get cancer, suddenly the cost of those two employees prohibit you from providing insurance to the other employees. but if you could pool your resources with small businesses all around the country, then the pool would be large enough that you could offer insurance. that proposal's been made by senator enzi. it's been through the health committee. the congressional budget office said that it did not add to the deficit. in fact, it reduced the deficit. and it would permit 750,000 more employees of small businesses to be insured and that their premiums would be lower than they otherwise would be.

that's a single step, madam president, to moving toward reducing health care costs. but if we took that step and the other steps that we have proposed, that would be a good way to start. and we could do that together. and we wouldn't have this partisan bill with so many questions and so many concerns. i wonder if my friends from south dakota and wyoming, i know they have thought a good deal about this step-by-step approach toward actually solving the real problem, health care costs. mr. thune: would the senator yield on that suggestion of small business health plans? doesn't that enjoy wide support among small businesses in this country? mr. alexander: it clearly does. it enjoys wide support everywhere except the united states senate where when senator enzi brought it up it was rejected by our friends on the other side. mr. thune: the one thing that strikes me about this proposal

that is in totality 2,700 pages is that it doesn't enjoy support from any small business organization that i'm aware of. maybe there's some out there i can't speak, but i do know that the organizations that represent small businesses that we're all aacquainted with -- the national federation of independent business, chamber of commerce, national association of wholesaler distribute tors, builders and contractors, electric contractors, franchise association, they go right down the list; all say that this does nothing to lower their costs. in fact, it increases the cost of doing business, increases the cost of health care. what they have argued repeatly is one of the suggestions that the senator from tennessee mentioned, small business health plans would in fact drive their health care costs down which is why they have been so, such strong advocates of this over the years. i guess the other question i would ask of my colleague from tennessee, would an approach, a suggestion like small business health plans require tax

increases that would hit small businesses and, incidentally, the latest version with the manager's amendment that we just received saturday increases the tax increases in the bill that were, previously it was $493 billion. it is now $518 billion. with the tax credits businesses get, they that up a little bit but not enough to help small businesses in light of the tax increases in the first ten years, when fully implemented about $1 trillion. the payroll tax that's going to hit a lot of small businesses is increased dramatically in the manager's amendment. the individual mandate was almost doubled in the manager's amendment. the taxes in the bill go up with this proposal. i guess my question is: with all these tax increases that are going to have a crushing impact on small businesses, does a suggestion like the one made by the senator from tennessee for small business health plans require tax increases or medicare cuts which are what's going to be necessary to finance this 2,700 page behemoth?

mr. alexander: i thank the senator from south dakota. the answer is no. the difficulty with the big comprehensive plans, it sounds good but has lots of unintended consequences. if our real concern right now is reducing costs in health care, the idea of a small business health care plan that has no new taxes and no new mandates but creates opportunities for small businesses to pool their resources and offer more insurance at a lower cost to their employees would seem a logical place to start. mr. thune: i appreciate the senator for his work on that issue. that's a view i share, one that -- a proposal that i've been a big advocate of going back to my days in the house of representatives and what one which, as the senator from tennessee noted, has tremendous support among small businesses across the country. about the only place it doesn't have majority support is here in the united states congress, because -- and maybe it makes too much sense. it seems to me there are suggestions and solutions out there which don't require half a

trillion dollars of tax increases on small businesses, which every small business organization has come out and said is going to drive up our costs of doing business and at the end of the day raise our health care costs and doesn't require these step medicare cuts that the senator from wyoming has alluded to over and over again and the impacts those will have on the delivery of health care to seniors across this country. but rather would bend the cost curve down without tax increases and medicare cuts. another example of that would be allowing for interstate competition, allowing people to buy their insurance across state lines, which is a suggestion that we have made over and over here. and according to the congressional budget office, both small business health plans and buying insurance across state lines actually reduced health care costs and can do it without raising taxes or cutting medicare, which is, to me would make a lot of sense especially when you've got an economy in recession, 10% unemployment, $1.5 trillion deficit last year,

another $1.5 trillion deficit this coming year. when you're talking about a $2.5 trillion cost in growth of government here in washington, d.c. to implement these 2,700 pages, that some suggestions along the lines of the one mentioned by the senator from tennessee and some of these others would make a lot of sense and i think would enjoy tremendous support among small businesses who create the jobs in this country as well as among the american public. so i thank the senator from tennessee for pointing out one of the many things that republicans are for and which we have tried to get in the debate. and i know that the senator from wyoming has advocated for many of these same types of initiatives and solutions. and as he mentioned earlier, was prepared to offer an amendment to address the issue of premiums, but it looks like you're going to be prevented from doing that. mr. barrasso: our friends at the university of minnesota said if people were allowed to cross state lines, shop for the insurance best for them and their personal situation that we would have 12 million more americans insured today than we

have now without a single page of legislation. that's all we need to do is allow people to shop across state lines. look at this bill which has mandates that are going to mandate, force people to buy insurance. one of the amendments i tried to introduce yesterday that i thought made a lot of sense for young people is individuals under the age of 30 or those making less than $30,000 a year would be exempt from the mandate, the individual mandate that they have to buy insurance. i was involved in a discussion on a college campus in a debate on this topic, and to talk to the students they were astonished to learn -- because they're not focused on this -- they're all going to have to buy as a matter of law, if this passes, insurance, health insurance immediately. and if they don't, they're going to have to start paying a tax or a fine, depending on how you describe it. i said for those under the age of 30 and making under $30,000 a

year, let's exempt them from the mandate. that amendment was rejected. and then i said, well, if they're going to do this and force these people to buy insurance and if they don't buy insurance have to pay these excessive fines or taxes, however you want to define it, i said how about that the penalties that these people would have to pay if they chose not to buy insurance because it is going to be a lot cheaper to not buy insurance and just pay the tax, what if that money would go into a personal account so that that person could then use the money? use the money to then buy insurance so kind of like a savings account so the money would be there for them to buy insurance. so individual mandate penalties would accrue not to the government, but in a personal account so they could purchase health insurance within a three-year period. the money would accumulate. that amendment was rejected as well. so we have lots of ideas, good ideas to help people with

affordable care, available care. and yet one after another they have been rejected in a step-by-step process to try to find ways to solve the health care crisis that we know faces the country. all 100 members of the senate know that we need to find ways to make health care more affordable and work on high-quality care. so it's been fascinating to see the dean of johns hopkins medical center and the dean of harvard and those who have looked at this, closely at this bill to say people who are supporting this are living in collective denial, that this bill is doomed to fail, that it will raise the cost of care not lower the cost the of care, and will do nothing to improve quality. mr. thune: if the senator from wyoming would yield on that point, that's why i think day after day after day, and i've said there is a pattern emerging here in the senate where the majority comes down and establishes the need for health care reform which we all

acknowledge, illustrates examples of those who are falling through the cracks, which we all know examples exist. all of us have dealt with those in our individual states. and then proceeds to attack republicans for not having their own ideas, which we have just mentioned there are lots of good republican ideas which don't raise taxes, don't cut medicare and actually do something to reduce premiums. but that seems to be the strategy employed and the pattern that emerges in the rhetoric day after day after day around here from the other side. the one thing i don't hear is them coming down here and talking about what this 2,700 page bill is going to do to reduce health care costs. if we all submit to the exerts on this, which -- the excerpts on this, the congressional budget office is sort of the referee. they don't have a political agenda. the actuary for the center for medical services doesn't have a political agenda. they are considered to be an umpire on this. the joint committee on taxation which looks at the distributional impacts of tax

policy isn't supposed to have a political agenda in all this -- all come to the same conclusions with regard to premium increases in this bill. so if the overall objective is to reduce the cost of health care and in fact your legislation, according to all the referees, all the umpires, all the experts not only increases premiums for most americans but increases the overall cost of health care, which is what they all conclude, it's pretty hard to come down and defend this product. that's why i think day after day they try to create distractions and counterattacks as opposed to actually talking about the substance of the bill. the substance of the bill doesn't accomplish the stated objective, which is to reduce the overall cost of health care and to get premiums under control for families and small businesses in this country. and it's also hard, i would argue, because of the $518 billion of tax increases that are in here and the unified opposition of the entire small business community which creates

70% of the jobs in this country to talk about how this can be anything but detrimental to job creation. this is going to cost us jobs. i think every business organization has made that abundantly clear. and all the analysis of this legislation that's been done comes to the same conclusion. mr. barrasso: when you look at what the centers for medicare and medicaid services has done, which is the group that oversees medicare, they have said ten years from now this goes through, still going to have 24 million uninsured. you're going to have 18 million more on medicaid, the program that the senator from tennessee appropriately referred to as having a bus ticket for a bus that's not going to come because that's what's happened. you have half of the doctors in the country don't take care of patients on medicaid because the reimbursement is so low they cannot afford to continue to care for those people. five million people will lose the insurance they get through work. and health care costs will go up. the cost curve will go up instead of going down. but the whole purpose of this

was to help drive the cost down. and then additionally they said 20% of the providers -- 20% of the providers -- of health care in this country -- and that includes physicians, nurse practitioners, medical clinics, hospitals -- 20% of the providers in this country under this plan ten years from now will be unprofitable, unable to keep their doors open. we've heard about sweetheart deals. we've heard about taxes going up. we've heard about medicare cuts. and what we've seen is one promise after another made by the president that have been unfulfilled and actually reversed by the bill that we see ahead of us. so i ask my friend from tennessee: wouldn't you agree that in the next two days the best thing for the country would be to have this bill not pass the senate and instead go back and in a step-by-step way regain

the trust of the american people? mr. alexander: i certainly do agree with that. i think most americans, when presented with a problem, wouldn't try to change it all at once but would say let's identify the goal, reducing costs, and go step by step. i wanted to ask consent to introduce in the record a column by david brooks in "the new york times" on december 18. the presiding officer: without objection. mr. alexander: most of us, we're pretty split up here, 60 there, 40 here, this bill anyway, but mr. pwraorbgs who's -- but mr. brooks writes a column on the radio. he said he had a hard time making a decision about whether to vote for the bill or against it if he were a senator. he came to know -- and i think it's interesting to see his reasons. he gave -- the presiding officer: the minority time has expired. mr. alexander: i thank the president and i yield the floor. a senator: madam president? the presiding officer: the senator from california. mrs. boxer: madam president, you just heard our republican

friends say that it's very hard to defend our bill. now maybe it's hard for them, but it's not hard for the american medical association, the a.m.a., who have endorsed our bill. it's not hard for the american heart association who have endorsed our bill. it's not hard for the american cancer society action network, who have endorsed our bill. the american hospital association, who have endorsed our bill. families u.s.a., the business round table, the small business majority. we hear colleagues say small business opposes our bill. the small business majority organization supports it. and how about aarp, who represent our seniors? millions of seniors. that's just a few. they not only defend our bill, they support our bill. madam president, this is indeed

an important moment in our nation's history as we approach a final vote on this major health care reform legislation. and i think whenever you're trying to change something, you have to take a look at how things are at the moment. so why is it that we need to change our current system? and there are certain numbers here that i think explain it. the first number is 14,000. madam president, we know that every single day 14,000 of our neighbors lose their health insurance through no fault of their own. they either lose their job, they can't afford to keep up the health insurance, or they have it, a condition and the insurance company walks away from them. or they just are priced out of the market. 14,000 a day. that is cruel, and we need to change it. 62% of bankruptcies are linked

to health care crisis. we're the only nation in the world where people go broke because they get sick. if we do nothing, 45% of an average family's income will go for premiums in 2016. i ask everyone to think about it. paying 45% of your income for premiums, it's not sustainable. what about food? what about clothing? what about shelter? can't do it. we are 29th in the world on infant mortality. we come in behind cuba. we come in behind singapore. we come in behind south korea. 29th in the world on infant mortality because people don't have good insurance or they don't have any insurance. 52% of women -- 52% of women don't seek the health care they need. they either put it off or they never get it because they may

not be insured or they are afraid of the co-pays. they're afraid of what it would cost. they may have limits on their policies, and we need to change that. and the u.s. spends twice as much on health care than most other industrialized nations. so what's the message here? we spend a huge amount, we're not doing very well in outcomes. by the way, i think we're 24th in life expectancy in the world. 24th. we must do better. i want to share with my colleagues some of the letters and e-mails that have been sent to me from californians that personalize the statistics i just showed you. mr. william robinson wrote i'm about to be laid off from the job i've had for 19 years. my biggest fear is not being employed, but being able to find and get affordable health care. i'm 60 years old. i have a preexisting condition

that will for certain make it impossible for me to buy health insurance. mr. and mrs. gilbert de la cruze -- quote -- "we're at the point of losing our home because we spent our savings on medical and prescription drugs. i'm 67, retired, and my wife is 62. because of the medicare gap in prescription drug coverage, we've had to pay $600 a month on prescription drugs. it's a huge portion of our monthly income. we will be selling our home shortly because -- and perhaps moving in with one of our children because there doesn't seem to be any option." well, i want to say to mr. de la cruze, help is on the way if we get the 60 votes we are forced to get. not 51, the majority. but 60 votes because of a republican filibuster. we get those 60 votes each time,

there's hope for you because we are going to fix that entire problem. mr. ronald kim, he says "i'm in the construction industry and i work, my work is very slow." he says he's in the design industry. "i'm in danger of becoming financially ill and i'm looking for ways to stay healthy. and one way may be to eliminate my medical insurance. it is a significant part of my budget. this may, heaven forbid, lead me to financial ruin if i get injured or sick. this is my situation." i want to say to mr. kim, help is on the way. mrs. madeleine foote wrote -- these are all californians, my constituents. "i recently turned 25, and i lost my health coverage under my parents. i attempted to get coverage under a blue cross plan created for young people my age. but because i had taken

medications, i was denied. i applied again for another plan, was offered a plan with a $3,000 deductible and it was $300 a month on top of that. as a young person working in a restaurant, repaying student loans and trying to make it on my own, this is a huge financial burden. i cannot afford an insurance that charges me so much and won't be any benefit for me until i've shelled out a huge portion of my income." to madeleine foote, i say help is on the way if we can break the republican filibuster. mr. john higden wrote, as a self-employed person i had a pacemaker implanted. the cost was borne entirely by me at prices much higher than any insurance company would have to pay. i'm told by every health insurance company i've contacted

that no one -- no one -- will offer me health insurance at any price with a -- quote -- " "preexisting heart condition." toiled say to mr. higden help is on the way. dr. robert meager, a pediatrician for over 30 years, you know what he wrote and told me? that he has to fake -- he's pressured to fake a diagnosis because when a parent comes in with a young child with asthma, they beg him not to write down asthma but write down bronchitis because if he writes down asthma, that child will have a preexisting condition. and when she turns 21, she won't be able to get insurance. imagine in america a physician being pressured to lie on a form because of a health care system that is so cruel.

so, dr. meager, we're going to change things here if we can break this filibuster. mr. douglas englesby wrote i own a small business, employ 11 people. he says i used to provide health care for all my employees and all the members of their families. and if i want to remain profitable enough to stay in business now, he says he can't do it anymore. he can only cover the employees, not their families. he feels terrible about it, and he says he may have to cut off his employees if prices keep going up. and i want to say to this fine small business owner, douglas, help is on the way. and mrs. linda schumaker wrote -- and this is the one i'll close with in this series of stories -- i am a republican. let me repeat what she writes: i am a republican, and my husband and i are small business

owners. the senators and congressmen of both parties who are against president obama's plan have their own insurance. and it's my understanding, she writes, that it does not cost what we pay. they do not understand what a huge expense this is. please listen to the middle class who are in our position or who no longer have insurance. it keeps me up at night worrying. this time the republicans have it wrong, and they need to know. please push the health plan. the insurance only care about the bottom line, not people. and i want to say to mrs. schumaker, thank you for putting aside party politics, because this isn't about republicans and it isn't about democrats. it isn't about independents. it's about all of us together. so what happens now is you're hearing the polls.

the polls show americans don't want us to act. and i understand why. there has been so much misinformation. senator durbin and i, our assistant majority leader, were talking about the misinformation that's on this floor from the other side day in and day out. and i believe much of it, if i might say, is purposeful. if you listen to my republican colleagues over the past few days and weeks, they have trashed this bill and they have trashed the process. over the weekend, the republican leader said health reform is a legislative train wreck of historic proportions. that's a direct kwoefplt earlier this will -- that's a direct quote. earlier this month senator coburn used more inflammatory language when he said to seniors -- i'm quoting senator coburn -- "i have a message for you. you are going to die soon." unquote. well, if you want to know what

fearmongering is, that's the best example i can give you. so you know, i decided to go back and look at the past congressional records. and i thought have republicans spoken like this over the years? every time we've tried to do some health care, every time we've tried to make life better for people, such as social security. and i will let you be the judge. in 1935, on the floor of the house of representatives, during the debate on social security, republican congressman jenkins of ohio said of social security bill -- remember, it hadn't passed -- quote -- "this is compulsion of the rankest kind. do not be mislead by the title. the title says kwo*e -- quote, old age benefits. shame on you for putting such a title on such a nefarious bill. old age benefits, think of it, he said.

oh, what a travesty. mr. chairman, what's the hurry? nobody's going to get a dime out of this until 1942. what's the hurry about crowding an unconstitutional proposition like this through the house today? and if you listen to some of my colleagues, you'll hear the same thing. what's the rush? as a matter of fact, they had four or five amendments. send it back to committee. what's the rush? the rush is that 14,000 people are losing their health care every day. the rush is that 62% of bankruptcies are linked to a health care crisis. and in 2016, our people will be paying almost half of their income for premiums. yeah, we've got to do this. and we started it seven months ago. and 100 years ago, teddy roosevelt, a republican president, put it in his platform. what's the rush? what's the rush? i want to tell you about another republican, congressman jay william ditter of pennsylvania, this is what he said during the

debate on social security. he said security for the individual, whether worker or agent, will be a mockery and a sham. this is what he said about social security: and it will allot to our people the role of puppets in a socialistic state. that's what he said back then. and i tell you, if you ask republicans who are getting social security, democrats who are getting social security, independents who are getting social security, they'll all tell you the same thing: keep your hands off it. it works. it's good. it's fair. it's insurance. it's what we did way back then. in 1965, when medicare passed -- that was health care for those 65 and up -- republican senator carl curtis said it's socialism. it moves the country in a direction which is not good for anyone. and years later we know newt

gingrich, when he was speaker of the house, said he wanted to see medicare wither on the vine -- his words. and in 1995, while seeking the republican nomination for president, senator bob dole, he said -- quote -- "i was there in 1965 fighting the fight, voting against medicare because we knew it wouldn't work in 1965." so when you hear our republican friends say, oh, my goodness, they're making a lot of savings in medicare, this is bad for the seniors, please, please. which party has stood for protecting our seniors? it's not a matter of being partisan. it's just the fact. so the echoes of the past fill this chamber, but i'm convinced now in 2009 that hope and reason and determination and good policy will triumph over fear and obstruction and the status

quo. let's look at the immediate and near-term changes for the better that people are going to have, because our colleagues say, oh, we're raising revenues but there's no benefits right away. let's talk about what the benefits are. and i don't have time to go into them. i have them in my statement which will be placed into the record. there will be a $5 billion high-risk pool immediately for people with preexisting conditions who can't find insurance. there will be reinsurance for retirees. so if you've retired and you're getting your health care benefit and something happens to your company, there will be reinsurance so you can still get your benefits. we close that doughnut hole for the medicare recipients who fall into it and suddenly they can't afford their prescription drugs. there will be billions of tax credits -- billions -- up to 50% tax credits for small business. that's why we have the support of so many small businesses.

and for new policies, no discrimination against children with preexisting conditions, and children can stay on their family policy until they're 26 years of age. what else are the immediate and near-term changes for the better? for new policies, no lifetime limits, no more rescissions. they can't walk away from you when you get sick. they're required to cover essential preventive health benefits like mammograms. prohibits discrimination by employers based on salary of their employees. so an employer can't say if you earn over $250,000, you get these great benefits. but if you earn under $50,000, you get a worse array. by 2011, standards for insurance overhead costs go into place. and if your insurance company spends too much on overhead and too much on executive pay, let me tell you what happens.

they have to rebate to you the policyholder. we also see increased funding for community health care centers. this is going to make a huge difference. there will be a national web site to shop for affordable insurance. there will be a long-term care program that is voluntary that you can buy into. insurance companies with unreasonable premium increases can be barred from the exchanges that will be set up in 2014 so they'll be making sure they don't increase your premiums beyond a reasonable amount. this bill will benefit the insured. and one way -- i don't think people understand this. by 2014, 62% of families will no longer face unsustainable premium costs. if you're a family of four and make less than $88,000 a year, you will never have to pay more

than 9.8% of your income on health insurance premiums. could we have some order, please? the presiding officer: the senate will be in order. mrs. boxer: so this is an amazing thing that most people don't focus on. i just explained that the nonpartisan studies show -- and this is important -- that we'll be paying the average family 45% of their income for health care in 2014, people in this country will not have to pay more than 9.8% of their income on health insurance. otherwise they'll get tax credit. and that's very, very important. now, this bill is going to benefit our seniors. that's why it's endorsed by the aarp. we eliminate the prescription drug coverage gap. that's the doughnut hole. we extend the life of the

medicare trust fund by nine years. we reduce waste and fraud in medicare. and we provide for free yearly wellness visits for seniors. this bill saves medicare. this bill makes our seniors stronger. they will have more benefits, and they can never lose their guaranteed benefits. small businesses will be able to reduce their cost, again, by getting immediate tax credits. and in 2014 they will be able to access the exchange, as will self-employed people. and they will have the power of big business behind them as they go into those exchanges. i want to talk about public interest provisions. i wanted a public option, let me be clear, because i felt it would keep the insurance companies honest. but let me tell what you we have in here that are definitely

public interest provisions. we expand medicaid. that's a public plan, to cover an additional 14 million people. and that starts in 2014. and that's 1.5 million californians. and the federal government in my state will pay the full fare for those added people for three years, and after that far more than we get paid now. h.h.s. will set the initial rules for the state changes. so those getting into the exchanges have to be fair. the o.p.m. plan -- that's the plan will be part of the exchange, will be set up by the government, the office of personnel management. again, community health centers. and a basic plan can be created by the states which i think is very important and i want to thank maria cantwell for working so hard on that. so, if people tell you we don't have anything to do with public options, they're really not right. you have to look carefully at

this bill. now i want to talk about the deficit. we reduce the deficit between 2010 and 2019 by $132 billion, and between 2020 and 2029, there's up to a $1.3 trillion deficit reduction according to the congressional budget office. that is a nonpartisan office. this bill reduces the deficit. i'm going to say it one more time. this bill reduces the deficit, and the reason is we invest in prevention, and that pays off. we finally will be able to say to the insurance companies, stop your gouging, and that pays off. and we do have competition here now because we will have that special plan run by o.p.m., the state option that maria cantwell put in there. this is why we see the reduction including taking the fraud and the waste out of medicare. we don't need fraud and waste.

so here's how i want to close. health care coverage for all americans has been such an elusive goal. for nearly a century if you look at republican presidents and democratic presidents and republican congresses and democratic congresses, we've tried it over and over again. and the status quo has always preveiled. our beloved friend, senator ted kennedy, whom we miss so much, particularly during a time like this, fought for health care right here on the floor from the moment he became a senator in 16962 to the moment he -- 1962, to the moment he died. in an op-ed in "the washington post", ted's wife wrote, that we can't let the perfect be the enemy of the good. i want to say to vicki, she's exactly right. each of us could write this bill

our way. believe me, if i wrote a bill, to me, it would be perfect. but to my friend in the chair, she would say, i could make it better. and all of us could. this is the legislative process. this is a good bill. vicki goes on to say the bill before the senate, while imperfect, would achieve many of the goals that ted fought for while he championed access to quality, affordable health care for all. he's not here to urge us not to let this chance slip through our fingers, and she says, i humbly ask his colleagues to finish the work o his life. the work of generations to allow the vote to go forward and to pass health care reform now. as ted always said, when it's finally done, the people will wonder what took so long. i want to thank vicki. not only for writing that wonderful editorial, but also for actually being in the chamber when we took that first

vote to break down this filibuster. colleagues, i am so proud that today we are moving closer to fulfilling the promise of health care for all americans including the 40 million californians that i'm so privileged to represent. i thank all my colleagues for all the work they put into this bill. i spent a lot of time on it myself and this moment is very poignant and i hope we pass it. i thank you and i yield the floor. the presiding officer: the senator from massachusetts. mr. kerry: i thank the chair. madam president, let me begin by commending the senator from california on a really

outstanding presentation regarding this legislation. i was listening to her before i came over in my office and i listenedded to her over here and she's really laid out in a very careful and deliberate and thoughtful way. the realities about this legislation before us, i really want to thank her for her terrific presentation. and i want to sort of pick up a little bit where she has left off. but let me just inquire, so i understand, where we are here. could i ask how much time we have remaining on the majority side? the presiding officer: the majority side has 34 1/2 minutes remaining. mr. kerry: i thank the chair. let me begin by -- let me begin by saying that -- i listened also to our colleagues on the other side of the aisle, particularly the senator from south dakota, just a little while ago, and i was really struck by the chart that they

put up showing chair going up and up and up and up, and then they talked to americans basically scaring them, trying to say, well, if you pass this bill, it's not going to do anything to -- to reduce the crisis of medicare down the road. and the reality is that that's all they present. is the scary picture of a future which they're not even describing accurately. now, they've had a year and a half -- a year and a half that we've been working on this legislation since it was announced in the finance committee, which i serve on, and we heard -- and we held a day long -- i think a two-day long conference over at the library of conference and within the committee where we began the work laying the groundwork and foundation for a new presidency and for the work that has gone

on this year. many of their members took part in that. and so there's no secret here as to where we are. this is a debate that has gone on in the united states of america since harry truman was president of the united states and before. we all know that president teddy roosevelt, a republican, put before the country the notion that every american should be able to have their sickness dealt with. and -- and nobody has ever contemplated that you ought to go bankrupt in order to be able to have health care. but, as we know, we have more bankruptcies in america, health care bankruptcies every year than any other nation on the planet. i think that we're the only nation that knows health care bankruptcy. and the stories that we've heard, countless stories earlier this morning, i guess, to get

any times correct when we were here at 1:00 in the morning, we heard the majority leader talk about those very poignant, moving situations of individuals in nevada. we heard the senator from california. there are stories from every senator, from every state. and, yet, it is only at this dividing line right here down the center of this chamber. it is only the senators on this side of the dividing line who seem to be prepared to try to address this -- this issue. the fact is that the managed package -- the managers package, which is now the pending business before the senate, brings us close -- even closer to being able to address many of the major concerns that we have. now, senator after senator has come to the floor and described the way in which this bill doesn't do everything that we want it to do. i have been a passionate supporter, as was ted kennedy,