care reform bill obviously one step closer to final passage, at least it looks obvious that that's going to happen, regardless of whether the other side has 60 votes, my friends on the other side still have a problem that they want to not have the public concentrate on. and that is that the pending bill still raises taxes on middle-income americans. the reid modification did nothing to reverse this fact. so i'll take a few moments to illustrate the winners and losers under the bill. and so we start with a question: if a person is not receiving a subsidy for health insurance under the bill, then how can the person receive a tax cut? this is a relevant question because the white house and majority leadership continue to

proclaim that the bill is -- quote -- unquote -- "a net tax cut for middle-class americans." for example, on wednesday, december 16, a senior white house aide wrote, quote -- "the bill being considered represents a substantial net tax cut for middle-class families." end of quote. so i think that statement begs more questions who do you believe, the white house on the one hand or on the other hand the nonpartisan independent experts that we on capitol hill rely upon for judgments, people that are not political. that's the joint committee on taxation. this committee tells us that in 2019, a little more than

13 million individuals, families, and single parents would receive the government subsidy for helping people under 400% of poverty buy health insurance. the joint committee also tells us that the number of tax filers in 2019 will be 176 million people. and if people are wondering why we talk about 2019, it's the budget window from now until the end of the ten-year period of time that we call a budget window. that means out of comparing this 13 million to this 176 million taxpayers, 13 million people receiving the subsidy, 176 million tax filers, that means out of that 176 million individuals, families, and

single parents, only 13 million of them would receive a government subsidy for health insurance. that is only 7% of the tax filers. pretty important to understand that only 7% of americans will benefit from the subsidy for health insurance. and we have a pie chart here so that people can see exactly what i'm talking about. 176 million taxpayers, 13 million receiving this subsidy. this means that 163 million families, individuals and single parents, or 93% of all taxpayers, will receive no government benefit under the reid bill. so what does that mean?

it means there is a small beneficiary class under the reid bill. 7%, 13 million people will receive benefit under the reid bill. a very large nonbeneficiary class. 93% will -- will not benefit. and this nonbeneficiary class is affected in other ways. yes, while one group of americans in this class would be unaffected, another group of americans will see their taxes go up. and this group won't have a tax benefit to offset the new stacks liability.

that means that these americans will be worse off under the reid bill. so it's legitimate to ask, for these 93% of the people, what happened to their net tax cut, because what they will see instead is a net tax increase based on joint committee data in 2019. 42 million individuals, families, and single parents with incomes under $200,000 will see their taxes go up. this is even after taking into account the subsidy for health insurance. again, this is on a net basis. if we were to identify those americans who are not eligible to receive the tax credit and those whose taxes go up before they see some type of tax

reduction from the subsidy, this number will climb to 73 million americans. the first bar illustrates what we have already established but looks at americans earning earning $200,000, less than than $200,000. here, 13 million families and single parents and individuals would receive the subsidy. the middle bar shows the net tax increase number of 42 million americans under $200,000 a year income. finally, when we identify those americans who get no benefit under this bill, and those americans who see a tax

increase, we find that there are 73 million individuals, families, and single parents under $200,000 category. that's this group here again. i want to close by referring to a final chart that illustrates the winners and losers under the reid bill. what we see here is that there is a group of americans who clearly benefit under the bill from the government subsidy for health insurance. this group, however, is relatively small. 8% of the americans, if you look at those earning less than than $200,000. there is another much larger group of americans who are seeing their taxes go up. this group is not benefiting from the government subsidy,

this group right here. and there is another group of taxpayers who are generally unaffected, this 82 million here. the joint committee on taxation tells us that this group may be affected by tax increases that are not included in this study like the cap on flexible savings accounts and the individual mandate tax that people are going to pay if they don't buy health insurance. the bottom line is this: my friends on the other side of the aisle first cannot say that all taxpayers receive a tax cut, and two, cannot say that the reid bill does not raise taxes on middle-class americans, because we have the professionals that are nonpolitical at the joint committee telling us differently. no one can dispute that data.

mr. grassley: i yield the floor and suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

the presiding officer: the senator from iowa. mr. grassley: i ask the calling of the quorum be suspended. the presiding officer: without

objection. mr. grassley: my friends on the other side of the aisle continue to argue that the reid bill eliminates the so-called hidden tax. they argue that this will reduce the costs of health care. for example, on wednesday, december 16, a senior white house aide wrote -- "even if you believe that some of the tax on insurance companies is passed along, it would be more than outweighed by the benefits middle-class families would get from reducing the hidden tax they currently pay for the uninsured." end of quote. i don't believe that the fees on health insurance companies will be passed through to the policyholders. i think it's just idiotic not to think that they wouldn't be passed through, so i want to flat out state that i know they're going to be passed through, and my authority for this is the congressional budget

office and the joint committee on taxation telling us that fact. the c.b.o. and the joint committee on taxation told us that these fees will be increased -- will actually increase health insurance premiums. premiums go up because the companies are paying increased taxes under this bill, and for insurance premiums to go up under a title of a bill that encompasses health care reform, that is going in the wrong direction. also, for argument's sake, let's assume my democratic colleagues are correct and this so-called hidden tax that results from uncompensated cold air equals $ -- care equals $1,000. the pending health care reform bill still leaves a large number of americans uninsured. specifically, the reid bill leaves 23 million out of

54 million without health insurance at the end of this budget window, 2019. so at best, the democrats' reform cut the hidden tax in half. in this case, to about $500 a family. to add insult to injury, however, the bill adds new hidden taxes. these taxes are the fees imposed on health insurance. c.b.o., joint committee on taxation, two respected organizations, say that this will increase costs. if you check the record, no one can dispute it. these fees now go into effect 2011. still, three years before any of the major reforms under the pending bill kick in. this means that this hidden tax will increase premiums in 2011, 2012, and 2013, and that is

before there's any government assistance for health insurance being provided the families that need it. the new hidden tax is also created as a result of the medicaid expansion on the one hand and medicare cuts on the other hand. a major cost shift in health care derives from government programs medicare and medicaid which reimburse providers at rates roughly 20%-40% lower than private providers. president obama understands that paying doctors below market rates lead to cost shift because this is what he said at a town hall meeting on health care reform. a quote from the president -- "if they are only collecting 80 cents on the dollar, they have got to make that up someplace else, and they end up getting it from people who have private insurance." end of quote.

the medicare and medicaid cost shifts will be increased significantly under the pending health care reform bills. according to the c.b.o.'s estimate, medicaid will be increased by more than 40% from 35 million to 50 million people. additionally, the bill includes half a million dollars in medicare cuts which will result in lower payments to providers. increase in the current medicaid and medicare cost shift as a result of the democrats health reforms would add more costs to family's health insurance policy. the easier cost shift to address would be the $1,700 cost shift from defensive medicine. the democrats do not address the cost shift from defensive medicine, which former c.m.s. director, mark mccellend --

addressing this reform alone could save more than covering all of the uninsured in america. so, you see, my friends on the other side say that their bill will eliminate the so-called hidden tax. well, my friends seem to come up short on that one. also they add new hidden taxes that will burden middle-class americans. so i think the present situation, the legislation before us, and the language used by debaters on the other side should be transparent. these people should be transparent when they're talking about getting rid of the hidden tax. the pending health care reform bill makes things from these

three perspectives worse. madam chairman, i'd be happy to yield the floor for a minute -- for the purpose of a colloquy to senator boxer on another subject. mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: i'd like to -- well, i'd like to address a colloquy with senator grassley, as he said on another subject that's not related to this bill. the presiding officer: without objection. mr. baucus: madam president, the senate is wrapping up legislative business, but there are a few expiring tax provisions that have not been extended. it includes tax benefits for individuals and businesses that would help teachers to purchase

supplies for their classrooms an families of college students, a great number of u.s. benefits rely on the research and development tax credit and the active finance exception both of which expire at end of the year. the energy industry relies on several provisions that expire on december 3 1s. unfortunately this is not the first time that we've allowed important tax benefits to expire when the sent recoconvenes, we will take up these important pro provisions. we have a letter to the senate leadership. the letter states our intention to work together to get extension done as quickly as possible in the new year. senator grassley and i understand that the key -- taxpayers need notice of the vaibility yif these provisions to full yanni effectively utilize their intended benefits. we must act quickly to cause the least disruptions and

administrative problems for the internal revenue service. i hope when the senate reconvenes early in 2010 we can address the expiring conditions as soon as possible. i'm wondering if that is also the intention of my good friend from iowa, senator grassley? mr. grassley: madam president? the presiding officer: the senator from iowa. mr. grassley: i'd like to add to what he said by speaking positively on this issue and to remind my colleagues who maybe have been watching the last three weeks and have seen senator baucus and i on separate sides of the issue on health care reform, that it's very uncharacteristic of our being on different points of view on most legislation. because in the 10 years that he and i have been leaders of the finance committee, most of the issues coming out of our committee have been very bipartisan. and what he just talked about and what i'm going to respond to is one of those issues. i agree, chairman baucus, that we should retroactively extend

the tax provisions as soon as congress reconvenes in 2010. as chairman of the finance committee in 2005, i worked with then ranking member baucus, and we authored the biodiesel tax credit. it's a tax credit that's really needed to be extended before the end of the year to prevent the biodiesel market to grinding to a halt on january 1, 2010. this tax credit differs from other tax provisions in that the price of biodiesel will be $1 higher on january 1, 2010ing as a result of the tax credit not being extended prior to that date. it means people will buy petroleum diesel rather than

biodiesel. i would say that by buying the biodiesel is a robust bipartisan and bicameral and has not been extended prior to january 1, 2010, do solely to issues unrelated to the merits of the biodiesel tax credit soivment want everybody to know that i agree with chairman baucus that the expiration of these tax provisions create uncertainty and complexity in the tax law. i also agree that the taxpayers need notice that these tax provisions will be in place so that they can plan their personal and business affairs to fully and efficiently use the intended tax incentives. in addition, extending the tax provisions as early as possible in 2010, as we intend to do, will minimize the administrative problems created by the internal revenue service. so i look forward to working

with chairman baucus to retroactively extend these provisions as soon as possible when the senate reconvenes on 2010. mr. baucus: i thank the senator for his statement and i look forward to working with him and other senators so we can pass this legislation as soon as possible next year. i commend my colleague and friend. it is true much more often than not we're working on the same side of the issue. even on the few occasion that we're on the opposite side, we do so very agreeably. i wish more of the senate would act in the same way. mr. grassley: i suggest the absence of a quorum. the presiding officer: the clerk will call the roll.

the presiding officer: the senator from iowa. mr. grassley: i ask that the calling of the quorum be suspended. the presiding officer: without objection. mr. grassley: there was a report released recently by the chief actuary, rick foster. i hope that this report will once and for all put to an end any serious consideration of the

class act. now the class act is going to be in the bill if this bill passes congress. but it shouldn't be in it and we should have had a long discussion on -- on -- on this provision because it's simply unsustainable. fiscally unsustainable. the information that the chief actuary's letter provides is amble -- ample evidence of why the class part of this bill can't work. and quoting from page 13 of the chief actuary's letter, "we estimate that an initial average premium level of about $240 per month would be required to adequately fund class program costs for this level of enrollment, anti-selection, and

premium inadequacy for students and low-income participants." so who would enroll in the class program? an american making 300% of poverty has a gross income o of $32,000-plus dollars. if the class premium is, as the chief actuary predicts, $240 per month, that's $2,180 per year, and an individual at 300% of poverty would have to commit 8.9% of their income to join the program. and that is simply not possible. nor is it plausible for -- to argue that young, healthy persons will commit almost 9% of their income to long-term care insurance policy. the people who will enroll then are those who have real

expectations of using the long-term care benefit. people who join the class program with the expectation of meeting the benefit become the bernie madoffs of the class action ponzi scheme. an individual becomes eligible for the class program after paying premiums for just five years. if a person pays premiums o of $2,880 per year for five years, they would have paid a total of $14,400 in these premiums for that program. that person can then begin collecting a benefit of $1,500 per month. in 10 months the person will have recouped their five years worth of premiums. this simple explanation should make it crystal clear while the class act -- why the class act is a fiscal disaster waiting to

happen. not based upon our determination, but based upon the determination of the chief actuary. the premium will be too expensive to entice young, healthy people to participate. the benefit payout is very entietion for people who know -- enticing for people who know they will need the benefit. healthy people don't participate, sicker people will. this adverse selection program will -- this adverse selection problem will send the program into classy insurance -- classic insurance death spiral. the chief actuary concluded on page 14 of his report this one sentence, i'll give you -- quote --"this is a very serious risk that the problems of adverse selection would make the class program unsustainable. if the class act becomes law, the federal taxpayers is at very

serious risk of paying the price to clean up the fiscal disaster when the class act fails." i yield the floor and suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: madam president, i ask consent that further proceedings under the quorum call be dispensed with.

the presiding officer: without objection. mr. baucus: madam president, i had a chart behind me, but it has disappeared. i don't know where it is. here comes an eas easel and the chart. this will not take long. just a minute or two. madam president, this chart shows very graphically -- this is a data put together by the joint committee on tax and also combining all the various provisions in the bill. basically it shows that in 2010, that's the bar to the far left, there will be a $26.8 billion net tax cut for individuals. net tax cut. next year -- two years later -- 2017, that's the middle vertical bar, a net tax cut

of $40 billion for all americans. not for all americans, some won't get all of it, but most americans. and the next year, 2019, a net tax cut of $40.8 billion. i just want to make it clear that there's a net tax cut in this bill and this is the distribution over three different years, 2015, 2017, 2019. that's information prepared by the joint committee on tax. i want americans to know that there are tax cuts in this bill and they're very significant. madam president, i yield the floor -- the presiding officer: under the previous order -- under the previous order the senate stands in recess until until 2:30 p.m. recess:

in the debate earlier today, senator ensign raised a point of order against the health care bill. what's that mean? >> senator ensign as you said raised a constitutional point of order. republicans haven't had much success so far thwarting democrats effort to pass a bill by christmas. senator ensign raised a point of order, claiming individual mandate to purchase health insurance in the bill violated the constitution. >> will that get a separate vote? >> it will. part of the reason why he went that route, constitutional points of order are non-debatable. they automatically get a vote if raised.

>> like other procedural votes, do they have to get 60 democrats to move forward? >> that is another reason why tactics republicans look to this year, only requires a simple majority or 51 votes to prevail. >> stories con thin in your publication and roll call, leadership is negotiating with a final passage before christmas eve. what can you tell us about the latest on that. >> there are some signs that the republican resolve to drag this, or, continue the debate through two more full 30-hour cycles of cloture which would put a final vote on final peaceage on december 24th, that resolve might be weakening a little. minority leader mitch mcconnell said on the floor, he and senator reid, majority leader are working on some kind of agreement. he didn't specify what the agreement would be, to presumably move up, potentially buy a couple hours the vote on final passage. there is ice storm predicted

for christmas eve. i think there is some concern about senators being able to get home to their families. >> is it likely we'll hear anything once the party caucuses meet as senator reid set to say something on that? >> in some ways the ball is more in the republicans court than it is in the democrats court right now. seems as though senator snowe said earlier today she said republicans will talk about the issue at conference lunch beginning momentarily littlely. we might have some kind of news as to whether some of the more, some of the members in the republican conference, people like tom coburn and jim demint, been very adamant they will stretch this out as long as possible, whether they will continue to insist upon that. or there might be a way to move this up. >> lastly there is real news on house side with alabama congressman parker griffeth switching parties from the democrats to republican party. how is that news been greeted on capitol hill, on the senate side? >> definitely something i would not be surprised if

the republicans seize upon that as, evidence that, the voters are making, that these opinion polls and their arguments this bill is unpopular is making some kind of an impact. one of the interesting things is that, this, this latest announcement is, coming on the heels of a couple of republican house members, sorry, democratic house members who said they're not going to seek reelection also from the south. so, i think it would be interesting to see, particularly with blanche lincoln from arkansas, who is from a conservative state and has been voting with democrats, whether there, republicans i expect would make links between her and representative griffin is expected to announce this afternoon. >> covering the senate health care debate. kathleen hunter of congressional quarterly. >> thank you. >> follow all the gavel to gavel coverage on c-span2. we bring you highlights on c-span radio.

you can read the legislation and catch briefing to see how your senator voted. for iphone and ipod you can follow the debate with the c-span radio iphone app. it is free. and listen to see span and c-span2 and c-span radio and. "washington journal" segments earlier on the issue. we spoke with wyoming. republican senator john barrasso. this is been a half hour. >> host: joining us from the rotundo buildings senator john barrasso republican of wyoming. put your doctor hat, former orthopedic surgeon. what is good in bill for doctors and what is bad for the for doctors? >> guest: thank you for having me. wish i could be in the studio. we're having three roll call votes on senate floor. they're in middle of third vote. i voted quickly. my name is on top of the

alphabet and ran over here to be with you. it is interesting. i've practiced medicine 25 years, taking care of people from wyoming, and families across the state. what the doctors would tell you if you ask them what is wrong with the bill, there is no really, no dealing with lawsuit abuse. doctors would tell you that the number one place you could save money in health care in this country is with the overuse of tests, exams, things that don't actually help anybody be healthier or get well but are there just to cover the doctor in case something does go wrong with a patient and that they want to make sure they can say yes, i did everything i could. i ordered the mri. i ordered the cat scan. we know that contributes hugely to the cost of medical care in america. it is not just what the doctors pay in malpractice insurance, which is again a business expense, which is passed on to patients. but the additional tests and exams which are much higher

than what doctors pay in insurance that costs everybody in this country. and those numbers are staggering when you talk about how many doctors when they're asked, have you ever ordered tests on patients that you know aren't going to help them get better and do it to maybe treat yourself instead of the patient? 95% of doctors say they will. so that's a problem with this bill. you asked what's good about the bill? i think mental health parity. some of the people with mental illness that is treated by insurance the same way as other diseases are treated. and i think that is helpful and it is important. it is something i worked on when i was in the wyoming state senate and conty continue to support and happy that is included in the bill. on balance this bill costs too much. it is going to add to the deficit even though the president promised that it won't. it will cause people's insurance premiums to go up even though the president promised it will not. and it will cut medicare by $500 billion.

>> host: this is not the end of the road for this legislation. the house and senate have to come up with compromise legislation. is there any way that you see to make this bill better in conference? what can be added? >> guest: you know, it is interesting because i'm fairly new at this process. i've only been in the senate for two years. i offered 19 amendments that harry reid said, no amendments. 373-pages that he brought forth on saturday. i had a number of amendments. i tried to offer four of them sunday on the senate floor. i think these are all to strengthen the bill. i think that if, what can you be added to make things better? i think that if you don't buy insurance and end up having to pay these fines and these taxes, i think it ought to go into an account with your name on it so you can accumulate that money to use it to buy insurance instead of just going into the federal treasury. i think that would

strengthen this. i think that you should allow, because the president said if you like your doctor, you could keep your doctor, you allow people on medicare to privately contract with doctors. if because of all these medicare cuts, they're having a harder time seeing a doctor, what's the harm of allowing someone to actually see a doctor and make that contract, in a private way so they could then go to the doctor of their choice? that is what the president promised and but harry reid and democrats rejected that amendment. since they promised that health care premiums would go down, i say, just to help you keep your promise, let's give the state insurance commissioners the right to if in any given state the insurance premiums go up faster than the consumer price index, that then, none of these mandates would apply for that state. those are things that i think would make this bill better and fairer for the american people. but you talk about a

conference, we'll see if there is actually one. i think the president is going to, in his desperation and white house desperation to get something passed, anything to his desk he can sign. it is very obvious that they're much more interested in signing anything than actually getting right and getting costs under control and helping people of america with their health care and getting health care more affordable and available and increasing quality, that in that desperate effort i believe they will try to force the house to accept the senate bill in total, even though as your last guest said, there are huge differences between the house and the senate bill. i don't think the white house cares at all about that. i think all they're interested in is getting something to the president's desk as soon as they can so they can sign it. and, i'm hoping that the american people have more of a say over the christmas holidays with their members of congress. >> host: first phone call for you. ohio, daniel on the

republican line. >> caller: good morning, sir. as a legal aid, my question is simple. how are you going to pay for this? you can't ask the people if they have health insurance because, if you do, then they say no, you fine them. that is self-incrimination. violation of the fifth amendment of the united states constitution. you can't come along here and demand that they answer the question because if they do, and they do it and you fine them, that's contract under duress, and that is i will in every state of the united states including under federal law. and, in 1935, the u.s. supreme court in 9-0 decision stated in shecterr, versus the united states, that congress does not have the constitutional authority to require a citizen to buy anything. therefore, if you can't do any of the three, how are you going to bring the people in, the young people to put into this bill to

help lower the cost? >> host: senator? >> guest: that is great question coming in from defiance, ohio. i like the name of that community. my background is in medicine not the law. we had a discussion among senators between the votes, of can washington mandate citizens buy a product and then do you fine them or tax them if they don't? can they go into your home and say you must buy this? there is a lot of discussion that we're going to see about that. 20 states right now have draft model legislation from the american legislative exchange council, a group that met here in washington not that long ago, 20 states are introducing legislation to say exactly what the caller from ohio asked about. and they want to say, stay out of our state. you can not tell the people of our state what to do. and, as a result, this could likely get all the way to the supreme court in the years ahead with discussion

and decision about what the rights of individual, state rights, individual rights as well as what the constitution truly says about this. so, his background is in the law. obviously researched this and knows what he is talking about. >> host: st. louis, donna on the independent line, you're next. >> caller:. thank you. two things. first, your party should have done something about lawsuits when they controlled everything for six years. secondly, if reid can ignore the doctors and ama who want people to go to the e.r., instead of have preventative health insurance because they make more money that way, if they can ignore the media and 44 senators which get millions from the insurance companies, and the far left who want to public option when they know there is not enough votes for it, and all the republicans are just interested in the 2010 elections and who fought

medicare every step of the way, and those who want to delay this, as long as they can, that might kill the bill, and if he can ignore all their selfish reasons and pay attention to the working poor of this country, working people who help pay for all of your health insurance, that is who pays for your health insurance. yet they can't afford to buy it for themselves. if reid can focus on this he will be the one who is loving his neighbor as himself. the real reason for the season, number one commandment. >> host: get a response. support, what do you think? >> guest: thank you, donna. you're absolutely right about the abuse of lawsuits you and i both agree raise the cost of care for america, run into lots of preventative, a lot of defensive medicine being practiced. and you're right, they didn't do that when the republicans were, republican party was in charge. a lot of reason there, there are a lot more lawyers in

this body here on capitol hill than there are physicians. that's why i like people from all different backgrounds and walks of life to serve in congress. in wyoming, i'm a physician. our other senator is an accountant. we bring real life experiences and, i've taken care of people from all sorts of backgrounds. i know exactly what you're talking about when you talk about the working poor, the people of this country. who make our country work and get up every day and go to work to put bread on the table and clothing on the backs of their kids and try to get them up to go to school and get an education. so think that is critically important. so you make some very good points. i'm very distressed like you are, the way this bill has been put together. the effects of the special interest groups, all of whom are meeting with the president at the white house. they were the ones that were cutting deals. whether it was insurance companies, drug companies, one group after another, went into the white house and cut a special deal and now they're all asking for special protections and

that's why you see this, as one of the papers this morning said, you don't want to watch the sausage being made but what is happening up here, right now, is actually giving sausage a bad name. one of the editorials called it bribery. another called it corruption for people to sell out their vote only after their state has been given $100 million prize. i think one of our next guests coming up will be in the situation they want to talk about that with the louisiana purchase and omaha stakes, all the money gone to specific senators who had concerns about the bill including bernie sanders from vermont. who was against the bill until they put in a $10 billion program he supported. i think discussion on legislation ought to be based on policy and principle, and if somebody is against a bill on principle i can absolutely respect that. but this is all turned into payoffs and politics.

i think it is the worst what you expect to see and what we would want from our elected members of congress. >> host: senator, the caller also asked republicans stop what she called delay tactics. that is, right now the clock begins again. there is another 30 hours until a final debate. should republicans at this point, give back time and allow a final vote to go forward before christmas eve? >> we'll see how that all works out. i'm committed to stay here all the way through the final, the final vote. it is harry reid who is the leader of the senate, the majority leader who sets the schedule of the senate. no one wells has input over that. he is the one that called us in at 1:00 in the morning yesterday to vote. he is the one that called and had bob byrd in his wheelchair brought in a snowstorm. harry reid sets the schedule and we're following the schedule as the constitution and the rules of the senate

apply. harry reid sets the schedule. >> host: lowell, missouri, pete on democratic line. >> caller: hi. >> host: go ahead, pete. >> caller: hi. i like to say that, for health care, it would be a real bit cheaper we could probably, as i should say, help health care, if we let's say, put a 10 cent tax on all beverages. okay, the reason i'm saying that is, for example, like, let's take pop. pop has got a lot of sugar in it. it is not perfectly healthy. let's say six-pack or 12-pack of beer, same, situation. all this, for every drink that you get at a bar. and i still drink. but what i'm saying is, let's say, if i have seven

drinks at the bar, by that time i'm pretty well-loaded. but that 70 cents. that 70 cents could go towards health care. same goes if i pick up a 12-pack of pop. that's just my suggestion. >> host: senator, what do you make of it? host. >> guest: there is lot of different ways to pay for this. the sugar tax or pop tax is one of them. he brings up important point. more than half of the money spent on health care are spent on 5% of people. the people eat too much, exercise little, and smoke. when when they're eating it is not healthy food. sugary foods cause high blood pressure, diabetes, cancer. that is why 5% of the people are causing 50% of the costs. so if we could do things to help get those 5% of the

people to develop healthy habits, that is going to be better. if they're drinking less pop and less sugar, i think those things will be helpful. but there are actually no incentives in this bill for focused, individual changes in healthy behavior. there's money for walkways and jungle gyms and street lamps hoping that somebody will come out and exercise but there is no individual incentive to help somebody say, no, i will try to have less sugar in my diet, lose some weight, get my blood sugar under control and my blood pressure under control. those things will actually help keep down the cost of care. >> host: next phone call from waycross, georgia, republican line. abraham? >> caller: yes, yes. >> host: go ahead. >> caller:, doctor, our small tea bag group here in waycross. we got our visual together and took dr. coburn's

instructions prayed real hard. -- couldn't show up at the vote the other night. how hard did you pray? i see one of our members is missing this morning? is it back problems. -- one of our members died. how hard did you pray senator? did you pray hard enough? >> host: senator barrasso, he was referring to the senator inhofe who was not in the round of voting this morning. >> guest: in vote this morning. 60 votes in favor of bill. whether senator inhofe was there didn't make a difference. no way he would vote for the bill, senator from oklahoma. so that's why he wasn't there this morning. >> host: do you know where he was, senator? why he wasn't able to make the vote this morning? >> guest: i don't know. >> host: new jersey, on

independent line. >> caller: i had a question on bribery issue, ben nelson, but that issue you addressed a little bit. but i have another issue. i tried to have this, issue discussed openly here with our community and stuff here in northern new jersey and how do we get you people to actually address the problems of illegal aliens? i was on c-span. we were in june -- he admitted it was up to 30 to 40% of our medical costs within new jersey. this is a major problem. i don't mind helping our neighbors out but why do we have to pay for people that don't belong here that are stealing our jobs? >> host: senator? >> guest: that is great question and continues to be a concern because these folks still do show up in emergency rooms, receive care and the people that do pay their own bills end up paying for themselves as well as for those who are here illegally. this is a problem that is supposed to have been covered in the bills. there is continues to be

debate as it is. you remember the president made a speech about that, and, there was some debate as to whether or not illegal immigrants would continue with coverage. but they continue to use health care services whether they're covered, whether they're not covered. those services are continuing to be used and taxpayers of america continue to pay for that. >> host: last call for the senator. georgia, gwen on the democrat line. >> caller: thank you for taking my call. i have a comment from the senator. rich republicans not though and speaking what the american people want about insurance. there's a whole lot of poor people that need insurance desperately. you all are not in contact evidently with the poor people of this country. i worked for 39 years and seven months. i am retired. i paid in my dues. and i have insurance from my job and i have medicare and, medicare a and b. but there is people that don't even have it. i'm willing to pay whatever

taxes i can under my under $55,000 a year income to supplement people from this country. >> host: senator, what about provisions in this bill and house bill would expand medicaid to more families? >> guest: the expansion of medicaid to include more people will give coverage to the people the debate is will they get health care? if they get medicaid card, we know medicaid reimburses doctors and hospitals so poorly, half of the doctors in the country don't take patients on medicaid. that continues to be a problem whether they have medicaid card or not. like senators says giving somebody a bus ticket when a bus doesn't come along that often. those are the challenges. it is not just providing coverage for people, it is making sure they can get care. that's what i want to make sure, that americans can get affordable care and high quality care. unfortunately i think bill which raises taxes, cuts medicare and will cause people's insurance premiums to go up will not help

americans have more available care, more affordable care or higher quality care. >> host: senator john barrasso, we appreciate your time this morning. senator. thank you for talking to our viewers. we hope you come back again. >> guest: thanks, greta

>> the senate is in recess for their party caucus meetings as they continue with day 19 on health care legislation. earlier today dem kroots moved the bill through number of procedural votes. tomorrow afternoon a vote to limit debate on the bill. if that gets 60 votes needed final passage on the health care bill is set for thursday evening unless republican senators decide not to push for maximum debate time allowed. we'll have live coverage when the senate returns this afternoon at 2:30 eastern. you can continue to watch live coverage of course on c-span2. get updates of the debate on c-span radio. lots online too. i can read the legislation, catch briefing and see how your senator voted now for iphone users follow the health care debate with the new c-span radio iphone app. it is free and you can listen not only to c-span radio but to c-span and

c-span2 and "washington journal" segments like this one available with senator mary landrieu this morning. runs about 25 minutes. >> host: from the rotunda, mary landrieu, democrat from louisiana. we've been watching this last round of votes, it appears this bill is on track for a final vote sometime this week and you have signaled your support for this legislation. look forward for us, in conference negotiations. what needs to stay in a final bill that comes out of house and senate negotiations in order for to you support a final bill? >> guest: there are a couple of very important principles that must remain in this bill. first, this bill has to address cost containment. in other words, the bill must be paid for within the context of this reform, and reduce the deficit not only within the next 10 years but over time. some of us entered this

debate not just to expand coverage which is an important goal but to make sure the federal government can afford health care in the future and individuals and families and businesses and state governments could also afford it. right now, we're on a trajectory towards bankruptcy. we already have 750,000 families that filed for bankruptcy every year in this country because they can't afford to pay their medical bills. we have states experiencing budget difficulties. the federal government, our, we're spending 16ness of our gdp, projected to go up to 18%. if anything is changed in the compromise, makes this bill drive up costs over long term instead of down, then my vote will be lost and so will several members of the democratic senate. >> host: what in the house bill would drive up costs? that you don't like? >> guest: there is something very specific in the senate

bill that drives down costs. one all economists liberal and conservative agree. and that is, taxing high cadillac plans, or taxing expensive premiums or ex-expensive health insurance plans. the government right now is subsidizing very expensive insurance through our tax code. that is driving up the costs. if people don't even know how much insurance they have because they're basically getting it through their employers and their employers basically write off the expense to the taxpayer. there is no accountability there. so that's one thing that must remain in the bill. it will be very difficult because the house did not do this but it has to remain this bill in order for the senate to stay committed because it will drive down costs. there is another thing that has to stay in this bill and these are exchanges that will start in 2014. now that's represented in both bills so i think that will also be a part of it. and there is some insurance reforms in the senate bill

that are much stronger than in the house bill because part of our goal is to reform the private market of health insurance. we don't want americans to be abused by health insurance companies any longer. now, i don't want to eliminate insurance companies. i believe in the private market but i think that the private market needs to be reformed, and senator rockefeller particularly worked very hard on this provision in the senate and of us think that no bill should lose the strong private sector insurance reform. in these negotiations? anything else you are looking for? guest: there may be provisions that i am not aware of. in most important thing that i have said to many of our caucus but particularly to the more moderate members is the cost containment, that we do not have

a government run system, there are exchanges established for individuals particularly the subsidies in small businesses in all states to be able to provide the kind >> but in all states to be able to provide the kind of health insurance they want for their employees. and i think this bill will stand the test of time. right now i've heard my colleagues rip it to shreds, try to, you know, republicans are plameing everyone else but themselves for the failure. they only have themselves to blame for walking away from the negotiating table and trying to blame everyone else. but we're very proud of this effort. we started out wanting to have bipartisan support. max baucus is on the floor as i'm speaking to you indicating the number of times that he worked and reached out to republicans to pull together a bipartisan compromise on this. but the republican leadership

walked away. they made a, i think, a mistake. they made a miscalculation politically that they could cause hysteria and alarm. but i think the test of time will show this is a solid effort and a good bill for america and one that was desperately needed. >> host: phone calls for you, senator. detroit, rick on the democrats line, you're up. >> caller: hello. hello, mary. >> guest: how are you? >> caller: i'm from detroit, michigan, and what i have is blue care network. is that considered one of the cadillac plans that would be taxed 40%? and would i lose my coverage under this plan? and if i did, the new insurance would i be able to still pick up my insurance cost -- >> guest: can i ask you a question? do you work in a dangerous job like construction, or do you work in an office-related job? >> caller: no. i actually work in food service. >> guest: okay. then if your plan is more than

$23,000 a year, it will be taxed through whoever your employer is. and that will give them the incentive instead of sending that bill to all the taxpayers in america, they will go look, hopefully, and find a more cost-effective plan, one that has, hopefully, the same value to your family. and then the taxpayers will be happy to subsidize a more efficient policy for you. but the taxpayers can't continue to finance plans over 25, 27, $30,000. and the average good family plan in america, what federal employees have, i think, is valued anywhere between 12,000 and 18,000. so we feel very confident that you will be able to get excellent coverage in the private market for less than 20,000. but we're even saying we'll give you up to 23,000, and if you're in a high-risk job, up to

26,000. but over that taxpayers cannot keep subsidizing, basically, these profits for insurance companies. and let me say one other thing that i think will make you happy and that you'll be happy on abo. right now you and your employer pay those premiums to insurance companies. you pay a lot in premiums through your hard-earned money and through the hard-earned money of your employer. right now insurance companies do not have to take those premium dollars and spend it on your health care. they can give profits to their executives unresulted, they can give profits to their shareholders. there's no basic requirement that they spend a percentage of the premium money they take from you on your care. and they can say, sorry, joe, or whatever, we can't afford it, and you're not going to be able to go to the hospital. under this bill that practice is stopped. insurance companies are going to have to spend anywhere from

85-90% of the money they take from you on you instead of spending it on anyone else. that is a key reform provision that i'm proud we have fought for, and people don't know it, but it's in this bill. >> host: next phone call from maryland. richard, go ahead. >> caller: hey, thank you for c-span. i've got a comment and then a question. first off, i think it's unconstitutional to try to force me to buy insurance from a private health company, and isn't it creating a new type of too big to fail not based on the economics, but based on how many people are insured by that company, then it can't be too big to fail. the senator and the democrats pledged they would not -- [inaudible] if not, will she admit this is not deficit neutral? >> guest: richard, first of all, under the commerce clause the government can require every american to purchase insurance, and this bill will require that. we either had to require

individuals, or we had to require the companies, or we had to have a government-run plan. i wasn't for a government-run plan, and i'm not for an employer mandate. so i am for shared responsibility where everyone is going to have to go to the private market and find insurance. now, you are incorrect to say that you're only going to have one plan to choose from. you're going to have multiple plans to choose from. and the federal health employees, what all federal employees have including members of congress, there are 34 choices of plans in new york. that's the most, and there are 14 in rhode island which is the least. so we're hoping that people will have anywhere from 10-40 choices on the private market. in addition, if you make less than $80,000 a year, if your family income is less than $80,000 a year, you will be subsidized through the tax code to buy the insurance that you want, not insurance is, you know, it'll be required that you have it, but you can buy and

choose your own insurance that fits your family. now, the reason we have to do this and some people are arguing against it, but the reason we have to is right now we have so many people getting out of the market instead of in, the ones that remain in are paying much more. even more than just their own. they're paying hidden taxes for everyone that doesn't. so the only way to fix this and the hospital association agrees, aarp agrees, most of the experts agree, the only way to fix this is to get everyone in america into the system and then everybody pay their fair share. >> host: senator, i'm looking at the senate floor, and your colleague, senator david vitter, is on the floor saying louisiana taxpayers are facing $518 billion in tax increases and 42.1 americans below 200,000 will see a tax increase by 2019. how do you respond?

>> guest: senator vitter has not lifted a finger to help pass this bill. the fact of the matter is when this bill passes, every family in louisiana that has a child with cancer or diabetes will be able to have health insurance for the first time in a long time and perhaps maybe in their life. insurance companies will not be able to take premiums from people in louisiana and not send it back to them by way of good quality can health -- health ca. the medicare trust fund will be expanded for everyone in louisiana and america by nine years. yes, we've had to raise some taxes and fees to pay for this bill, we've had to cut waste, fraud and abuse out of the system to pay for these new changes. but over time many, many millions of people are going to be benefited by these changes, including the 4.5 million people and families that live in louisiana.

>> host: next phone call, pittsburgh. tom on the republican line, good morning. >> caller: yes, hello. my observation is that this health care bill just a redistribution of wealth. it should be called health care welfare because let's look at the big picture. there's a household that has $10,000 of credit, and it's all maxed out. and some responsible party in the household has to say, no, we don't have any more credit. and then the other person says, well, maybe we'll ask our neighbors to help us. and that's not the way america's supposed to work. individual responsibility. and somebody has to say no tocepsless expenditure -- to senseless expenditure, and that's why republicans say no. call them the party of no, but if a father sees as a household there is no more credit and yet

the wife says, we need a car, we need a driveway, we need a new roof, sorry. >> host: senator? >> guest: well, richard, you're actually making a great argument for the bill, not against the bill. that's exactly what this bill does, it requires individual responsibility on the part of every american. there's no more free ride. there's no more half the people that have insurance pay for everybody else that doesn't. every american is going to have to step up and take the personal responsibility to go to the private market to buy the insurance that they want to buy, and the government's doing the very best job it can to help subsidize middle income families up to almost $90,000 because we know 90,000 sounds like a lot of money, but it isn't when you have four kids and you're trying to do this or do that. even two children. so we understand it can be expensive. so we're going to try to subsidize through the tax the code so there are no more free

rides, no more welfare. this is going to be every individual taking responsibility. and then the government is putting in place, again, some help for individuals and small businesses. so that's actually an argument for the bill, not against it. >> host: senator, the 900 mr -- 300 million in this bill that was set aside for louisiana to help pay for the cost of expanding medicaid has been dubbed the louisiana purchase. you were not a supporter at the beginning of this whole process, and now you've become a defender of the bill. talk about how you've come to this position that you're in now and your thoughts about people calling it the louisiana purchase. >> guest: well, again, it's been a very unjust criticism. the fact of the matter is and i know people don't believe this, but i can't be bought, and that is not why i'm supporting this bill. i'm supporting this bill for any number of reasons of which i've gone into through this

interview, because i think it's the the right thing for louisiana and the right thing for this country. but this provision, first of all, is not just for louisiana, it's for any state that would face a disaster. secondly, the republican governor of my state, bobby jindal, called us to the mansion in baton rouge a year ago in a public meeting at a press conference and said this was his number one priority because in his view louisiana was going to be treated unfairly. we all agreed. we're not asking for special help for louisiana, we're just asking for us to pay everything we have paid in the past we want to pay in the future. as you know when katrina hit and the governor can explain this as well as i can, lots of federal money poured into our state. and because wages were increased because the labor market constricted which always happens after a disaster, the price of

supplies go up, everybody needs a new roof so roofers charge five times what they normally charge. we had an unusually high spur up in our income. as a result, it push bed us into -- pushed us into a very different medicaid reimbursement category than we had been in before. now, the governor can explain this. he won't defend it because it's gotten hot in the kitchen, he's taken a hike. but when the heat gets turned up, i was raised to fight even harder, so that's what i'm going to do to explain this. it's not only not embarrassing, i'm proud to have fought for this. so louisiana was going to be treated like we were connecticut or maryland, a much richer state. we are not. this isn't about the reality in washington, d.c. among bureaucracies and inflexible formulas, this is about the reality on the ground in louisiana. our entire delegation supported this. so, yes, i asked for it to be in the bill, it was included in the bill, it's a $300 million help

to our state. but as i said, any state that suffers a catastrophic disaster could also be helped by this provision. i make no excuses, i am not bowed, i am proud to have done this, and it did not cause me to vote for this bill. it is one of about 12 things that i asked to be in the bill and had this been in but other things weren't, i wouldn't have voted for it. it's just as simple as that. >> host: florida, jeff on the democratic line. good morning. >> caller: how you doing? >> guest: how are you? >> caller: if we put through a renewable energy industry throughout this country, it's going to save us over the next ten years between 5-8 trillion dollars. that's what we're importing in fuel now. that'll easily, easily pay for health care even on a public option, and the higher education so we'd have more doctors and more engineers. so we need to put the package

together that health care, education and energy is the key issue here, not just one simple issue. >> guest: i couldn't agree with you more, and i'm absolutely supportive of the direction you're going in, and i hope if you're from florida that you could agree we could do more domestic drilling off the coast of florida, off the other coasts so that we don't have to import our oil from cuba or from russia or from venezuela, that we could produce more domestically and then, as you said, move more quickly to alternative energies creating all sorts of wonderful domestic jobs whether it's in wind or solar or building efficiencies or energy efficiency. and, yes, we can save a tremendous amount of money. and i think you've really hit on the right piece here. this health care reform issue is one leg of the stool. if we're going to try to get our country back into economic competitive status and lower our costs, health care must be

reformed. the next big win could be energy. jobs and energy efficiency and energy savings. and then the third big piece is reforming our education system. and i've always been proud to be part of all three of those and looking forward, hopefully, we can convince some republicans to come on board. lindsay graham has indicated an interest, there are others to really be forward leaning and not trying to just hold to the status quo. >> host: port charlotte, florida. john on the independent line, good morning. >> caller: good morning, greta. i would like ms. landrieu to justify how the commerce clause which pertains to the interstate conduct of business can force individuals to pay for something that they don't want. and for her to sell her vote along with ben nelson and others makes them nothing more than political prostitutes. >> guest: well, i've been used to hearing that criticism, and you're dead wrong. as i said, my vote for this bill had nothing to do with the fact

that my republican governor asked our delegation to fight hard to get the formula changed for any state. not just louisiana, but any state including your own that might be hit by a natural disaster. i make no apologies, and you are dead wrong. number two, the government most certainly has a responsibility to require people to take individual responsibility for themselves. we can't any longer ask people who are in the private insurance market or, for that matter, the government to pick up the entire tab for people who just will not or can't or won't under the current circumstance get insurance. there's no more free ride here. everyone's going to have to do their part. and we hope with the subsidies that we've placed in this bill that we can make it affordable for many families. if we don't, people in my state will be spending right now

they're spending about 30% of their average income to try to find really bad health insurance on the market. we want to have them spend 10% of their income to find good health insurance and save the taxpayers of america lots of money. and that's what we spend to do, and -- intend to do, and that's what we're going to do. >> host: one last phone call, senator. houston, harold on the republican line. go ahead. >> caller: i would like to say that i'm glad to see the senator there because after 2010 if she's up for vote, i feel like her people are going to kick her out of office. she's nothing but a judas goat selling out for 30 pieces of silver, and for her to sit there with a grin on her face, she knows she's lying. bobby jindal is not for this right now. >> host: , well, the senator's already explained what happened there and defended -- >> guest: you know, really, being in public office isn't

easy because we have to listen to situations like this, but the fact of the matter is i'll be very clear, and i am not, i'm doing nothing but telling the truth. governor jindal doesn't support this bill, that is true. but he does support this provision. he asked for it, he did so publicly, and it is a worthy and justifiable provision, and i'll say it again and i'll continue to say it, i did not vote for this bill because of that. i voted for this bill because it's going to lower costs for americans, it's going to give the private market the boost and the reform it needs to do a better job for all consumers in our country. it's going to expand the life of medicare for nine years, it's going to reduce the federal deficit, and it's going to bring efficiencies to a system that is wasteful, abusive and out of control. i know there's some people that don't belief -- believe that. time will tell. and i'll tell that gentleman i've been elected three times to the united states senate, and i will probably be elected again. thank you.

>> host: and, senator, what i was going to ask you is you have said that you voted for this bill or you plan to vote for other reasons, one of them that it will lower costs. can you specifically tell viewers how this will lower health care costs? >> guest: first of all, it's going to lower costs to our government over time. again, we're spending 16% or our gross national product on health care. japan, which is a competitor -- now, they're a much smaller country, but they are a robust economic country in the world -- they're spending 8% of their gdp. now, ours is projected to go up to 18%. so if we can taper this off and stay at 16% be or go down to 15% over time 14% and maybe aggressive, but if we start bending this cost curve, the government will save money. therefore, every taxpayer in america will save money. in addition, small businesses right now have virtually no

subsidies. they have deductions, but no credits to buy health insurance. so they're paying full dollar for very poor, limited choices. the federal government is going to lower their cost by subsidizing up to 30% of the cost of their premiums so they can provide health care for their three or four or five employees. now, we're hoping that over time premium costs go down. and what we're hoping is that there's more competition in the private market. so instead of having just one or two choices, these exchanges will create private market competition. just like the way that prices at target are kept low because walmart is their competitor, kmart is their competitor. if walmart raises its prices too high, everyone will simply go shop at target. that's what's happening in the insurance market. there's only one plan out there. you have to buy it, and it's expensive.

but when we finish this bill and as these exchanges come in, there are going to be more choices. now, that's what i believe. some of my colleagues believed that was hopeless, we couldn't do that and what we should create is just a government-run health care plan. i fought hard against that, and i'm happy to say there is no government-run public option in this bill. i think private market reforms will work. let's see. if it doesn't, we'll have to come back in five years or six years or ten years and do something else. but what we're hoping is that, you know, the market forces -- if framed correctly -- will work for the consumers of our country. >> host: senator mary landrieu, we appreciate your time, senator, thank you for talking with our viewers. >> guest: thank you.

>> host: we are joined on capitol hill by kathleen hunter of congressional quarterly. a point of order was raised against the health care bill, what does that mean? >> guest: well, senator ensign raised a constitutional point of order, but republicans haven't had much success so far, so he raised a point of order claiming that the individual mandate to purchase health insurance in the bill violated the constitution. >> host: will that get a separate vote at some time? >> guest: it will. part of the reason why he went that route is because constitutional points of order are nondebatable which means

they automatically get a vote if they're raised. >> host: do they have to get, like the other votes, do they have to get 60 democrats to move forward with it? >> guest: no, that's another reason why it's a tactic that republicans have been looking to because it only requires 51 votes to prevail. >> host: the stories continue both in your publication and roll call that leadership's been negotiating, been talking about a final passage vote before christmas eve. what can you tell us about the latest on that? >> guest: well, there are some signs that the republican resolve to drag this, or to continue the debate through two more full 30-hour cycles of cloture which would put a vote on final passage on december 24th, that that resolve might be weakening. minority leader mitch mcconnell said he and the majority leader, harry reid, are working on some kind of an agreement. he didn't specify, but presumably to move up at least by potentially a couple hours

the vote on final passage. there is an ice storm predicted for christmas eve, and i think there's some concern about senators being able to get home to their families. >> host: is it likely we'll hear anything once the party caucuses meet as senator reid to say something on that? >> guest: yeah, actually in some ways the ball's more in the republicans' court than it is in the democrats' court right now. though senator snowe said is earlier today she expected the republicans to talk about this issue at their conference lunch which is beginning momentarily. so it looks as though we might have some kind of news as to whether some of the more, some of the members of the republican conference, people like tom coburn and jim demint who have been adamant they're going to stretch this out as long as possible, whether they will continue to insist upon that, or there might be a way to move this, move this up. >> host: lastly, there is real news on the house side with alabama congressman parker griffith announcing he's switching parties from the democrats to republican party. how has that news been greeted

in capitol hill on the senate side? >> guest: it's definitely something i would not be surprised if the republicans seize upon that as evidence that the, that the voters are making, or that these opinion polls and their arguments that this bill is unpopular is making some kind of an impact. one of the interesting things is that this, this latest announcement is coming on the heels of a couple of republican house members, i'm sorry, democratic house members who have said they're not going to seek reelection who are also from the south. and so i think it would be interesting to see particularly with blanche lincoln from arkansas who's from a conservative state and haven't been voting with the democrats whether the republicans, i would expect, would be making links between her and what representative griffin is expected to announce this afternoon. >> host: covering the senate health care debate, kathleen hunter of congressional quarterly, thank you for the update. >> guest: thank you. >> u.s. senate due back from

their recess at 2:30 eastern. we'll have live coverage here on c-span2. earlier today the senate agreed to move forward with the bill on a party line vote 60-39, jim inhofe the only senator not to vote today. senate democrats react to that vote and talk about what lies ahead for the measure. this news conference is about 20 minutes.

>> twenty seconds, everyone. >> heads up!

[applause] [applause] [applause]

>> today's a very, very big day, and there are many celebrations, there are many different times we're going to be explaining the benefits of this bill and how this is going to help americans very, very much, but today we want to just express our deep preex for so many groups that are supporting this legislation. they're all standing behind us. let me read them off. let's all applaud first. [laughter] [applause] here we are, doctors for america, americans united for change, small business majority,

u.s -- [inaudible] , families usa, national hispanic council on aging, community catalysts, business forward, faith in public life, japanese-american citizens league, american association of homes and services for the aging, organizing for america, aarp, american cancer society, cancer action network, american heart association, consumers union, unity 2009, and national jewish democratic council. we are truly closer than ever to bringing security and stability to our health care system to providing real reform that american families, businesses and workers so desperately need. the finish line is in sight, and all the groups standing behind us know it. and now we know with certainty that we have the will to cross it.

history has called upon us to act to finally address the growing health care crisis facing our country, and the senate has shown it is prepared to answer that call. i'd like to thank leader reid, chairman dodd, chairman harkin, my colleagues in both the finance committees for working tirelessly with us on this legislation. together we have crafted a bill that will finally provide consumer protections american families have been waiting for. we have crafted a bill that will provide the tax relief that small businesses so desperately need. we have crafted a bill that will slow the growth of health care costs, reduce our national debt and improve the quality of health care. we have crafted a bill that will provide vital health insurance coverage to 30 million more americans without adding one thin dime to the national deficit, and we have crafted a bill that will represent the largest tax cut congress will have passed since 2001.

this is what the american people sent us here to do, to provide real solutions to the real problems facing american families, businesses and workers every day. we are not the first to attempt such reforms, but we will be the first to succeed. [applause] >> make no mistake, we will deliver the meaningful health care americans have been waiting for for decades. senator dodd. >> thank you, senator baucus. well, max said it all, and you heard this wonderful applause behind us. i just hope they're all from connecticut. [laughter] but let me, let me, first of

all, begin by thanking majority leader harry reid. this has been a phenomenal undertaking over the last, well, more than a year now. in fact, it goes back decades, in fact, where others have tried. people like president nixon and president clinton, obviously, made the most significant efforts. i thought a lot about john chafee these days. i've served in the senate from the neighboring state of rhode island and working with max baucus in trying to put together a health care bill. i've heard a lot of people say recent he we regret we didn't take advantage of his ideas and suggestions earlier. so while this is partisan today and it looks as such with the votes that are occurring, i think it's important to remember that a lot of people have made significant contributions that have brought us to this point, and it's the thought of those individuals and what they tried in the past that, i think, served as encouragement to all of those who continued with this

effort despite the tremendous number of difficulties. my hope is still, and i know this may seem naive to some, but my hope still is that our friends on the other side as we move forward in this process into conference will step up and offer suggestions and ideas so that we might still emerge with a partisan, or bipartisan, rather, effort on health care. certainly in the years to come as tom harkin has said, this is the beginning, not the end of a process. and long after those of us who are not here anymore participating in this process, others will come after us that will build on what we've achieved so far today in the senate vote. and that will make america better and a stronger place. this wasn't done, obviously, with just people in a political office making decisions and making tough choices, it's done because we have people like those standing behind us that made this possible. but for their involvement, their participation, their commitment, their passion about this issue that we would not be where we are today. so on behalf of all of us around the country, particularly those who are not in this room today but who will benefit as a result

of these efforts, i want to express my gratitude to our leader, to max baucus, for his efforts in the fitness committee, to tom harkin who is following in the footsteps of ted ken key who, obviously, was the moving spirit behind all of this, and to thank our respective staffs, many of whom who are here in the room today, many of ted kennedy's people are in this room. all of this collectively brings us to this moment, and for those reasons we're grateful to all who have begin us a hand to bring us to this cusp of achieving an american dream of health care for all americans, a right that can be achieved by millions and millions of americans. it is a great, great day for our country. [applause]

>> well, with apologies to santa claus, christmas is going to be kind of anticlimactic this year. [laughter] because we've already gotten the best possible gift, 60 votes in the united states senate to create a health care system that works for all americans, not just the healthy and the wealthy. [applause] and for this great gift, we have to thank the senators who are standing beside me. senator baucus who, as senator dodd said and i said the other day not only bent over backwards and went the extra mile, but went the extra 100 miles to get his committee to get this bill through. senator dodd who led the effort

on our health committee from the beginning and down to the very end to get this pulled together. and, of course, as senator dodd said, our leader, harry reid. to put it in biblical term thes, harry reid has the patience of job, the wisdom of solomon and the endurance of sampson. he has hung in there day after day, has hut put this -- put this together, and he is about to achieve what has eluded so many majority leaders going back over half a century. truly with the passage of this bill, harry reid will have everyoned his place in the senate's history. [applause] so -- [applause]

i thank all the groups for all their support behind us here who have gotten us to this point, and without further ado, the person who has led us to this point of victory for the american people, our great leader, harry reid. [applause] >> we have a line up here today that is the lineup that is the reason that we are able to complete this legislation. i played baseball, i love baseball. i love baseball season, i can come home even if it's for a short time the, turn on the tv

and watch an inning or two, it's extremely relaxing, and i enjoy it very much. i know a lot about baseball. i know a lot about why managers do things with lineups in baseball, and the reason i wanted this done today this way is to talk about the lineup. in baseball your leadoff hitter is so important. the leadoff hitter has to have speed and has to be able to hit with power. but the leadoff player is somebody that sets the tone for the ball game, and that's what max dodd -- that's what max baucus has done. he has set the tone for what this team has done. he was always at practice early, he had a lot of people he had to deal with. you know, a leadoff hitter has to be able to bunt, has to be able to hit with power, and max

has done all of that. but for max baucus, we would not be here. the months and months of the time spent with that committee when we did not have 60 votes, efforts were being made to obtain that, and so i have said before but i say again, the leadoff for this whole venture has been max. chairman baucus. [applause] and the personal that bats second is someone if you look at some of the great players that have batted second, joe morgan. he hit, he was leadoff sometimes, mainly he hit second.

he was a switch hitter, he could hit from the left or the right, he had speed, he had power. and that's chris dodd, a great -- [laughter] now, if you look at some of the great players that have batted third, who are some of those players? how about lou gehrig? lou gehrig was a set-up man for babe ruth. the reason they had lou gehrig there is that they knew that they had to pitch to him, because if you got past him, you had babe ruth. and that's what managers look for. and so for me for once in my life, i'm batting cleanup. because when i played baseball, i couldn't bat cleanup. [laughter] but by the time it got to me

through baucus, dodd and harkin, it was pretty easy. so i appreciate the nice words everyone has said to me, but by the time that this thing got to me, most of the hard work had been done. every one of the men and women standing with us represents not hundreds, not thousands, millions of people are represented by the people behind us. they represent millions of americans who support this bill, people who know we must make it possible for everyone to have a healthy life. inaction is not an option. yesterday we were here with the head of the ama. he said, we have the best health care in the world for a few people. we want it for everybody, and that's what we're trying to do. and just as importantly every one of these leaders behind us today who represent so many americans will benefit from the protections and reforms in this bill. families will benefit, consumers will benefit, senior citizens

will benefit, physicians will benefit, small business owners in the state of nevada because of this bill, 24,000 small businesses will have the opportunity to insure their employees. they can't now. not because they're cheap or mean-spirited, they don't have the money. they can't afford insurance. the insurance companies don't allow them to buy insurance. entrepreneurs will benefit. patients and survivors of diseases will benefit. americans of different backgrounds and ethnicities will benefit, and americans of all faiths will benefit. these are people who now know how our broken health care system doesn't work, they don't need statistics or charts to tell them this, they know because they live it every day. the people they represent wake up every morning trying to figure out whether they're going to make it through the day. they go to bed every night second guessing the agonizing decisions they made that day about whether to sky this or

that to try to stay healthy. so to all of you who join us this morning, we thank you for your support. you're the reason we've come this far, and i say that without any equivocation. you never let us forget this fight isn't about politics, it isn't about partisanship, it's about people, real people. while many have tried to knock us off course, you made sure we stayed true to our principles, and that is the reason we're going to succeed. we'll take a few questions. >> yes, i have a question here. >> yeah, actually, i was wondering, the constitutionality of being able to repeal the bill, there was a report in the weekly standard saying that -- >> in the what? >> in the weekly standard -- >> yeah, i haven't read that yet today. [laughter] >> well, particularly, sir -- >> i understand. >> particularly over on page 1020 there was a saying they wouldn't be able to repeal the independent medicare advisory -- >> my colleague, senator ensign, has raised an issue dealing with constitutionality. it's a simple majority vote, and

i am glad he raised it. we feel very sound in our position. >> senator? >> yes. >> [inaudible] senator nelson and senator lieberman have said that the senate bill can't really change very much in conference if it's going to win 60 votes. how have your counterparts reacted to that, and what is on the table to offer -- >> first of all, in our meeting coming here and this may surprise some of you, we actually have prepared for this press conference can -- [laughter] we are focused on one thing and one thing only. that is passing this bill. we have, we hope to be able to complete it tomorrow. certainly with the ice storms coming to the midwest, we hope that we can finish tomorrow and not have to do christmas eve, but we'll do whatever's necessary. we are focused on passing this bill. we will work with our house counterparts, with the white house, but that's going to come at a subsequent time.

our focus today and tomorrow is to complete this legislation. >> do you have any idea how hard it was to get everybody on board and the delicate compromise? is the reality that the house is going to have to get it back through the senate -- >> no matter how many ways you ask the question, you're going to get the same answer. we are focused on passing this bill in the senate. we'll worry about subsequent things we have to work on at a later time. >> is there any progress with a debt limit negotiations? do you think you might be antibiotic to do something before -- >> i've had some very constructive conversations with senator baucus who is finance committee chair. he and i have spoken to secretary geithner, i've had some good conversations with mitch mcconnell the last couple days, and we'll just have to wait and see. we know we have responsibilities, we will fulfill our responsibilities. it relates to health care reform and the situation with the debt. thank you all very much. [applause]

[inaudible conversations] >> senate democratic leaders from about mid-morning, 10:30 eastern or so, on day 19 of the health care legislation. the senate's in recess, back in about 40 minutes after passing

the bill be through a number of procedural votes this morning, next vote set for tomorrow afternoon. we got an update on earlier action from a capitol hill reporter. joined by kathleen hunter of congressional quarterly. in the debate earlier today senator ensign raised a point of order against the health care bill, what does that mean? >> guest: well, senator ensign, as you said, raised a constitutional point of order. the republicans haven't had much success in thwarting democrats' efforts to pass a bill before christmas, so senator ensign passed a point of order claiming that it violates the constitution. >> host: will that get a separate vote at some time? >> guest: it will. part of the reason why he went that route is because constitutional points of order automatically get a vote if they're raised. >> host: do they have to get, like the other procedural votes, do they have to get 60 democrats to move forward with it? >> guest: no, that's another reason why it's a tactic

republicans have been looking for only because it requires 51 votes to prevail. >> host: stories continue in both your publication and roll call that leadership's been talking about a final passage vote before christmas eve. what can you tell us about the latest on that? >> guest: well, there are some signs that the republican resolve to drag this, or to the continue the debate through two more full 30-hour cycles of cloture which would put a vote on final passage on december 24th, that that resolve might be weakening a little. minority leader mitch mcconnell said on the floor this morning that he and harry reid, the majority leader, are working on some kind of an agreement. presumably, to move up at least potentially by a couple hours the vote on final passage. there is a ice storm predicted for christmas eve, and i think there's some concern about senators being able to get home to their families. >> host: is it likely we'll hear anything once the party caucuses meet as senator reid set to say

something on that? >> guest: yeah. actually in some ways the ball's more in the republicans' court than the democrats 'court right now. senator snowe said earlier today she expected the republicans to thought about this issue at their conference lunch which is beginning momentarily. so it looks as though we might have some kind of news as to whether some of the more, some of the members of the republican conference, people like tom coburn and jim demint who have been very adamant that they're going to stretch this out as long as possible, whether they will continue to insist upon that, or there might be a way to move this up. >> host: well, lastly, there is real news on the house side with alabama congressman parker griffin announcing today he's switching parties from the democrats to republican party. how has that news been greeted on capitol hill on the senate side? >> guest: well, i think it's definitely something i would not be surprised if the republicans seize upon that as evidence that the, that the voters are making, or that these opinion polls and

their arguments that this bill is unpopular is making some kind of an impact. one of the interesting things is that this, this latest announcement is coming on the heels of a couple of republican house members, i'm sorry, democratic house members who have said they're not going to seek reelection who are also from the south. and so i think it would be interesting to see particularly with blanche lincoln from arkansas who's from a conservative state whether there might, whether the republicans, i would expect, would be making links between her and what representative grin is expected to announce this afternoon. >> host: covering the senate health care debate, kathleen hunter of congressional quarterly, thank you for the update. >> guest: thank you. >> so in a couple of votes earlier today, the senate adopted the amendment by senator reid to invoke cloture or limit debate on the substitute. both votes 60-39. the senate's coming back at 2:30 eastern, we'll have live coverage for you.

we're going to show you a portion of the debate earlier today after that series of votes. >> i said when the senate opened today and i'll say again, because of the long hours we've spent here -- for weeks now -- there's a lot of tension in the senate. and feelings are high, and that's fine. everybody has very strong concerns about everything we have done and have to do. but i would hope that everyone would go back to their gentlemenly and ways, and i would hope that -- i was trying to figure out how to say this. gentlemenly ways. we used to say in the house gentlewomen, so i guess the same here. [laughter] anyway, i hope everyone just has -- as i've said to a number of people, rodney king. let's just all try to get along.

this is a very difficult time the next day or so, and let's try to work through this. we have for those of the christian faith we have the most important holiday, and that is christmas. and i would hope everyone would keep in mind that that's a time when we reflect on peace and good things in life. i would hope that everyone would kind of set aside all their personal animosity if, in fact, they have any the next little bit and focus on that holiday. >> mr. president? >> the minority leader. >> let me add to my good friend, the majority leader, he and i have an excellent relationship. we speak a number of times in the course of every day and have no animosity whatsoever, and we are working on an agreement that will give certainty to the way

to end this session, and hopefully, the two of us together can be recommending something that makes sense for both sides in the not too distant future. >> who yields time? [inaudible conversations] 's the regular order? >>reporter: senator from montana. >> mr. president, what's the regular order? >> time until 9:30 is equally

divided between the leaders and their designees. >> thank you. mr. president, the senate's not in order. >> senate will come to order. members, please, take your conversations off the floor. chair recognizes the senator from montana. >> mr. president, it has been more than a month since the majority leader moved to proceed to the health care forum bill before us here today. at long last, the senate is in the final throes of passing this historic legislation. from the beginning this senator has sought out what abraham lincoln called the better angels of our nature, and that's why we proceeded the way we did, and that's the way that this senator has always sought to leapt. legislate. a year and a half ago i convened a bipartisan retreat at the library of congress. half a year ago i convened three

bipartisan round tables with health care experts. half a year ago the finance committee conducted three bipartisan walk-throughs of the major contest behind us -- mr. president, the senate's not in order. >> members, please take your conversations from the floor. the senator from montana. >> we went the extra mile. i reached out to my good friend, the ranking republican member of the finance committee. i reached out to the ranking republican member of the help committee. we sought to craft a bill that would appeal to the broad middle. we sought to craft a bill that is correct win the support of -- that could win the support of democrats and republicans alike. we met, the six of us -- three democrats and three republicans -- we met more than 30 times and i might add encouraged by the president to do so.

our group met with the president several times, he encouraged us to keep pursuing our negotiations hoping to get bipartisan agreement. we did not reach a formal agreement. the leadership on the other side of the aisle went to great lengths to stop us from doing so. but even though we did not reach a formal agreement, we came very close to doing so. the principles that we discussed are very much the principles upon which the finance committee built this bill. the principles that we discussed are very much the principles reflected in the bill before us today. i might say actually our work began much earlier than i've already indicated, we met all the preceding year, about ten hearings in the finance committee working towards health care reform. we also finished with a white paper in november a year ago, november 2008, and i dare say with some trepidation that basically that is the foundation, that white paper's

the foundation from which almost all ideas in health care reform have emanated. i might say, also, to be totally fair the ideas on that paper have been floating around for some time the. the principles came from massachusetts health care reform, most of the health care experts, the policy experts and health care economists who have been working on health care reform have published their ideas, and we sought out the best and compiled them and put together the best in that white paper published in november of last year. other side of the aisle have mischaracterized the bill before us. some on the other side of the aisle set about a systematic campaign to demonize this bill. through bare assertion alone, with the thinnest connection to fact, they have sought to vilify our work. if one listened to their assertions alone, one would not

recognize the bill before us. and so let me quite simply state the facts. some on the other side of the aisle assert that this bill is a government takeover of health care. the fact is that the nonpartisan congressional budget office says that this bill would reduce the government's fiscal role of health care. just three days ago, c.b.o. wrote, and i quote -- "c.b.o. expects the proposal would generate a reduction in the federal budgetary commitment to health care during the decade following the ten-year budget window." some on the other side of the aisle assert that this bill would add to our nation's burden of debt. of debt. >> some on the other side of the aisle a circus bill would add to our nations burden of debt. the fact is, the nonpartisan congressional budget office says this bill reduces by $132 billion the first 10 years and by $650 billion, and 1.3 to

your dollars in the second tenure, reduction. between $650,000,000,000.1.3 trillion reduction in deficit in the second 10 years of this bill. the fact is that this is the most serious deficit reduction efforts and more than a decade. some on the other side of the isle assert that this bill would harm medicare. the fact is that medicare is independent actuaries says that this bill would extend the life of medicare by nine years. the fact is this is the most responsible effort to shore up medicare in more than a decade. some on the other side of the aisle assert this bill is not doing enough to ensure the uninsured. the fact is the nonpartisan congressional budget office says that this bill would extend access to health care to 31 million americans who otherwise would have to go without.

the fact is that cbo says, and i quote, shared legal with insurance coverage with about 83% currently to about 94%. nothing that senators on the other side of the proposed would come close. the congressional budget office estimated the republicans offered in house of representatives would have extended coverage to just 3 million people. the fact is cbo says of that plan, ethical, shared legal non-elderly residents with insurance coverage in 2019 would be about 83%, roughly in line with the current share. that's the description of the republicans substitute in the house of representatives contrast that with the increase in a persons insured the bill before us from 83 percent to about 94%. i could cite the facts about the republicans substitute in the senate. the fact is there is no republicans substitute.

some on the other side of the aisle assert that they simply prefer a more modest reform of health care. the fact is that the republicans controlled the senate and from 2032006, in fact is that before they took control and 1994, 36 million americans, 15.8% were without health insurance coverage. last year they controlled in 2006, nearly 47 million americans, that it's 17.8 percent of non-elderly americans were without health insurance coverage. the legacy of republican control was 10 million more americans uninsured. some on the other side of the aisle say we are moving too fast. the fact is, it was 1912 when former president theodore roosevelt first made national health insurance part of the president's party campaign platform. the fact is that people of goodwill have been working on this for nearly a century.

and the fact is health care for america is now within reach. the fact is, the most serious effort to control health care costs is now within reach. the fact is, life-saving health care coverage for 31 million americans is now within our reach. let us, at long last, grasp that results. let us this time not let this good things slip through our hands, and let us at long last enact health care reform for all. >> mr. president, in a little while i will be making a constitutional point of order against the substitute amendment, and i will make that because we are working on an agreement on when we can have that vote. but i want to start talking about the reason i believe that this bill is unconstitutional, the individual mandate in this bill, and i'm going to be speaking for about 10 minutes now and then resume my remarks

at 9:30 after one of the democrats comes down to use their 15 minutes. mr. president, this constitutional point of order, if it's rejected and the health care bill reform passes, i believe that the court should reject it unconstitutional grounds. some of my colleagues may not be aware of the finance committee's debate on the constitutional -- constitutionality of his health care reform bill. during the committee markup of its version of the health reform bill, senator hatch raise some very thought-provoking, constitutional questions that he also offered an amendment which i supported to provide a process for the courts to promptly consider any constitutional challenge to the finance committee. and the reform and which in that bill. he chose the same language that was put into the bipartisan campaign reform act, unfortunately the amendment was deemed nongermane.

i'm seriously concerned that the democrats health reform bill violates the constitution of these united states. as part of comprehensive health reform, the democrats would require every single american citizen to purchase health insurance. americans who fail to buy health insurance that meets the minimum requirements would be subject to financial penalties. this provision can be found in section 1501 of the democrats health reform bill. it's called the requirement to maintain minimal essential coverage. while this is a constitutional point of order, i feel it is important to know that in the declaration of independence, america's founding fathers provided that, and i quote, we hold these truths to be self-evident that all men are created equal, that they are endowed by their creator with certain unalienable rights, that among these are life liberty and the pursuit of happiness.

what happened to life, liberty and pursuit of happiness? i guess americans can only have life, liberty and the pursuit of happiness if they comply with this new bill and buy a bronze, silver, gold or platinum health insurance plan. america's founders and subsequent generations are dearly for the freedoms that we have today. i question the appropriateness of this bill and specifically, the constitutionality of this individual mandate. is it really constitutional for this body to kill all americans that they must buy health insurance coverage? and if so, what's next? what personal liberty of property will congress seek to take away from americans next? will reconsider legislation in the future requiring every american to buy a car? to buy a house? or to do something else that the federal government wants wax my friend and colleague senator hatch raises similar questions during the debate in the finance

committee. in fact, he raises the following question. if we have the power simply to order americans to buy certain products, why did we need a cash for clunkers program were the upcoming program providing rebates for purchasing energy efficient appliances? we can simply require americans to buy certain cars, dishwashers, or refrigerators. mr. president, where do we draw the line, or will we even draw one at all? mr. president, the constitution draws that line. it's called the enumerated powers. i don't think congress has ever required americans to buy a product or service like health insurance under penalty of law. i doubt that congress has the power to do that in the first place. as the cbo explained during the 1990s, and i quote, a mandate requiring all individuals to

purchase health insurance would be an unprecedented form of federal action. government has never required people to buy any good or service as a condition of lawful residence in the united states. closed quote. yet that's exactly what this health care bill would do. this bill would require americans to buy a product that many of them do not want, or simply cannot afford. some individuals may raise the example of car insurance in the context of this debate. but requiring someone to have car insurance for the privilege of being able to drive is much different than requiring someone to have health insurance. as the senator hatch pointed out, people who don't drive don't have to buy car insurance. senator hatch is right. if you live in new york city, you probably rely on subways or some other form of mass transit. and you probably don't own a car so you have no reason to buy car

insurance. yet of his health care reform bill requires americans to buy health insurance, whether or not they ever visit a doctor, get a prescription, or have an operation. under this bill, if you do not buy health insurance coverage you will be subject to a penalty. let's call this penalty what it really is, a tax. even worse, this penalty operates more like a taking than an ordinary tax. if an american chooses not to bite minimal essential health coverage, he or she will face rapidly increasing taxes. up to 250 -- $750, or 2 percent of taxable income. whichever is greater by the year 2016. there is no penalty for americans who qualify for hardship or religious exemptions. there's also no penalty for illegal immigrants or for

prisoners. americans typically pay taxes on a product or service that they buy or on income that they earn. if you fill up your car at the pump you pay a tax. if you earn income, you pay an income tax. yet this bill creates a new tax on americans who choose not to buy a service. is very counterintuitive. this bill taxes on americans for not doing anything at all, other than just existing. and this building is assessed through the internal revenue code. senator hatch made the following statement. if this is a tax at all, it is certainly not an excise tax. instead, it is a direct tax. and while the constitution requires that excise taxes must be uniform throughout the united states, it requires that direct taxes must be a portion among

the states by population. now just as the excise tax on high premiums is not uniform, this direct tax on individuals who do not purchase health insurance is not a portion. i recognize that the authors of this health reform bill included in individual mandate on this bill based on the idea that health care costs would be spread among all americans, and would ultimately reduce their health insurance costs. the claim is that insurance costs will be lowered because of cost shifting. because of cost shifting will be reduced. this cost shift arguably takes place because health care providers, doctors and hospitals, who provide free or uncompensated care to the uninsured, shift the cost of providing that care to insured or paying patients. the hospital or doctor then

shifts the costs of that and paid for care to the pain, injury patient in the form of higher charges in order to cover the cost of uninsured patients. well, i understand this concept, but i am incredibly concerned that the individual mandate provision takes away too much freedom and choice from nevadans and from americans across the country. mr. president, i've read and studied multiple articles by scholars on the constitutionality of the individual mandate. i believe the individual mandate provision in this health reform bill calls into question several provisions of the constitution. and i think that congress does not have the authority, under its enumerated powers, to enact such a mandate. i know the supporters of the individual mandate have claimed that the commerce clause and the

taxes and general welfare clause in article one, section eight of the constitution provide authority for congress to enact such a mandate. well, i wholeheartedly disagree with that assessment. according to the constitution, the federal government only has limited powers. although the supreme court has upheld some far-reaching regulations of economic activity, most notably in record versus tilburg, and gonzalez versus right, neither case supports the individual health insurance mandate on the commerce clause. in these cases, the court held that congress was allowed to regulate intrastate economic activity as a means to regulate interstate commerce, in fungible goods. a mandate to purchase health insurance, however, is not proposed as a means to regulate interstate commerce.

nor does it regulate or prohibit activity in either the health insurance or the health care industry. the mandate to purchase health insurance does not purport to regulate or prohibit activity of any kind, whether economic or noneconomic. instead, the individual mandate provision regulates no action. it purports to regulate inactivity by converting the inactivity of non-buying insurance into commercial activity. so in effect, advocates of the individual mandate contend that the congressional power to regulate commerce among the several states, congress may reach the doing of nothing at all. in recent years, the supreme court has invalidated to congressional statutes. that attempted to regulate non-economic activities.

to uphold the individual mandate based on the commerce clause, the supreme court would have to concede that the commerce clause provides unlimited authority to regulate. this is the position the supreme court has never confirmed, and that it rejected in recent cases. congress lacks the authority to regulate the individual's decision, not to purchase a service or enter into a contract. so similarly, i believe that congress cannot rely on its power to tax, to justify imposing the individual mandate. this mandate amounts to a taking under the fifth amendment takings clause. i'd like to take for a moment, i'd like to take a moment to read the relevant parts of the fifth amendment. it says in part, no person shall be deprived of life, liberty or

property without the due process of law. nor shall private property be taken or public use without just compensation. now let me repeat the part of the fifth amendment that most applies to the issue at hand. it says, nor shall private property be taken for public use without just compensation. the bill before us today would require an american citizen to devote a portion of his or her income. that his or her private property to health insurance coverage. there's an exception, of course, for the religious reasons or for financial hardships. but mr. president, if one of my constituents in nevada does not want to spend his or her hard earned income on health insurance coverage, and would prefer to spend it on something else such as rent, for a car payment, this requirement could be a taking of private property

under the fifth amendment. as noted in a recent article, co-authored by dennis smith and former deputy general counsel of the department of health and human services, peter r. benowitz, requiring a citizen to purchase health insurance could be considered an arbitrary and capricious taking, no matter how many hardship exemptions the federal government might dispense. some of my colleagues also may be familiar with david b. rivkin. and lee a. casey. they are washington, d.c.,-based attorneys who served in the department of justice during the reagan and bush administrations. in september, rivkin and casey published an op-ed in "the wall street journal" entitled mandatory insurance is unconstitutional. i emerge my colleagues to read this article and many others that i will be submitting for the record.

in the op-ed, rivkin and casey argued that the health insurance mandate, and i quote, would expand the federal government authority over individual americans to an unprecedented degree. it also is profoundly unconstitutional. making healthy young adults pay billions of dollars in premiums into the national health care market is the only way to fund universal coverage without raising substantial new taxes. in effect, this mandate would be one more giant crossgenerational subsidy, and pose on generations who are already stuck with the bill for the federal government prior spending sprees. a tax that falls exclusively on anyone who is uninsured is a penalty beyond congress' authority. if the rule were otherwise,

congress could evade all constitutional limits by taxing anyone who does not follow an order of any kind. as the fourth of chief justice of the supreme court, john marshall stated, the power to tax involves the power to destroy. well, unfortunately, this could certainly be true in the context of this health bill. we in congress must zealously defend our citizens right and prevent this from happening. i believe that the legislation before us a violates the greatest political document in the history of the world, the constitution of the united states. i urge my colleagues to thank very, very carefully about the constitutional issues that i have raised. now i know, that most people around here don't like to talk about whether something is constitutional. we just want to do what feels

good. because we think we are helping people. but our founders set forth in the enumerated powers limits on what this body and this federal government could do. and as members of congress, one of our most important responsibilities is to protect, to defend, and preserve the constitution of the united states. and that like him is not only appropriate but essential for this body to question whether it is constitutional for the federal government to require americans to buy health insurance coverage. we should also question whether it is constitutional. for the federal government to tell americans what kind of health insurance coverage that they have to purchase. so not only does this bill tell them they have to buy health insurance, it tells americans what kind of health insurance must be purchased.

americans also deserve to know how the bill will impact their ability to choose health insurance coverage that best fits their needs. so that's exactly why i'm raising this constitutional -- will raise this constitutional point of order. freedoms -- freedom of choice are very precious rights. let's not bury our heads in the sand and take away freedom and choice from american citizens. we need to think about this individual mandate very carefully. now, mr. president, i have several articles here, and i'd like to read a couple of quotes from these articles. the first one is by -- from the "washington post" by david rivkin and lee a. casey. it says in here the otherwise uninsured would be required to

buy coverage, not because they were even contingently engaged in the production, distribution or consumption of commodities, but for no other reason that people without health insurance exist. the federal government does not have the power to regulate americans simply because they are there. americans significantly, in two cases, united states versus lopez 1985, and the united states versus morrison in 2000. the supreme court specifically rejected the proposition that the commerce clause allowed congress to regulate noneconomic activities, merely because through a chain of causal effects they might have an economic impact. these decisions reflect judicial recognition that the commerce clause is not infinitely elastic.

and that by enumerating its powers, the framers denied congress the type of general police power that is freely exercised by states. mr. president, i would just ask consent that after the senator from illinois, that my statement in the record would appear as if i had given it continually. >> without objection it will be social in the record. >> i will yield to the democrat side of the aisle. >> senator from illinois. >> mr. president, thank you. and i would like to thank the senator from nevada for that courtesy. thank you, mr. president. as this debate draws to a close and my colleagues and i prepare to vote on a health care reform bill, i recognize the long hours and tense negotiation have left some nerves and tempers frayed.

that's what i came to the floor today, although our work keeps us away from our family and friends, for much of this holiday season, i see no reason why we can't share good cheer to one another right here in washington. so in the spirit of the season, mr. president, i would like to share my own version of a classic holiday story with my good friends on both sides of the aisle. and it goes something like this, mr. president. it was a night before christmas, was the night before christmas, and all through the senate, the right held up a health care bill, no matter what was in it. the people had voted. they mandated reform. but republicans blew off the gathering storm.

we will clog up the senate, they cried with a grin. and in the midterm elections, we will get voted in. the new regular folks need help right this second, with fund raisers, politics beckoned. so try as they might, democrats could not win, because their majority was simply too thin. then across every state there rose such a clatter. the whole senate rushed out to see what was the matter. all sprang up from their desk and ran from the floor, straight through the cloak room and write out the door. and in what in the world would be quite so raucous, but a mandate for change from the democratic caucus. the president, the speaker, and of course leader reid, and had answered the call in our hour of

need. more rapid than eagles of visions of a cane, and they whistled and shouted and called them by name. better coverage, cost savings, a strong public plan, accountable options, we said yes, we can. no exclusions or changes for preexisting conditions. let's pass the bill that restores competition. the democrats all came together to fight for the american people, that christmas eve night. and then in a twinkle, i heard under the dome, rollcall was close and it was time to go home. despite the abstraction of the tactics of some, the filibuster had broken, the people had one. and a good bill was ready for

president obama, ready to sign and in health care drama. democrats explain as they drove out of sight, better coverage for all, even our friends on the right. and i say to all of my colleagues in this season, mary christmas, and a happy, happy new year. thank you, mr. president. i yield the floor. >> c-span, christmas day.

>> all next week a rare glimpse into america's highest court through unprecedented on the record conversations with 10 10 supreme court justices about the court, their work and the history of the iconic supreme court building. five days of interviews with supreme court justices starting next monday at 8 p.m. eastern on c-span. >> u.s. senate coming back momentarily for more debate. this being day 19 of the health care debate in the u.s. senate. they have been in recess for their party caucus meetings, and back your momentarily. earlier today a couple of votes, both votes 60-39 adopting the manager's amendment by senator reid, the majority leader and then voting to invoke cloture to limit debate on the substitute amendment. we showed you moments ago senator ensign from nevada and his constitutional challenge. his constitutional procedural move of the point of order against the legislation. kathleen hunter from sea to rice

that while the senate is unlikely to uphold his challenge, senator ensign raised points almost certain to resurface in litigation if the legislation becomes law. most points are not debatable but under unanimous consent agreement the senate will not vote on senator ensign's challenge until wednesday. on the health side of things, associate press reported that freshman democratic house number parker griffith of alabama is switching to the republican party that his office said on tuesday that the senate is back in. live coverage now here on c-span2. time and also for your great efforts on this legislation. thank you very much. mr. president, it is a profound privilege to have the opportunity to serve the people of rhode island and in that capacity to support the legislation that is before us. this effort has been decades in the making. every year that passes without health insurance reform has made the task more difficult and the need for reform more essential.

rhode islanders have seen their health insurance costs double in just the last decade. in 2000, the average employer- sponsored family health insurance policy cost about about $6,700. in 2008, the same plan cost nearly $12,700. and without reform, by 2016, that family will pay over over $24,000 in premiums, consuming 45% of their projected median income. such costs are unsustainable by the families of rhode island. soaring health care costs are hurting family budgets, small businesses, and the national economy. in 1980, americans spent spent $253 billion a year on medical bills. today we're paying $2.5 trillion on medical bills. that pressure is pushing medicare towards collapse, and 750,000 americans into bankruptcy. this legislation will help

contain health costs, extend insurance to millions, and give health consumers more protection against discriminatory insurance practices. by shifting the balance of power from insurance companies to consumers, we will make health care more affordable for individuals and businesses and provide families with greater health care access and stability. this bill is fiscally responsible. it is fully paid for. we trimmed wasteful spending and imposed new fees on drug makers, reined in entitlement spending and imposed taxes on things like tanning beds that lead to health care costs. but we also provided every american family with greater health care stability and extended affordable health insurance to 30 million more of our fellow citizens. the nonpartisan independent congressional budget office, the c.b.o., estimates this bill will reduce the deficit by by $132 billion over the next decade, and $1.2 trillion over

the following ten years. we need urgent action. the delay tactics, the procedural obstacles employed by the other side are hurting our fellow citizens. every day, 14,000 more americans lose their health coverage, and every day we are here delaying this measure, 14,000 more americans lose their coverage. we have to, i think, reverse that trend and begin to extend coverage to america. since 1999, rhode island's uninsured population has nearly doubled, growing from 6.1% to 11.8% in 2008, and it is soaring up to about 15% today in the wake of unprecedented economic conditions. but while some have made this debate about trying to fix the broken health care system, others have made it clear their real intention was to use this issue to -- quote -- "break

president obama and make health reform his -- quote -- waterloo." partisanship must not come before providing access to the life-saving health care for children, families, and seniors. i also don't understand how some party loyalists who spent the past eight years helping george w. bush drive our economy into the ground and inflate the deficit to record levels are now obstructing every reasonable effort to fix these problems. how could they help george w. bush double our national deficit, running it up more in eight years than all 42 presidents before him and then turn around and claim president obama isn't doing enough to control it? how could they say this this $800 billion insurance reform bill, which is fully paid for and reduces costs to consumers, is too expensive? but the $1.4 trillion prescription drug bill they passed which was financed through deficit spending and amounted in many respects to a

giveaway to the drug companies was somehow good policy. how can they rail against health care reform right after overseeing the largest expansion of our government in decades? and how will they change their approach when through hard work and implementation, we do, in fact, extend coverage and reduce costs and begin to deal with the deficit that has to be dealt with in the years ahead? health insurance reform hasn't always been this partisan. indeed, many republicans have said they support a great deal of what is in this bill, but for whatever reason, they refuse to support the overall bill. indeed, by my count, this bill increases competition which republicans said they wanted. indeed, by my count, this bill lowers costs which republicans said they wanted. indeed, by my count, this bill does not contain a public option. i regret that, but that is a

position that i think most of the republicans, not all, took. and indeed, this bill provides americans with tax credits to purchase insurance which republicans said they wanted. so the bill we seek to pass seeks to tear down inefficiencies in the system, curb the costs, and reduce the waste and abuse that rhode islanders and americans experience every day. it is our responsibility to enact meaningful health reform. just saying no may be a powerful political weapon, but this country is built on hope and a better future, not fear. health insurance reform will offer rhode islanders access to stable and affordable health insurance coverage. here are some of the changes that will happen immediately with the enactment of this bill. insurance coverage for the uninsured with pre-existing conditions will be provided through a high-risk pool. in my state, one plan already acts as the insurer of last

resort and provides coverage for those who have pre-existing conditions. this bill will support their efforts because now other insurance companies in the market must also enroll these individuals as we approach the full implementation of this bill. and you will surers will be prevent -- insurers will be prevented from denying coverage to children immediately because of a pre-existing condition. there will be no lifetime limits on coverage for all new policies. this means no one will exhaust their coverage plan, no matter how sick they become. there will be restrictions on annual limits for all new policies. insurance companies will have more difficulty denying care in the middle of treatment. all new policies sold will cover children up to the age of 26, and this is particularly helpful since graduates from college, often particularly in this economy, have a hard time finding unemployment with health care benefits. insurers will no longer be able to rescind coverage upon illness

when treatments, checkups, screenings, and medication are absolutely critical. insurance companies will be required to cover free of charge preventative care for new policyholders, and beginning next year, 2011, small businesses will be eligible for tax credit to purchase insurance for employees. then in 2014, after allowing the states the time to design and develop and prepare themselves, our bill will extend affordable coverage to over 31 million uninsured americans through a new health insurance exchange which promises to expand choice, increase competition, and rein in costs. rhode islanders without a job will be able to purchase insurance on a newly established and government-regulated health insurance market. many will receive federal support for the purchase of coverage. rhode island is employed boy a company that does not provide insurance or inadequate insurance will be able to

purchase insurance on this new market exchange. small business owners will be able to easily compare the costs of insurance coverage offered by a multitude of plans through a new health insurance exchange, and it will allow small business owners to pick the coverage that fits the needs and budget of their employees. rhode islanders on medicare will no longer have to pay out of pocket for important preventative services and no longer spend portions of the year in the so-called doughnut hole without paid drug coverage. and low-income adults without children will have access to medicaid which will provide them with insurance at reasonable costs. having access to health insurance is important. individuals, employers, employees, and families will access the new insurance options after reform, which is important. however, affordability, the amount that a family has to pay, is also critically important. mr. president, we have examples

of sits that have already enacted insurance reform that covers their entire population, and what we have found is that premiums have gone down significantly since this reform was enacted. and we have learned a lot from their efforts, and federal reform will improve upon those efforts. as i suggested before, the average premium for rhode island -- a rhode island family is $12,507. if we don't do something, experts predict this premium will double in just six or seven years. rhode islanders will be looking at insurance bills, just the bills to annual premiums of over $25,000. again, that is not sustainable. it will literally bankrupt the families of rhode island, and they will make a very difficult choice. paying this much money, which for many if not most is extraordinarily difficult, or not having insurance, or doing

other things, limiting the access of children in college, not saving for their retirement. we can change that today by moving forward with this legislation. now, the congressional budget office has also analyzed the effect of this bill on the premiums that rhode islanders will pay, and they expect premiums to decrease anywhere from 14% to 20%. c.b.o. found that these changes, these decreases will result from an influx of enrollees with below average spending for health care. one of the problems we have in the health care system today is that healthy young people, unless they are offered employment -- health insurance in their business, don't typically take it. they are the classic free riders. if they get hurt in an accident, they'll go to the emergency room and be treated, but they will not pay into the system. the whole principle of insurance is spreading risk across the largest population to reduce

costs, and that's precisely what we're doing. this is fundamental to any insurance program. so this approach will actually lower costs as the c.b.o. has reported. hard-working rhode islanders could save anywhere from $2,000 to $3,000 a year on their health insurance, and these are real savings for the families of rhode island. additionally, the bill will provide permanent tax credits for rhode islanders to purchase insurance. depending on income, individual rhode islanders can expect a a $500 to $3,000 break on their insurance costs because of these tax credits. rhode island families can expect to save much more. $1,400-$855 on their insurance through these credits. and everyone should recognize that the insurance reforms in this bill will mean that people will get better coverage at lower cost. the bill also mitigates the costs facing small businesses,

which in my state accounts for 95% of all businesses. every year, these business owners face increasing premiums of 15% to 20%. they don't have much choice. two companies control 80% of the market in rhode island. and you either accept, if you're a small business person, what they offer you or you go without insurance, and every year they see double-digit increases. again, this is not sustainable, not only over the long term, but over the next several years. starting in business and finding the right personnel is a challenging and expensive proposition. innovation and entrepreneurship is risky. often start-up companies have difficulty hiring qualified individuals because the business owners can't face these increasing costs of health care insurance. in rhode island, these kinds of pressures have led to the loss of employer-sponsored health

care or reduction in premium assistance from employers, and what has happened is that for the last several years, real wages have been flat, because health care has been taking all the extra money that at other times would have gone to increased wages. and as a result, if you're a middle-income american and you look around through all the struggle and all the work you're doing and you have the sense that you haven't made a lot of real progress in terms of additional wealth, additional money put aside, it's no wonder because you have been paying the indirect costs of ineffective, inefficient health care system. the money is going into health care. the money is going into, in many respects, health care that's not efficient or effective, and it's not going into the paycheck of working americans. now, the reforms set forth in the patient protection and

affordable care act will strengthen the employer-sponsored health insurance market. there has been some suggestion that this is going to create no opportunities or options for employers to continue to provide insurance, health insurance for their workers. but according to the c.b.o., 83% of privately insured americans will be insured through their employers. that is a dramatic change. nearly double the total of americans insured through their employer today. so what we're going to see is not the decrease in employer insurance, but an increase. and this is something that will, i think, match the best aspects of our economy. individual business men and women making judgments about what plan is best for them and providing that benefit in a cost-effective way to their employees. it will occur because of a few

simple changes. first, as i mentioned, small business owners will actually receive a tax credit to purchase insurance for employees should they choose beginning next year in 2011. small business will get a tax credit arcs tax break which they're not getting now. second, individuals will have the option of finding affordable insurance on their own with increased competition and drive down costs as more people shop effectively for health care insurance. and, third, there will be lower administrative overhead and greater simplification as a result of this legislation. under the proposal that we are considering, premiums for small businesses will stop the never-ending trend of increase after increase and will begin to come down, making health insurance more affordable for small business owners. it will help them by defraying their start-up costs and ensure

individuals can seek employment regardless of benefit option. it will put companies in a situation where they have an edge over foreign competitors and win in a global marketplace. american companies today are competing against nations around the globe that either have a national system which does not directly affect their balance sheet in terms of health insurance costs or they have no health insurance at all. and as a result, that's not on the balance sheet of these companies. every one of our businesses is in some way or another competing against other countries that subsidize heavily their insurance, that provides an advantage, a competitive advantage. we want to in some small way diminish -- in fact in a large way, but at least begin to diminish that advantage. there's been lots of many ill-founded claims about the

reform package. the simple fact is that the tax credits provided in this bill is the largest health tax credit bill that's ever been considered in congress. over $400 billion in tax credits will be provided to americans in order to increase affordability. since health insurance will provide rhode islanders access to affordable health coverage, our providers should no longer face the financial pressure from uncompensated care. hospitals will care for patients with insurance and doctors will be able to prescribe preventive measures to patients so they don't become ill. today it is estimate that had all the private insurance premiums we pay in rhode island, at least $1,000 of those premiums is to pay for uncompensated care in our hospitals, in our clinics throughout the state. when we have a significant number -- 95%, 94-plus percent of rhode islanders covered,

those uncompensated costs won't be uncompensated. there will be an insurance plan behind those individuals so they can seek preventive care and pay for regular care. there are 11 hospitals in my state. each one of them are contributing in our efforts to insure more americans and doing so with the knowledge that they can in fact benefit from the fact that people will not be showing up at the emergency room, but without insurance -- but will bring their insurance card and the support that card insures to the emergency room. in addition, the safety net providers around the country will find great support from this legislation. there will be improvements also, direct improvements for the physicians in rhode island. the looming 21% medicare payment reduction will be eliminated as it is impending. and it will continue to look for

permanent solutions not only to this issue of medicare payments, but also a payment formula used to pay doctors in a more equitable and more appropriate way. i'm pleased also we've taken steps to train and enhance a new generation of primary care physicians that will be necessary to fill the increased demand. and these improvements will help our overall efficiency. this bill will also provide seniors with an improved medicare program. nearly one-fifth of my state is on medicare. over 180,000 rhode islanders rely on medicare for their health care costs. our seniors have paid into medicare during their lifetime. they deserve a program that will provide comprehensive coverage at the lowest cost without the risk of coverage being terminated. however, that is not the medicare coverage that rhode islanders always receive today. here is what medicare does today: medicare frequently allows the same test for the

same complaint to be performed multiple times. this costs money but it doesn't necessarily improve patient care. medicare leaves over 31,000 rhode islanders without prescription drug coverage for parts of the year. this costs them money. and medicare today is on the path toward insolvency in just eight short years, which will affect every senior in rhode island. instead of allowing medicare to go bankrupt, the comprehensive health reform bill that we are currently debating would extend medicare solvency for at least five additional years. some predict it will be extended for nearly a decade. this is important for seniors enrolled in the program today and those who will soon enroll in the program. solvency is extended by reforming the system. seniors in my state will not have to make multiple trips to their doctor's office for the same test for the same complaint because we would eliminate unnecessary duplication and tests and services. they will not fear being readmitted to the hospital after distinguished

after -- after discharge. -l they will not be put off for important preventive care because the out-of-pocket costs are just too great because cost-sharing component for preventive care will be eliminated. many of my seniors are on the medicare advantage program, which is a privatized version of traditional medicare. over 65,000 seniors in my state have elected to enroll in this option, and there has been an effort to characterize the changes to this program as undermining that program. the private insurance companies have been saying that for over months now. and why? because they profit very handsomely from medicare advantage. they spent months telling seniors that health reform will take away their coverage. these claims are knack rat. we will e-- are inaccurate. we will eliminate excessive overpayment to private insurance companies. in my state medicare advantage plans are paid over 20% more per beneficiary than traditional fee

for service. the g.a.o. found 19% of medicare beneficiaries pay more than traditional medicare for home health care and 16% pay more for inpatient services. seniors should be angry and upset at insurance companies as they continue to profit from the medicare system while simultaneously taking more money from seniors' pocketbooks as they charge extra for these services. this is -- was not the intent of the program. in fact, the intent for the program, the argument insurance companies made is give us the flexibility to manage medicare patients and we will lower cost. and very shortly after that, they came back repeatedly saying we need more money and more money because apparently they're not managing that well. of course the bill is going to target waste, fraud and abuse. for every $1 we spend on these

efforts -- and you have to invest in this fraud protection -- we expect to recover $17. our efforts will improve the health care of seniors and will stabilize medicare. it's also important to note that we will be doing a significant amount with respect to children. i want to particularly call senator bob casey's amendment to ensure citizens won't have to fear losing their safety net coverage. finally, i think it's important to note these reforms are paid for. this is in stark contrast to others. we voted on the medicare prescription drug bill in 2003 which i opposed. it was unpaid for and more costly than the amendment was originally presented to us. we voted for causes outside of the budget to fund wars in iraq. 13% of my state's unemployed and 15% of my neighbors are

uninsured. we are moving forward to reduce the deficit with this bill, to provide valuable coverage to ensure that the promise of health care in the united states is fulfilled, not denied. and with that, mr. president, i would yield the floor. mr. baucus: mr. president the? the presiding officer: the senator from montana. mr. baucus: mr. president, pending unanimous consent request reported by the two leaders, i yield now such time as the senator from massachusetts desires. the presiding officer: the senator from massachusetts is recognized. mr. kerry: mr. president, thank you. i ask consent to speak as if in -- mr. kirk: mr. president, thank you. i ask unanimous consent to speak as if in morning business and the time be counted postcloture. the presiding officer: without objection, so ordered. mr. kirk: thank you, mr. president.

i know all my colleagues share an indebtedness to the many staff members who worked so tirelessly behind the scenes each and every day. they assist us in serving the public and in responding to the needs of our constituents. today i am honored to pay particular tribute to the contributions of one truly outstanding member of the senate staff. she will retire at the end of this session of congress after 47 years of impressive service to the the citizens of massachusetts. barbara suliotus worked on senator edward m. kennedy's first campaign for the senate in 1962. she was the first employee in senator kennedy's office in november of that year. and from the moment he joined this body until the end of his life, barbara served as a member of his staff and for the last 23 years she was the state director of his boston office.

barbara recalls that on her first day at work here in washington, she spilled a glass of coca-cola on senator kennedy. when she started to apologize, he smiled his iconic smile and said "bar pwrarbgs you and i are going to get -- and said barbara, you and i are going to get along just fine." they certainly did. she served him brilliantly throughout his entire senate career, the only member to run the race as a staffer, though many of us reported back whenever barbara sent out the call. senator kennedy considered barbs to be his indispensable assistant. if anyone had a question relating to the massachusetts people whom he loved, he would inevitably ask "have you checked with barbs?" i know how proud ted would be that this tribute honoring

barbara is taking place this day. i first met barbara when i joined senator kennedy's staff in 1969, 40 years ago. i could see right away that behind barbara's modest demeanor was a remarkable woman who would never let senator kennedy down. why? because she had learned that his values and his commitment to making a positive difference in people's lives was the very reason she wanted to work for him in the first place. as i thought about public service through the year, it has become clear that the best of our nation was built on the labors of loyalty and love, the unsung public heroines like barbara. it was once said that loyalty means nothing unless it has at its heart the absolute principle of self-sacrifice. if that is the standard of loyalty, i can tell you, mr. president, there is no more loyal united states senate staffer than senator kennedy's

own barbara su li otus. she embodies the quality of loyalty no matter the circumstance. barbr -- barbs planned it retire years ago but she worked for senator kennedy through the difficult months of his illness and during his final days. after senator kennedy passed away in august, barbara continued her remarkable life's work as service as the director and my boss in office. this woman i had known as a colleague came once again to the aid of a friend. as one who was appointed to, among other things, continue subsequent service for the people of massachusetts, i knew i could keep that pledge because barbara volunteered to stay on to lead the kennedy team during these last few months.

barbara's loyalty, integrity and commitment are legendary. she is the true noble public servant. the tireless and compassionate friend, the unassuming aide to all around her. and if public service is barbs vocation, sports is her a vocation. she is an outstanding golfer who plays without a hand catch and who -- handicap and who has at least one hole in one on her score card. she has scored literally thousands of holes in one for the constituents of massachusetts. in acknowledging barbara's all-star service to senator kennedy and for me these historic few months, i add my heartfelt thanks to her, especially for the blessings of her friendship, support and counsel over the many decades.

i wish her a well-deserved happy and healthy retirement in the many years to come. thank you, barbs. we love you. hit them long and hit them straight. mr. president, i yield the floor. i note the absence of a quorum. the presiding officer: the clerk will call the roll.

mr. reid: mr. president? the presiding officer: the majority leader is recognized. mr. reid: i ask unanimous consent that the call of the quorum be terminated. the presiding officer: without objection, so ordered. mr. reid: mr. president, i ask unanimous consent that all postcloture time be considered expired on h.r. 3509 at 8:00 a.m. thursday, december 24, that immediately the bill as amended be read a third time, that after the passage of h.r. 3590 as amended, the senate proceed to the consideration of calendar 25245, h.r. 4314, that no amendments be in order, that the bill be read a third time and senate proceed to vote on passage, the passage require a 06-vote threshold if that is achieved the motion to reconsider be laid on the table, further on wednesday, january 20, 2010, the time be determined by the majority leader following consultation with the republican leader, the finance committee be discharged

from h.r. j res. 45, that the majority leader to be offered a substitute amendment and that the following be the only first degree amendments in order to the joint resolution, coburn rescissions, session spending caps, reid relevant to any of the lists, reid paygo, baucus relevant to any on the list, conrad, gregg fiscal task force, that it be a 60-vote threshold. that if they do not achieve the 06-vote threshold, they be with dawn, upon disposition of all amendments, the substitute amendment if amended be agreed to the joint resolution be read a third time and the vote to passage and that it be subject to a 06-vote threshold. i ask consent that on wednesday

january 20, 2010, the senate proceed to executive session to consider 421, that there be 60 minutes of debate with respect to the nomination, time equally divided and controlled between leahy and session ors designees, on the use of debrissing back to time, the motion to reconsider be laid on the table, no further motions be in order, the president be immediately notified of the senate's action and the senate resume legislative action. the presiding officer: is there objection? mr. mcconnell: reserving the right to object. i want to be sure that the senator is aware, that the subs treat amendment will be -- substitute amendment will be limited to an actual amount when it is offered. mr. reid: that's right. and if there's any amendments here that would pass, it would be be a part of it. a senator: mr. president? the presiding officer: the senator from montana. mr. baucus: reserving the right to object. i wonder why under that consent

is propounded whether the secondary amendments would be in order to the orders on that list? mr. reid: no. mr. baucus: i suggest the absence of a -- i do not object. the presiding officer: hearing no objection, so ordered. the republican leader. mr. mcconnell: i want to recognize two young pages who are actually on the floor with us today. martin shabin o&m icalla, stayed until the -- volunteered to stay until the senate adjourned and sacrificed some of their christmas vacation and

volunteered their service during the weekend before thanksgiving break. we have pages on the republican side and democrat side. but both martin and micalla worked on the democratic side and republican side to make a 14 person job work with two people. one can imagine how difficult it is for two individuals to prepare for the speech that's we've had over the past week and i know that senator reid joins with me in thanking them for their garbus and impeck -- gracious and impeccable service to the united states senate. the presiding officer: the senator from north dakota's recognized. mr. conrad: mr. president, i want to begin by recognizing the work on this legislation of leader reid, chairman baucus, chairman harkin, and chairman dodd. mr. president, i believe when

the history of this bill is written, that it will be recognized what a remarkable job of leadership senator reid has provided. bringing together a desperate caucus around extraordinary complex issues to accomplish something that will be mean? the future as a leap forward for america in reforming the health care system in this country. chairman baucus, no one has made a deeper, more committed personal sacrifice than senator baucus in advancing this legislation. his commitment to getting this bill done and getting it done right will stand the test of history. chairman harkin, who is -- who came in as the replacement to chairman kennedy made major

contribution on the wellness provisions. and chairman dodd, who filled in for senator kennedy and continued in the role of handling this legislation, even while being chairman of the banking committee as well, provided an example of legislative leadership that's really unmatched. the four of them have done a superb job in putting together the pieces of a bill that i believe will lead the way to a dramatically improved health care system in our country. and if we reflect just objectively on the package before us, it is an entirely reasonable and responsible approach. there is no government takeover of health care. no rationing. no cuts to guaranteed medicare benefits. no benefits for illegal immigrants. and the bill sets a goal of no taxpayer funding for abortion

beyond the hyde amendment provisions in current law. in fact, this bill does much of what republicans said they wanted in a health plan. it's fully paid for and it reduces deficits in both the short and long term. it expands coverage and provides assistance to help families and small businesses afford health insurance. it sets new rules to stop insurance company abuses, it reforms the delivery system to control costs and improve quality. it allows for the sale of insurance across state line and it supports medical malpractice reforms. those are facts. every one of those elements is in this bill. this is an approach that senators on both sides of the aisle who want solutions, rather than slogans, should embrace. the need to act is clear.

the status quo is simply unsustainable. health care costs are crushing families, businesses, and even the government. the premiums for individuals and families are rising three times as fast as wages. you can see where we're headed. it's as clear as it can be. without action, families will see average health care premiums rise to $22,000 a family by 2019. $22,000 on average for families' health care premiums in 2019 unless we act. mr. president, it doesn't stop there. premiums, as i've indicated, skyrocketing. and national health care costs skyrocketing right along with them. without action, total health care spending will equal 38% of the gross domestic product of the country by 2050.

38% of the gross domestic product for health care. that would be one in every $2.50 in this economy. already we're consuming $1 in $6 in health care. and that is an unsustainable course. this is driving the long-term fiscal balances threatening our future economic prosperity. without action, federal spending on medicare and medicaid will reach 12.7% of g.d.p. by 2050. this chart makes very clear. -- makes it very clear. in 1980, they were consuming 2% of gross domestic product. by 2050, these two, medicare and medicaid will consume more than 12% of our g.d.p. one in $8 in our economy.

the growth in health care costs threatens to bankrupt medicare. medicare went cash negative last year. without action medicare will be bankrupt in 2017. the trustees have just told us that will happen. that's two years earlier than forecast just last year. so, again, medicare went cash negative already, that means more money is going out than is coming in and the medicare a-- in the medicare accounts and it will be insolvent, broke in eight years. this legislation extends its life by nine years. and these health care costs are hurting our competitive position in the world. we are spending far more than other countries on health care, leaving less money for research and development, investment, and higher wages for americans. in fact, as a percentage of our gross domestic product, we spend twice as much as most other advanced countries. here it is, we're now even

higher than 16% of our g.d.p., latest numbers indicate we've gone to 17% of our g.d.p. for health care. that's one of every $6. look at other countries, japan and the united kingdom are half as much. belgium, germany, switzerland, france, a little over half as much as what we're paying. even with spending more, we are performing worse on virtually every metric. we're ranked 19th in preventible death, 22 in infant mortality, 24th in life expectancy and we leave people without life insurance. continuing the status quo is not an option much america can do better. and this bill proves it. the bill before us is fiscally

responsible. the nonpartisan congressional budget office, the official scorekeeper, relied on by both sides of the aisle, tells us that the bill reduces the deficit by $130 billion over the first 10 years. now, those aren't my numbers, those aren't the chairman of the finance committee's numbers, those aren't the democratic leader's numbers. those are the numbers of the nonpartisan congressional budget office. they say this bill will reduce the deficit by $130 billion over the first ten years. the savings in the following decade are even more impressive. between $650 billion and and $1.3 trillion. the congressional budget office says all told, c.b.o. expects the legislation, if enacted, would reduce federal budget deficits over the decade after 2019 relative to those projected under current law with a total effect during that decade that

is in the broad range between .25 and .5% of gross domestic product. that is $650 billion to to $1.3 trillion. so shame on those who get up on the other side and say this is going to increase the deficit. where is there evidence other than claims, other than assertions? we're talking about the considered judgment of the congressional budget office that is nonpartisan and is the official scorekeeper for the congress of the united states. and the bill bends the cost curve for the federal commitment to health care in the long term. in its december 19 estimate, c.b.o. reports that the proposal would generate a reduction in the federal budgetary commitment to health care during the decade following the ten-year budget window. so yes, it bends the cost curve for the federal expenditure

during that period. this legislation also reforms the insurance market. the senate plan, we have all heard the horror stories. i have got loads of letters in my office from constituents telling me about what's happened to them, being dropped because they got sick even after years of paying premiums. being denied coverage because of pre-existing conditions. in many cases, pre-existing conditions that had nothing to do with the illness for which they now need assistance and being denied even though they have paid the premiums. mr. president, this is serious business. this bill puts a stop to these abuses. it prohibits insurers from denying coverage for pre-existing conditions on new policies. it prohibits insurers from rescinding coverage when people become sick after they have paid premiums for years on new plans.

it bans insurers from lifetime caps and annual limits on health care benefits, and it prevents insurers from charging more based on health status. it also expands choice and competition. the bill before us builds on our current market-based system and makes it better. it's not government-run health care. instead, it embraces choice and competition. it sets up a new health exchange where consumers can shop for the best value. it creates consumer-run co-op health plans. not government-run plans, but plans run by the members. it allows for insurance sales across state lines to further increase competition. the manager's amendment also creates a new national plan. the office of personnel management, the same agency that currently overseas health plans

for all federal employees, including members of congress, would select private health insurance carriers to offer plans that would be available nationwide. these plans would provide new competition for state-based health plans, particularly in areas where just one or two insurers currently dominate the market. at least one multistate plan would have to be a not for profit insurer such as the one of the newly created co-ops. i am particularly excited by this development. when we look around the world at the countries with the best outcomes and the lowest costs, one feature stands out. these countries rely on primarily not for profit insurance -- germany, france, switzerland, belgium, japan. all have adopted this model. they don't have government-run health care, but they do have universal coverage. they do have extremely high-quality health care outcomes, and much lower costs

than we do. so i believe the not for profit national plans and the co-op option may in the long run play a key role in transforming our system into a more efficient, higher quality system. this legislation also expands coverage. according to the congressional budget office, it covers 94% of the american people. it creates state-based exchanges for individuals and small businesses. it provides $476 billion of tax credits to help working americans and small businesses buy coverage. you don't hear that much from the other side about this this $476 billion of tax assistance for people to afford better health care coverage. it also reforms the delivery system to focus on quality and not quantity. and the bill before us slows

cost growth while improving quality. the sad fact is that 30% of current health care spending does nothing to improve health care outcomes. we're wasting about $750 billion a year on unnecessary and counterproductive procedures. again, that's not a congressional estimate. that's the work of dartmouth that did a survey all across the country and concluded 30% of health care expenditure in this country is wasted. and this bill reforms the delivery system in a fundamental way. it contains every delivery system reform health care experts believe is needed to provide better care while slowing cost growth. this proposal also extends the solvency of medicare. the medical actuary says the senate bill extends the life of medicare by nine years. some say on the other side because medicare is heading

toward insolvency, we can't have medicare savings. what? what are they talking about? odg i have seen in this debate was in the last year of the bush administration, they sent up a proposal to have nearly nearly $500 billion in savings under medicare. and we didn't hear one peep from the other side, not one. in fact, they all said it was critically important to do. now all of a sudden it's the death of medicare. and what's even more bizarre about their argument is now there is an offset for the savings from medicare providers. the offset is they're going to get 30 million new consumers, 30 million americans who haven't had insurance who will now have it so their uncompensated care costs will go down, making it

more affordable for providers to provide these savings. most of these savings have been negotiated with providers. why have they been willing to agree to savings? hospitals, nursing homes, home health care? it's because they know they're going to get substantially expanded business. 30 million customers with insurance who previously did not. mr. president, this is important legislation. these medicare reforms don't hurt seniors. some of the other side have said you can't reduce the growth in medicare costs without taking benefits away from seniors. that's just scare tactics. the medicare savings provisions lower cost growth without harming beneficiaries, and this legislation also helps my state. i'm proud to say it. some have said the medicare changes will hurt north dakota

providers. clearly, they haven't read the bill. right now, we get paid way below the average for medicare reimbursement. in fact, we're the second or third lowest state in the country in medicare reimbursement. north dakota providers get get $5,000 a year per medicare beneficiaries -- beneficiary. in miami, they get three times as much, more than $16,000 a year to take care of seniors there. now, i would be the first to say it may cost more to provide medicine in miami than it does in minot, but it doesn't cost three times as much. the fact is moving to a system that is based on outcomes rather than procedures will benefit, not hurt, a state like north dakota. in addition, this legislation includes the frontier states provision that senator dorgan and i offered as an amendment. our provision puts a floor under payments to north dakota providers, and in other states

like ours that are rural states that have not received fair levels of reimbursement. it will mean an additional additional $66 million a year in medicare payments to my state. overall, this bill is a win for north dakota, a win for the nation. it reduces the deficits, it controls costs, it saves medicare or at least extends its life for at least nine years. it embraces choice for american consumers and competition and expands coverage. it reforms the insurance industry and it rewarthis legist start. i urge my colleagues to allow it to continue, because we all know this isn't the last step. next we go to the conference committee where we will have a chance to write the final legislation. no doubt this bill will be further improved as it has been

at every step of the process. again, let me conclude as i began by thanking the leadership who have made this bill a possibility. senator reid who has done really a remarkable job of bringing people together. senator baucus who has spent more than a year and a half in as dedicated an effort as i have ever seen by a committee chairman in this body to bring major legislation to a conclusion. senator dodd who filled in for senator kennedy on a pinch-hit basis but worked so hard to produce a result in that committee, and senator harkin, the new chairman of the committee, for all of his assistance in getting the job done. when the history of this legislation is written, those four will be recognized as producing something that was critically important for this country. we should salute them. i thank the chair and yield the

floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i very much thank my good friend from north dakota for his generous statements. this is, as he knows, all teamwork. we're all in this together. all senators, especially on this side of the aisle, with the president to get health care reform finally passed for all americans. teddy roosevelt started this many, many years ago. many presidents since were unable to get health care reform passed. i think finally this time we're going to do it. we're -- it's a moment we're all very proud of. mr. president, i yield the balance of my time to the senator from washington. i don't know how much that is, but whatever it is, it's all hers. the presiding officer: the senator from montana has seven and a half minutes remaining. the senator from washington is recognized. mrs. murray: mr. president, i thank my colleague from montana, the chairman of the finance committee, who i remember months ago with a smile on his face said we can get this done, and we're on the verge of doing it. we all owe you a huge debt of gratitude, so thank you very much. mr. president, as this debate now moves forward, it has become

apparent that some of our colleagues are losing sight of what we're working on here. should it be a robust debate about a critical issue that is facing all of our families and businesses that have been bogged down by distractions and political gimmicks and obstructions and a lot of delay. well, american families watch and wait and wonder where they exactly fit into this conversation. so i want to be clear. with my colleagues and with americans from across the country today, this bill is about you. it's about your loved ones. it's about the people just like you across the country to bring down your premiums, expand your options, and increase your stability. it's about helping our economy and creating jobs by reducing the drag that's created by the skyrocketing premiums and unlocking the potential for new health care careers. it's about supporting the doctors and the nurses, the hospitals and the clinics who work every day to take care of you. it's about helping you or your

father or your mother, your grandfather, your grandmother, by increasing benefits, cutting waste, and strengthening the medicare that you depend on. and it is about catarina. she is a rahm from redmond, washington, and she is one of my more than 10,000 constituents from my -- from my home state who have sent me their stories about their experience was our broken health care system. mr. president, catarina is a single mom. she has a good education she told me and she has a good job and a solid, middle-class lifestyle. but like a lot of americans this year, struggling in the toughest economy since the great depression, she was laid off from her job and she lost her employer-provided health care. she was able to scrape enough money together to pay for cobra coverage, but catarina told me that she didn't dare go to the doctor because she knew she wouldn't be able to afford the co-pays. so although she was technically covered right now, in practice,

neither she nor her child had access to true health care or preventative services. and she found that living that way had some real consequences. last month, she told me she got an eye infection and eventually had to go to the doctor for treatment. she said after all of her out-of-pocket costs and still with no job and no income, she had to make some very serious and very tough choices about her family's food and clothing budget. and who knows what would have happened if catarina or her child got seriously ill? mr. president, our broken health insurance system is failing catarina, and she is not alone. millions of people have lost jobs in this current recession. millions of families have been tossed out of their employers' plans, families who had health care, who felt secure all of a sudden understand how broken the system really is and how few options they actually have today for affordable care. that's why we need health

insurance reform. it's why we need this plan. for katarina and the millions of americans in similar situations and the hundreds of millions of americans who may switch jobs or move or start small businesses or who just want more options for high-quality, affordable health care. mr. president, let me talk for a minute about how this bill will specifically help katarina and many others. our plan sets up a market where people can shop for and purchase insurance, where insurance companies would have to compete for your business, and why people like katarina would be able to choose a plan that fits her family best from among a range of options in an open marketplace. it would inject competition into the insurance market. it will lower costs and it will give families like katarina more choices. that means that instead of just having one choice when she's laid off, which was to purchase high-priced cobra, katarina will

be able to compare the price and performance of plans and make a decision for her family with the benefit of true options. that will increase her stability and it will help keep our insurance companies accountable. and never again will insurance companies be able to drop a family's plan simply because somebody got sick. no longer will losing your job mean losing access to affordable coverage, and no longer will people like ca cat katarina havo choose between food, clothing and health care for herself and her chile. it will keep families secure by ensuring that all insurance plans offer an adequate level of coverage, including free preventive care that will keep them healthy and ensure that minor, inexpensive medical issues can be treated before they become major expensive medical problems. our plan will increase options. it will enhance security and stability, and it will reduce costs for people like katarina by providing credits and premium

assistance so families will no longer have to worry about their coverage if they lose jobs or switch jobs or move or get sick. mr. president, that's what this plan is about. it's about katarina, it's about her child, it's about the millions of americans in similar situations. and, mr. president, if the status quo wins out, things will only get worse. if some of my colleagues continue to play politics with this issue, katarina's going to continue to struggle. and if we continue to have delay and distraction and obstruction, families will pay more for less, they'll lose their coverage, they will be denied treatments and continue to have to fight their insurance company red tape to get the care they deserve. so, mr. president, that's what this is all about. i'm going to continue to stand up and tell the stories of families and small business owners from my home state of washington because they are counting on us to fix this broken system.

and i urge my colleagues to focus on their states and join us with to pass true health insurance reform. and before i yield, mr. president, i want to take this opportunity to make just one additional point. you know, as everyone knows, we have been working incredibly demanding schedules in the recent weeks. senators have seen this floor at every conceivable hour: late at night, early in the morning, in the face of a blizzard. but, you know, far too frequently we forget that every time we are here, there are literally hundreds of staff forced to be here along with us. in fact, they are often here long before we arrive and long after we leave. you know, this body couldn't function without the tireless dedication of these men and women. many of them are here now, the clerks, the parliamentarians, cloakroom staff, doorkeepers, capitol police officers, maintenance workers. they work very long hours. they work nights and mornings and weekends with no regard to government closures or dangerous snowstorms or need to complete

their holiday shopping. if we're here, they're here. every one of them deserves our thanks. and i just want to take a minute this afternoon to express my own gratitude to every one of them and to all of my own staff as well. this hasn't been an easy time but all of you should know we are deeply appreciative of your service. and i, for one, am strongly supportive of bringing this debate to a close so that each one of you can be home with your families enjoying some well deserved time off for the holidays. thank you, mr. president. i yield the floor. the presiding officer: the senator from mississippi is recognized. mr. wick he: ier: is it now in r for me to ask that that several republican colleagues engage in a colloquy for the next hour. the presiding officer: without objection, so ordered. mr. wicker: i also want to thank my colleague from washington for

commending and thanking the staff certainly. that is a bipartisan sentiment at this holiday and christmas season. i appreciate her giving me the opportunity to echo those thoughts and i'm sure every senator on the floor feels the same way and expresses that appreciation to the hard-working staff. i -- i want to start off by saying that there's still an opportunity, mr. president, for this bill to be amended and changed in some of the very harmful ways that this will affect our people back home and particularly our state governments. now, i was on the floor several days ago pointing out the objections that most of the state governors have with regard to the medicaid mandates. and i want to read from a letter dated december 10 from my governor, governor haley barbour of the state of mississippi, who

reminds senators that this bill continues to place a huge unfunded mandate on states while harming our small businesses and seniors through budget gimmicks and increased taxes. governor barbour says this, mr. president: "if the current bill, which would expand medicaid up to 133% of the federal poverty level, were enacted into law, the number of mississippians on medicaid would increase to 1,037,606, or one in three citizens in the state of mississippi. over 10 years, this bill would cost mississippi taxpayers $1.3 billion. now, i was on the floor a few days ago also with this map which shows in red the number of states which are facing this unfunded mandate because of the increased federal mandate for medicare coverage coming from this bill should it be enacted

into law. and i was pointing out that only the two states, vermont and massachusetts, because of a formula that has been worked out will be exempt from this. every other state, i pointed out to senators, will have to come up with the extra money, either through cutting education programs, cutting mental health programs or other vital services or by raising taxes. they will have to come up with the extra money under this legislation so that half of the people covered by this new act will be covered by medicaid. now, i want to make an amendment to that today and add one other state because i think it's become quite -- quite a well-known fact that we need to put one other state up there in yellow and that is the state of nebraska, because we know that

pursuant to an agreement that was made before senator nelson announced his support as the 60th vote for cloture on this very important legislation, a deal was cut -- the minority miy leader said a cheap deal, and i agree -- that the state of nebraska would be exempt in perpetuity from its requirement to pay the federal match -- the state match, and so the federal government, according to this legislation that we'll be asked to vote on in the next two days, will pick up all of the extra expenditures for the state of nebraska. now, the poverty level in nebraska's not quite as bad. now, i don't know how the powers that be felt that they should justify this expenditure, but i'll tell ya, the state --

people in the state of mississippi are going to have to come up with another $1.3 billion over the next 10 years to pay for what we're going to be required to do by congress in its wisdom. how is it fair that one senator from nebraska goes behind closed doors with the majority leader and cuts this deal so that his citizens don't have to pay this extra tax, his citizens don't have to do without services and other state programs to come up with the money? no one in this building, no one within the sound of my voice can come in here and explain why this is fair. the fact of the matter, mr. president, is that the majority leader needed that vote and that was part of the deal that was cut, so that now citizens in arizona, citizens in wyoming, citizens in

mississippi, arkansas, louisiana will have to come up with the extra federal tax money on our part so that the federal government can cover all of the additional costs, state and federal. i will yield to my good friend. mr. mccain: could i ask my colleague, on that map there, i wonder why -- shouldn't there be a sticker there for the state of florida? according to published reports, according to one of my favorite columnists, dana milbank, this morning in "the washington post" says "gatorade. senator bill nelson included a grandfather" -- and a quote -- "inserted a grandfather clause that would allow floridians to preserve their pricey medicare advantage programs." so maybe should we have one of the stickers for florida there? and by the way, that will cost my constituents more money because they will not have that same deal. and should there be a sticker for, according to, again,

milbank, "handout montana. senator max baucus secured medicare coverage for anybody exposed to asbestos as long as they worked in a mine in libby, montana." should there be one there? and it says -- and then another one that dana milbank quotes -- "iowa pork and omaha prime cuts. senator tom harkin won more medicare money for low-volume hospitals of the sort commonly found in iowa." and maybe there should be a -- i don't know if you have north dakota in there. it says -- and i quote congressmen dana milbank -- "meanwhile, senators byron dorgan and kent conrad, both north dakota democrats would enjoy a provision bringing higher medicaid payments to hospitals and doctors in 'frontier counties' of states," let's see here, north dakota. and should there be one for

hawaii? mr. milbank goes on to say, "hawaii, with two democratic senators, would get richer payments to hospitals that treat many uninsured." and should there be a sticker there for michigan -- quote -- "home" -- and i'm quoting from the milbank article -- "home of two other democrats would earn higher medicare payments for some reduced fees for bluecross blueshield." vermont -- vermont, senator bernie sanders held out for larger medicaid payments for his state. neighboring massachusetts would get one too. i guess there's a number of maybe states that should have stickers on them so that the american people can see where these special deals were cut o out. and the american people, the majority of the population of this country can see where they were not, and they're going to pay more while those states pay less because not just their location but because they happen to be behind closed doors and

cut special deals. mr. baucus: mr. president, i wonder if i could enter this colloquy just very briefly? mr. mccain: sure. sure. we'd welcome it. mr. baucus: i thank the senator. mr. mccain: i ask unanimous consent. the presiding officer: is there objection? without objection, so ordered. mr. baucus: i thank my colleague. i appreciate that. i just wanted to point out that, do the senators know, for example, that under the underlying legislation that the federal government would pay all the costs of newly eligible enrollees through the year 2016? that is, in this legislation, we're really talking about the so-called expansion population. that is, those between 100% of poverty in medicaid and 133% of poverty in medicaid. and under the underlying statute -- mr. mccain: let me ask the senator does, that mean athat all these states are being treated the same? mr. baucus: it means through 2016, all these states are treated the same. all paid. 100%.

mr. mccain: this happens to be 2009 bordering on 2010. i ask my colleague, whapsz between now and 2016? mr. baucus: no, beginning next year when this goes into effect, 2010, through 2016, all states will get 100% payment of that -- for that expansion coverage. all states. a senator: what would happen after 2016 under the current legislation? mr. baucus: one sentence of background. today, as the senator well knows, different states receive different medicaid -- federal contributions to medicaid. it varies according to states. the average is about 57% federal. the average is about, for all states on average, 57% of the cost of medicaid is paid for by the federal government. let me finish. that's the average. mr. mccain: -- the same

provision inserted for the state of arizona that was inserted for the state of florida -- you don't have a problem with that, do you? do you have a problem with that? mr. baucus: i can only answer one question at that time. the first question i'm answering is that of the senator from mississippi. all states on average get 90%. we're talking about the -- mr. wicker: the senator yielded to me the other tkaeurbgs and i appreciate that. we have a number of republicans who want to speak during our hour. the fact of the matter is in 2016, every state in red has to tax their own citizens and pay their state's share except vermont, massachusetts and nebraska. and i still challenge any colleague in this united states senate to come before and say that is fair. i do not believe they'll say that's fair. mr. mccain: my question to the senator from montana is this:

would the senator from montana be willing to have the same provision that senator nelson, according to these reports, inserted a grandfather clause that would allow floridians to reserve their price in the medicare advantage program. would he accept a statement right now that that same provision apply to every state in america? i ask unanimous consent that the same provision that was put in for the state of florida by senator nelson that would apply to every state in america. mr. baucus: mr. president, reserving the right to object, i think it would be highly imprudent for me to not object, so i will object to that. but i want to also point out that on average uncle sam pays 90%. 90% of the medicaid payments for this expansion population after the year 2016. the presiding officer: objection is heard. mr. mccain: i think the fact that the objection is heard

resolves the case. those are comforting words on the part of the senator from montana. the fact is there are special deals for special people. it is very well known. could i say to my colleagues before they go, one comment is a special privilege here. the senator from louisiana came to the floor, and she said -- and i quote -- "recently, just yesterday, senator john mccain, our colleague from arizona, claimed the american people are opposed to reform and he speaks about the will of the majority. i'd like to remind respectfully my colleague from arizona that the will of the majority spoke last year when they elected president obama to be president, and they decided not to elect him. and the president is carrying out the will of the majority of the people to try to provide them hope and opportunity." i say in response to that, i really didn't need to be

reminded. i had not forgotten. sometimes i'd like, very much like to. but i appreciate the reminder. but the fact is that the senator from louisiana and other senators should know that poll after poll after poll, public opinion, partially because of what the senator from mississippi is pointing out, the latest says u.s. voters oppose health care plan by wide margin. quinnipiac finds voters should not pay for abortion. it says american voters disapprove of the plan 3356 and disapprove 573 -- 53-38 president obama's handling of the health care issue. if i can remind my colleague from louisiana, i did carry her state. and the senator from montana's.

mr. johanns: if i might jump in here, like probably every senator in here, i read the newspapers back home every morning as i start my day. there was an editorial in "the lincoln journal star" on the 21st of december that speaks to this issue of special deals, and i thought -- i thought it was excellent. now, "the lincoln journal star" has covered me for a long, long time. sometimes i agree with them, sometimes i don't. sometimes they agree with me, sometimes they don't. but i've always respected the work that they do, and here's what they said in their editorial. they said this: "since when has nebraska become synonymous for cynical "what's in it for me" type politics. the term corn husker kickback is already a favorite of television's talking heads." they go ton say "that's how the

rest of the country sees this deal." the he had toerpl continues, "under its provisions, the federal government would pay all additional medicaid costs for nebraska in perpetuity. the congressional budget office has estimated the deal may be worth $100 million over ten years." they go on to say, i think in very, very powerful language, "the deal is the embodiment of what is wrong in washington. instead of thoughtful, careful work on problems, washington lawmakers cobble together special deals and implementation on a grandiose scale." and they devote a paragraph to the many special deals cut to -- your board just illustrates one. and if i could just finish this, senator mccain, and then you

can ask me. they say this: it's time to push the reset button on health care reform. the effort has gone awry. mr. mccain: doesn't this bring up a larger issue, i'd ask all my colleagues to comment on this, whether our job here is to do whatever we can to just simply help our state, even if it is at the expense of other states, as the senator from mississippi pointed out. or is our title "united states senator arizona, nebraska, mississippi, et cetera." my title is not arizona senator u.s. it's u.s. senator arizona. of course i'm there to represent the people of my state. but is a u.s. senator's job to go out and do something which would then be at the expense of the citizens of another state simply by virtue of their clout

and influence? is that what people were sent here by our constituents to do? is it true what the senator, majority leader said yesterday -- and i quote -- "i don't know if there's a senator that doesn't have something in this bill that was important to them, leader harry reid reasoned when asked at a news conference monday about the cash for cloture accusation. and -- quote -- "if they don't have something in it important to them, then it doesn't speak well of them. doesn't speak well of us when we do something like the senator from mississippi just pointed out, that favors libby, montana, and not the rest of the country? that helps the seniors in medicare advantage in florida and not in arizona? is that what we are sent here to do. that has never been my view of what our obligations to our citizens, but also to the citizens of this country. i ask my colleague --

a senator: mr. president? thank you. here's what this has come to. in the next 48 hours, this 2,400-some page bill is going to pass the united states senate. but how did we get there? was it done the way things are usually done in this body? mr. risch:one party has been able to gather 60 votes to vote for this. not one person from the other party is going to vote for it. how did they get those 60 votes? did they get it by arguing this out? they didn't do that. they have bluntly, boldly and on the front of virtually every newspaper in this country have bought the votes to pass this bill, to get to the 60. they bought the last handful of votes, and they didn't even buy it with their money. they bought it with the american people's money. now, that is wrong.

the explanation i heard from the majority leader the other day; well, that's the way this is done. well, that maybe the way this is done in banana republics. that may be the way this is done in third-world countries. but this is america. american people are outraged over this. the other party ought to be outraged over this. i heard one member quoted as saying i was too stupid to get any money for my state in there. i heard the minority leader say you're not doing your job if you don't have something in there for you. where's the outrage from the other side not only about the process it was but how they're getting snuckerred by some other members of the other party. where is the outrage? i watched the debate from the other side, and i've seen members come down here and say the american people want this. are they living in a cave? sure there's a handful of american people that want this, but let me tell you who doesn't. the united states conference of

bishops don't want this. the national right to life people don't want this. not one republican wants this. the democrats don't want it. list ton what howard dean, the former leader of the party, of the democratic party said -- quote -- "at this point the bill does more harm than good." ask any democrat government in america. this bill transfers $25 billion in costs, in unfunded mandates to the governors and to their taxpayers. they've got to come up with $25 billion. they don't want it. i've stood here and listened to the other side say, oh, this is wonderful for small business. small businesses is going to come out so well on this. well, then why does the national federation of independent business, small businesses, say -- quote -- "the senate pw*eul fails small business -- the senate bill fails small businesses. the national association of

wholesale distribute tors, the small business entrepreneurship council says small business says reid health bill more of the same. big spending and nothing to help lower business costs. associated businesses builders and contractors are against it, the independent electrical contractors, the international franchise association. even the labor unions have said don't tax our health care benefits. we agree with them. we're on the side of the labor unions. we shouldn't be taxing health care benefits. but set all that stuff aside, these are all people that have an ax to grind. the american people do not want this bill. these people that are coming out here saying the american people twhapbt, i don't know whether they're not reading the newspapers, whether they're not listening to their own e-mails at their office, quinnipiac poll

says, taken this morning, that was out this morning, tuesday through sunday, 36% of the american public support the health care spending bill. 36%. 53% opposed. that's an 18% difference. gallup says 16% of american people don't want this. stop coming out here saying the american people want this. the american people don't want this. you want it. the labor unions don't want it. nobody wants this thing. and most of all, small business doesn't want this. i've listened to anecdote after anecdote after anecdote from the other side. there is some very touching stories and everybody here is empathetic with that. but you don't legislate using anecdotes because you're only hearing one side of the story. you're not hearing all the facts that have to do with those

anecdotes. then patched with these pages and say this will solve that. that is not the way you legislate and not the way you argue a point. i heard the other side come out here and patch the bill and say when we pass this, 94% of american people will have shaourpbs. in court they say you have to tell the truth, the whole truth and nothing but the truth. that's exactly why you can't pass this and say 94% of the american people are going to be covered. somebody listening to that will say gosh, what a wonderful bill. costs $2.5 trillion. that's fair to cover 94% of the american people. but it doesn't! the bill only adds another 7%. the fact that they don't tell you is 87% of americans are already covered by some kind of health insurance. don't say this is a grand and glorious victory because we're now going to cover 97%. this is gimmickry at its worst.

to tax for four years without giving any major benefits, giving some minor benefits, but holding off the major benefits until later is plain gimmickry. and say look how wonderful this is, it's not going to add to the national deficit because we're going to collect taxes for four years. and then only then are we going to start the benefits. what do we have here? when all is said and done, you strip it away, you've got $2.5 trillion. 2,400 higher taxes, higher insurance premiums and i can give you one fact that is the best reason to vote against this, and that is it cuts a -- half a trillion dollars out of medicare benefits. if you are a senior watching this, a half a trillion dollars of medicare benefits are going to disappear. i heard the president say and my friends on the other side say, look, if you like your program,

if you like are your insurance plan, you're going to be able to keep it. well, try to tell that to the people on medicare advantage. it something stripped. it is being eliminated under this bill. indeed, if you read the rules and regulations under this bill, the plan that you have won't even exist when it's done. you know, i've heard the other side say, oh, you republicans are just playing on the fears of the american people. let me tell you something, my friends on the other side, the american people are frightened. they're afraid. and it isn't just this health care bill. they sat here for the last year and they watched stimulus packages costing $1 trillion. they watched multibillion dollar bailouts. they've seen buyouts. they've seen trillion dollar deficits running up. they've seen the national debt run into trillions, and, yes, they are afraid. but it isn't us that's doing it to them. it's you that have done it to them and it's you that have committed the acts that have put the fear into the hearts of the

american people. don't do this. stop this nonsense. you have the opportunity still to stop this. you can do it. the american people don't want this. stop the insandtcy. i -- insanity. i yield the floor. a senator: i say to my friend, i'm afraid. i'm afraid for my country. mr. wicker: we're going to have a vote between now and christmas eve on raising the debt limit. it will be a short-term thing. i doubt a single republican will vote for that. and then we'll have to come back again in february and do the same thing. the -- the debt that is piling up on our country is something to be frightened about. it is something that we need to fight again and be resolute about. we don't -- we're not shedding crocodile tears, but i'm frightened by this debt and we should be if we want our economy to stay strong. and the fact that we are addin

adding $2.5 trillion in an entitlement program, which apparently the majority has the votes for, is simply going to add to this enormous debt and so it's no wonder when you add the medicare cuts, the taxes that most states are going to have to pay unless they cut a special deal, on top of the tremendous national debt that we're facing, the american people have a right to be frightened and worried. mr. barrasso: and i would say -- i don't know how many of you have seen the editorial in today's "investor's business daily," and i ask unanimous consent to have it put in the record of the senate. and it's called "louisiana purchase and omaha steaks," it says, politics, mary landrieu's payoff was the new louisiana payoff, ben nelson got -- they

say maybe we should just put senate votes up on ebay. they say nelson won a permanent exemption from state share of medicaid expansion for nebraska. uncle sam will take the hit for 100% of the medicaid expansion for nebraska forever. the world's greatest deliberative body has now become the most corrupt. that's what this says. and it goes on to say, it's not what legislating is about, it's about bribery. mr. president, it is horrible for us, as a nation, to have these things written about this institution when we should be way above any of these sorts of -- sorts of claims. and i look at that map that my colleague from mississippi has with just the nebraska on there as the special deal, that is not the way legislation should be. we should be looking at ways to improve health care for all americans.

improve the quality. make it more affordable. make it more available to people. give them the access they need. i brought four amendments the other day after senator reid brought his massive amendment. each was rejected and they were things that would actually improve this bill to make it better for americans. so i stand here looking at this at a time when headline after headline and editorial after editorial talks about just about how very bad it is the way that this bill is being pushed forth. in a way that is -- that is nothing that any young child would want to know is happening in their country as we try to get them involved in the -- in the process and learn and study and say, yes, maybe i should become involved in this. this isn't what legislating in america is all about. we're better than this. and if you need to do these sorts of things to get a 60th vote, then the bill isn't good enough to pass. if the ideas in the bill aren't good enough to get the votes,

then it shouldn't pass. in this country we look for bipartisan solutions to the big issues of the day. that's what we did in the wyoming legislature, major issues passed with overwhelming numbers. that's what happened in this country throughout the course of this country, the big bills have come forthwith large numbers of supporters and that's how you get the country to follow you. not trying to force through a vote and buy a vote here an buy a vote there to just squeak by with the minimum amount of support. that's not the way to change policies that going to affect every member of the united states, everyone personally. and one-sixth of our economy. that is not the way to do it. it's not been the way. it's not -- it shouldn't be the way. it should never be the way again. i'm looking for one democrat to stand up and say, this isn't the way i'm not going to vote for this thing. mr. mccain: there was a senator from colorado that came down on the floor and proudly stated that he had not asked for

anything or gotten anything. i'd like to ask the senator from nebraska because that seems to be the center of a lot of attention. first of all, you know, there is a little booklet put out by the government printing office who says, how our laws are made. we give it it out to our constituents. we send it to schools all over america. you know, i've never seen anything in that little booklet. it's very interesting, that says, you get behind closed doors and you cut deals. you get behind closed doors, particularly after your president said during the campaign, and we're -- we're a little bit cynical when we run -- about politics and campaign promises. but time after time the president said, i'm going to have all the negotiations around a big table. we'll have doctors and nurses, hospital administrators, insurance companies, drug companies, they'll get a seat at the table. they just won't be able to buy every chair, but what we're do, we'll have the negotiations televised on c-span so that

people can see who's making arguments on behalf of their constituents and who's making arguments on behalf of the drug companies. of all people, he recognized the drug companies, who got the best deal of all? pharma who spent the most money lobbying on advertising? pharma. and who's going to cost the american consumer $100 billion because it could have been saved by the consumer if we would have been able to reimport prescription drugs. but i -- i would ask my friend from nebraska, that this -- this one with the louisiana prch and probably the -- purchase, and probably the florida deal, this nebraska deal, has probably gotten the most publicity and visibility. because because it was the 60th vote. i don't know if it's the biggest in terms of money. because we'll be finding deals in this 2,700-page bill for months. for months we'll be finding provisions, even though we and

our staff carefully read it. it's not 2,700 pages for nothing. i would ask the senator from nebraska, how does this go over in the heartland of america? how do the people in nebraska who see that -- that they have gotten some kind of special deal -- provision, certainly reported so in the media, special provision, and that would come at the expense of another action pairs in america. i'm curious the reaction the senator from nebraska gets. mr. johanns: it doesn't go over. it just simply doesn't. in every way possible over the last four or five days, i've been asked, do you support this special deal for nebraska? i don't. i think it's wrong. and i also say and i could read through all the special deals. we've all got the list.

it's florida, it's louisiana, montana, and on and on and on. i came to the floor this morning, and i asked unanimous consent that all of the special deals be taken out. and i listed a long list of them. and, of course, there was an objection to that request for unanimous consent. why? i mean, why would we want to try to pass legislation with all of this? it makes no sense to me. but let me take a step back. we all remember a few months ago there was a big story that nevada was going to get a special medicaid deal. and it was right about that time that we took a few days off and i went back home and i did town hall meetings like i've done for years and years and years. but we really invested time and effort. and we identified six principles of health care. they're on my website. you can go look at them.

and i literally had a powerpoint presentation. i did four town hall meetings, carney, grand island, lexington, lincoln, and i put these principles up. and one of the principles was no carve outs, no backroom deals, no special deals. and i presented that to the people that were at those town hall meetings. i did tons of interviews. i explained why i felt the way i did. and people were so irate at the possibility that nevada was going to get this special deal. now, since then i think that's fallen to the wayside. but all of these other things have come along. that's why i read the lincoln journal star editorial. this is an editorial page that sometimes likes what i'm doing and sometimes it does not. and over the years they have not hesitated to take me to task.

but they looked at this and they said, since when is nebraska -- has nebraska become synonymous cynical, what's in it for me-type politics. they went on and said, it's time to hit the reset button. we're not getting this right at all. we simply are not getting it right. and they talked about the issues of cost containment. they talked about the actuary's report, which i had spent a little bit of time talking to them about and other folks around the state. and after look at all of that, they just said, look, this isn't going the way it needs to go for the american people. now, here's what i would say to all of my colleagues in the senate, i love my state. i love the people there. they're just such honest, decent people. you know, in many parts of our

state people really believe that you seal a contract not by putting things in writing, but by shaking hands and giving your word. they don't want this kind of attention. they don't want to be on the evening news every night, the talking heads talking about the corcornhusker kick back, whatevr it is, the latest terminology. they ask me to come here and represent them as fervently as i can to try to do all i can to get fair treatment for them. but not a single person in any town hall i've ever had stood up and said, you know, mike? i disagree with that principle. i want you to go back there and get me a special deal or to get our state a special deal. so, senator mccain, i appreciate you asking me the question. i feel very, very strongly about

this. i wish -- i wish that the other side would consider my request for a unanimous consent agreement that just says, time-out, everybody. let's pull out the special deals. whether it's nebraska or montana or whoever. it doesn't matter to me. let's pull those out and let's take a step back and let's work for what senator risch talks about and the rest of us. we can get 80 votes on the health care reform bill. i guarantee not this bill. mr. wicker: i would echo what the senator from nebraska has just said. and i know my friend from arizona has been one of the most outspoken critics of special deals and special earmarks. this is not some catchall appropriation bill to get us through the end of the year. this is one of the most major

pieces of legislation that any member of this senate currently serving will ever vote on. this is one-sixth of the american economy. and the american people are learning about the special carve outs where the citizens of one state will be treated differently, not because of a form larks not because of the -- formula, not because of the poverty level, but because of political power. and it would just seem to me that one member of the majority party in these next two days might step forward and say, you know, you're right. and i will not be a party to this. mr. mccain: let me just make one additional comment. i have seen reform go through the congress of the united states. the first one i saw was when we saved social security, a major reform of social security. there was no back room dealing. it was a straightforward proposal as to how to fix -- how to fix social security. we fixed welfare.

it was welfare reform. again, open, honest, bipartisan negotiations and bipartisan agreement. welfare reform, social security reform, the efforts we made at tobacco reform, at campaign finance reform, at immigration reform, all the reforms, and many others, patients' bill of rights. every reform that i have ever been involved in has had two major and sole components. one is bipartisan. two, there was no special favors or deals cut or provisions in thousands of pages of legislation. so again, i -- we know where the train is headed, and we know what's going to happen a short time from now, but they will make history. you will make history. you will have rammed through a -- quote -- reform on a strictly partisan basis without the

participation of the other party over the objections of a majority of the american people, done in closed negotiations and results that are announced to the american people without debate or discussion and to this side without debate or discussion. the american people don't like it. they don't like for us to do business that way. and i am sure that this peaceful revolution that's going out there, -- going on out there already -- because as the senator from idaho pointed out because of the involvement in the car companies, the stimulus, the bonus, the generational theft that we're committing, this all on top of that is going to give great fuel to the fire that's already burning out there where they want real change, real change which they were promised in the last presidential campaign and certainly did not get. a senator: probably one of the

great ironies of all this is going to be at 8:00 on the 24th when this bill passes with the 60 votes, all democrats. mr. risch: immediately following that vote, it's going to be a vote again all 60 democrats and only democrats raising the national debt. what an irony, to put put $2.5 trillion in spending of a new social entitlement program, adding it to the three already huge entitlement programs that are in the process of bankrupting america, adding this to it and then turning right around and increasing the debt ceiling, and when they increase it, it's going to be -- nobody knows exactly how much it's going to be. it's going to be hundreds of billions. but putting that -- that's only in the last two months. they're going to have to come back again in february and increase the national debt ceiling again. what irony. what irony. mr. mccain: this legislation

turns everything we know about budgeting on its head. although it's been done before and it's been done by republicans, to our shame. today if you go out and buy an automobile, you can drive it for a year before you have to pay for it. under this bill, it's the opposite. you pay the taxes, you have the reductions in benefits, and then four years later, you start having whatever benefits would accrue from this legislation. so for four years, small business people, people all over america will see their health care costs increase before there is a single tangible result from it. remarkable. mr. wicker: the senator mentioned the florida carveout and asked why i -- or perhaps i should have it on my map. the reason i didn't, it involves medicare advantage and not medicaid. the map was about medicaid. but he makes a good point about the florida carveout.

and hi a discussion with some of the leadership on the democratic side on the floor of this senate the other day about medicare advantage. the strong assertion over on that side is that medicare advantage is not medicare. as a matter of fact, some of the leadership in this very body said -- the booklet that the government puts out, it says medicare advantage is part of medicare should be changed. those words should be stricken from the handout because it really is not part of medicare. the website that the federal government has up saying that this is -- that medicare advantage is part of medicare, that should be changed because really it's just an insurance company masquerading as medicare. let me just take a second. this is betty, and betty represents -- she is from louisiana. now, i don't know if she voted for -- if she was one of the 60%

of louisianans who voted for senator mccain in louisiana, but -- but she enjoys medicare advantage. she was told during the election that if you like your coverage under any plan that the president would -- that the obama administration would approve, you get to keep that coverage. she gets hearing aids, vision coverage, dental care, and she likes her medicare advantage. now, if betty is one of the 150,000 seniors in the state of louisiana that enjoys this benefit, she is at risk of losing it. but if she happens to be in the state of florida in any of these counties with the $100 million carveout, she is fortunate enough to be able to keep her

medicare advantage. in other words, it may not be guaranteed, but she sure likes it. and obviously, one of the senators from florida believes that his constituents really, really like it, and so, again, a carveout so that this nonguaranteed, nonmedicare benefit that is really not very good, they can keep it in florida. that is in the bill, and no one can deny that special treatment is given to that one state under medicare advantage, and then i challenge any american to come on the floor of this senate and tell me how that is fair. mr. barrasso: it's not, and there have been a number of references to our friend and colleague, the late senator ted kennedy, but let's take a look about the book that his brother john kennedy wrote, "profiles in

courage," and as we've seen all of this, it's time for one courageous democrat to stand up and say this is about our country, this is about our country, not about a kickback. this is about health care, not about a hand in the cookie jar. that's what we need. we need one courageous democrat to stand up and say i don't want to be a part of this editorial that talks about the louisiana purchase and omaha states. i don't want to be a part of this that calls it the world's greatest deliberative body has now become the most corrupt. i don't want to be a part of this that says this is about bribery. it needs one courageous democrat, one out of 60 to stand up and say i am going to vote no. we need to back up. we need to think about this. we have 100 members of a senate who want to reform health care in this country, who want to get the costs under control, who want to improve quality, who want to improve access. a hundred senators want to do that. that is the goal of each and every one of us here.

we need one courageous senator to say it is time, time now to take a step back. let us go home over christmas, let us think about this, let us talk to our constituents at home, let us hear what they have to say about this looking out for number one, $100 million, dana milbanks' column in "the washington post" today. that's what we need now in the united states senate. we need the kind of courage that john kennedy wrote about in "profiles in courage." mr. risch: senator barrasso, there already are some courageous democrats stepping up, and i would hope that every democrat on the other side, call your governor and say governor, what do you think about this? help me out here. should i vote -- i'm in caucus and they have bought enough votes to get to the 60, but i got to tell you, i don't like the way they did it, number one, and number two, what about the rest of us? we didn't get -- we didn't get

the $300 million, we didn't get the x number of million, help me out, governor. you know, they say they're going to shift $25 billion to the states that you're going to have to come up with. what do you think? do you think i ought to vote for this? or maybe, maybe if one of us steps forward and says, you know, i'm going to vote no and i want to set the reset button and i want to put people back to the table and say let's do this right. we can do this right. we're americans. we know how to do this. we are the most innovative people in the world. all we have to do is get together and do it. but to -- to jam this down the throat of the american people and make no doubt about it, this is being jammed down the throats of the american people on the eve of christmas, in the middle of the night, in the face of poll after poll that says don't do this to us. that's what's happening. there are courageous democrats out there. none of them are sitting here.

mr. wicker: let me tell my friend from idaho about some courageous democrats. when the house version of this was being considered at the other end of this building, a number of democrats stepped forward and said i -- i can't vote for it. it was very close. they have a huge majority, 40 votes over there. as a matter of fact, one member of the house today basically said i -- i really can't take it anymore. he switched parties. the member from alabama is now joining the republican conference. but there are a number of loyal democrats who have no intention of switching parties, and they have stepped forward and said i can't vote for it. don't count me in on this. now, bart stupak is a representative, a courageous pro-life representative from michigan, and he did vote for the bill. and i don't impugn his motives. he did what he thought was right, but before he voted for it, he made sure that legislation was included in the house version to make sure that

the hyde language which has been the law of the land for almost two decades was included. and here's what representative stupak said yesterday, or day before yesterday about this so-called pro-life compromise that was included in the version that we'll have to vote on in the senate. he said it's -- "not acceptable. it's a dramatic shift in federal policy that would allow the federal government to subsidize insurance policies with abortion coverage." that's a release that -- actually on december 19. i appreciate the courage of someone from a democrat state, from a district that's long been democrat, who is a member of -- a chairman of a committee and a member of the leadership over there stepping forward and say i can't go this far. and unless this language is

changed -- and we're told by members of the senate that there better not be much of a conference. what we vote on on christmas eve better sort of stay -- stay like it is or it won't be passed by the senate when it comes out of conference. bart stupak is stepping forward and said if that's the case, then i'm switching from a yes to a no. i appreciate that kind of courageous democrat. mr. mccain: could i -- could i say that i appreciate the senator from mississippi bringing this important aspect of this issue to our attention and continuing to do so. i'd like to pick up on what dr. barrasso mentioned about the kennedy family. it's well known that i had a very close relationship developed over the years with senator ted kennedy, and that we worked together on a variety of issues, so there is a great irony in the constant over there

on the other side of the aisle references to senator kennedy who always began legislation by getting bipartisan -- by getting members of the other side of the aisle committed and working together, whether it be on immigration reform, whether it be on health care reform, whether it be on -- one of the great achievements of president bush ii, no child left behind. in other words, every dealing that i ever had with senator kennedy was to reach out, establish a fundamental base for agreement, and then move forward with legislation in a bipartisan fashion, which i think is one of the major reasons why he had such an impressive legislative record. so how did the other side do it? without a bit of serious negotiation, without trying -- really bringing anybody on board before moving forward. no one. which ends up now with a 60-40 vote, which is a pure partisan

vote, outcome, when there has never been in history a single reform that was not bipartisan, and that's why the american people are rejecting this. that's why the american people are seeing through it. and to hear the constant refrain that the american people want this, read any poll. it's just a matter of difference, because the american people have figured this out. and it's going to be one of the great historic mistakes. not historic, but historic mistakes made by the congress of the united states. mr. mcconnell: if i may just say to my friend from arizona, you're absolutely right. i've had an opportunity to observe senator kennedy over the years and that's exactly the way he operated. but if i may, just to make a point with regard to the senator from mississippi's observation about congressman stupak, as i understand it, i'd ask my friend from mississippi, congressman stupak was not asking for some special deal for michigan in

return for his vote. he was, rather, trying to establish a principle that would apply to all americans. is that not the case, i would say to my friend from mississippi? mr. wicker: i would say to the distinguished republican leader, that is exactly correct. and i commend my colleague -- my former house colleague for taking that principled stand. mr. mcconnell: could not the same thing be said about our colleague, senator lieberman, from connecticut? i'm sorry he ended up voting for this 1,700-page monda monstrosi. but you have to say, as i understood senator lieberman's position -- and senator mccain certainly knows him very, very well -- his position was if the government goes into the insurance business, i can't support this bill, not i'm open for business and what can you do for connecticut. mr. mccain: i -- there may be on the floor a unanimous consent agreement to remove the nebraska

medicaid deal. i would hope that if there's any unanimous consent agreement at any time, that the whole bill be fixed, which means every special provision would be removed, whether it be from nebraska or any other state. because we still have the louisiana purchase of $300 million. we still have the florida medicare grandfather clause, $25 billion to $30 billion. the list goes on and on and on. the connecticut hospital -- i guess it's the connecticut hospital. you know, it's always in legislation so you have to do research to see who qualifies. so i would hope that we could have, again, agreement that all these special provisions that affect certain specific states would be removed as well. i think it would go over rather well with the american people. so i -- i just want to say to my colleagues, thank you for your passion. i know that a lot of people don't watch our proceedings here on the floor, but i think it has played a role in educating the

american people as to what we're facing. the media have played a role, our add assess groups, grass-roots organizations all over america. but i've had a great privilege of engaging in these colloquies with my colleagues, and, to me, it's been both helpful to my constituents but, frankly, it's also been helpful to me to work with doctors, to work with people who have been involved in these issues, former governors and others. and i think we've made some kind of contribution which i think what we're all sent here for. mr. wicker: mr. president, how much time remains? the presiding officer: two minutes. mr. wicker: well, i -- unless my colleagues want to join in, i want to thank them for joining us and certainly thank senator mccain, one of the most distinguished public servants, someone who's sacrificed for his country and who has been on this floor hour after hour.

i would simply point out that the bill that we'll be asked to vote for on christmas eve by the administration's own chief actuary increases health care costs, threatens access to care for seniors, forces people off their current coverage, and actually increases the amount of the gross domestic product that will be spent on health care rather than increasing it. these are not facts that -- these are not statements i have made. these are assessments made by the chief actuary for the obama administration. there's still time, even if this bill passes, we'll go home for christmas, for the holidays. we'll hear from our constituents. and i would hope that we listen to that over 60% of americans who say, we advise you not to

vote for this legislation. mr. barrasso: and it's time for a new chapter to be written in profiles in courage, and one of the members of this body can be that profile. all they have to do is stand up and say no, i will not be part of what has been called corruption in the senate, i will not be part of what has been called in the editorials bribery in the senate. i will be that courageous person and vote no. it is time for a new chapter in profiles in courage. and with that, mr. president, i yield the floor. the presiding officer: it's the understanding of the chair that the senator from mississippi had the floor. mr. wicker: i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i have several points to make. first, as a matter of personal privilege, on behalf of the people of libby, montana, the senator from arizona made it sound like the folks of libby were getting some kind of a

sweetheart deal. i wish the senator would not leave the floor so he could actually hear what's -- hear what's actually going on. and i think the senator from arizona would agree with me that he would not want his constituents to suffer an environmental calamity. he would not want his constituents to not get some redress because of a declaration of public emergency due to contamination of asbestos. i assume the president -- the senator from arizona would very much stand up for his constituents. let me explain this provision. in the law in 1980 -- this congress passed a law in 1980. it's called circl-a. that legislation said that whenever there's a declaration of a public emergency because of a contamination at a superfund site, that the government has a opportunity to declare a public emergency and help those people get medical care because of contamination of asbestos. in this case, especially something called tremolite,

which is even greater damage -- causes greater damage than ordinary asbestos does. and i would assume that the senator from arizona would want his constituents to get some help from a -- from contamination from asbestos. mr. mccain: may i respond? mr. baucus: absolutely. mr. mccain: all the senator had to do was have it authorized, bring it up on the floor as an appropriation and i'm sure that the senator's arguments would have been far more cogent than jamming it into a bill which has to do with health care reform. mr. baucus: this is health care. mr. mccain: of policy of health care reform. and this bill -- this legislation and this cause of the senator from montana has been turned back several times. mr. baucus: reclaiming my right to the floor. mr. mccain: i'm responding. the presiding officer: the senator from montana. mr. baucus: i'm reclaiming the floor because he doesn't want to deal in good faith with this issue. the second point -- second poi point. it is disrespectful, it is

unseemly for senators in this body to invoke the names of ted kennedy and jack kennedy in opposition to this bill. it is disrespectful and unseemly and i, frankly, am very much surprised that senators would go to that level and try and invoke the names of ted kennedy and jack kennedy in -- in opposition to this legislation. talk about profiles in courage. i hear senators on the other side say where is the courage of one senator to stand up and vote against health care reform. that's what i keep hearing on that side, where's the courage, where's the courage of one senator on the democratic side to stand up and vote against health care reform? mr. president, i'm going to turn that around. profiles in courage by jack kennedy and also ted kennedy were senators who worked to try to find resolutions to agreements. they wanted to compromise, they wanted to work together to get just results. and i ask the senators: where is the senator on that side of the aisle who's got the courage to

break from their leadership, break from the partisanship they're exercising on the other side of the aisle to work together to pass health care reform? i ask them: where is the -- where is the -- where is the courage? where are the senators who've got courage on that side of the aisle to stand up and work together on a bipartisan basis to get health care reform passed? where? we on this side reached out our hands for bipartisan agreement on health care reform probably to a fault -- probably to a fault. and i say "fault," because for months and months and months, this senator anyway extended the hand to work with other senators in a bipartisan basis -- on a bipartisan biases. i know the current occupant of the chair knows this. he watched this. he saw it happen in the finance committee. and senator grassley and i worked very hard to get senators on both sides of the aisle to work to pass health care reform. very hard. then after awhile, we had to work towards another approach. the group of six, three

republicans, three democrats. we worked for days. we worked for months on a bipartisan basis to get health care reform passed. do you know what happened? i watched it happen. those senators there in the room who were acting in good faith. they were in good faith. they wanted to mutually work together to pass health care reform. they asked very good questions. senator enzi, for example, from wyoming, very good questions. senator snowe asked very good questions. senator grassley asked very good questions. we worked together on health care reform. but you know what happened? you know what happened, mr. president? i could feel it happening. one by one by one they started to drift away. they wanted to pass health care reform, they wanted to act i ona bipartisan basis but they were pressured, pressured from the out -- from their political party not to do it, not to do it, not to do it. why were they pressured not to do it? unfortunately they gave in to that pressure because their leadership wanted to political -- wanted to make a political statement.

one senator on the floor here said let's make this obama's waterloo, health care's waterloo. they did not to want work with us on that side of the aisle, they did not want to work with us because they thought it was better to make a political statement -- attack the bill, attack the bill, attack the bill, attack the bill, in order to make points for the 2010 election. so i ask, mr. president, where's the courage? where's the courage? where's the republican senator that's going to stand up and say, boy, let's work together to pass health care reform? where is the senator that's going to stand up on that side of the aisle and say you bet, we want to work together to pass health care reform? this senator tried mightily to get bipartisan support. a senator: will the gentleman yield just briefly? mr. baucus: the senator from iowa, who i've been working with for a long, long time, and they just kept -- they were pulled away. senator grassley, i don't want to speak for him, but i know he wanted to get health care reform passed on a bipartisan basis. i know that's the case. but, frankly, he got pressured, pressured, pressured and he just couldn't do it. i have the highest respect and regard for him. he just couldn't do it.

and i would say it's very unfortunate. mr. wicker: the senator has asked a question. i wonder if he would yield just briefly? mr. baucus: absolutely. mr. wicker: i think the senator has answered his own question. as a matter of fact, senator grassily and senator enzi met for hours and hours, weeks upon weeks with my friend from montana in good faith hoping to come up with -- with a program that could get that 80-vote support that we usually get on matters of -- matters of -- mr. baucus: that's true. that's how they started out. mr. wicker: absolutely. and then eventually it dawned on them that my friends on the other side of the aisle wanted to europeanize the health care system of the united states of america to cut medicare -- mr. baucus baucus: i'm going tom my time. i reclaim my time. and i want to tell the senator, that is not what happened. i was in the room constantly, constant. i talked to those senators many, many times. that is not what happened.

i'll tell what you did happen, your leadership pressured them, pressured them, pressured them not to work together. there is no european-style effort in that room. that is a totally untruthful statement. totally untruthful statement. none whatsoever. mr. wicker: i thank the gentleman for briefly yielding. mr. baucus: we're passing a bill here that's uniquely an american solution. it provides competition. it helps the doctor-patient relationship. so that assertion in working toward a european solution is entirely untrue. it's entirely false. the fact is that those senators did not want to work with us. it's regrettable. it's highly regrettable. and do you know what, mr. president? one of the biggest travesties i think here, there was not a good-faith effort on that side of the aisle to come up with a constructive, comprehensive alternative to the democratic version of health care reform. if there had been a constructi constructive, honest alternative to health care reform, we could have had a real good debate.

you know, what's the better approach to solving the health care problems in our country. that did not ever happen. it did not ever happen at all. rather, they didn't come up -- they didn't have anything. they didn't have a health care bill, none whatsoever. the only one that kind of came up a little bit was over in the house, because after all the criticism, the republicans don't have an alternative, finally the republicans in the house came up with an alternative. it was very, very small. there wasn't much to it, to be honest, the congressional budget office said it hardly creates any cove coverage whatsoever. it was not really a comprehensive health care reform bill and there's been none in the united states senate on the republican side. no alternative for a comprehensive health care reform bill. so i -- i just -- i just want the public to know that we've worked very hard to get a bipartisan bill. that side of the aisle started out working with us but gradually they began to believe politically -- at least in this person's judgment -- began to believe politically it would be better politically and they

would do better in the 2010 elections by not working with us and just attack, attack, attack, attack, attack and try to score political points to defeat any honest effort to get health care reform. mr. president, i now yield -- how much time does the senator desire? a senator: thank you, mr. president. i thank my colleague from montana. mr. baucus: i yield such time as the senator from nebraska would like. the presiding officer: the senator from nebraska. mr. nelson: thank you, mr. pres. this has been quite an enlightening experience here on the floor this past 30 or 40 minutes with all -- it shows how emotionally charged this body has become over this issue and perhaps other issues as well. but the challenge is we're all entitled to our own opinions. we're just not entitled to our own set of facts. and i'd like to take a moment to explain the so-called medicaid fix for the state of nebraska. it's been described as the omaha

stakes fix. i take issue, and i only wish my colleague from nebraska had stayed on the floor to hear this. i take issue with one of the premier businesses in the state of nebraska used in a matter of derision to outline something that is factually incorrect on the basis of how they are presenting it. you can twist and you can turn and you can try to distort what happens, but it doesn't change the underlying facts. the underlying facts are that this was pursued initially as an opt-in or opt-out for all states. it was impossible to do that at the present time, and so as a matter of fix, there was in fact the extension of the federal dollars from the year 2017 on.

well into the future as a marker to lay down, so that every state could object to this manner of unfunded mandates. now, as a governor -- and my colleague is a former governor -- we fought against federal unfunded mandates. and as a senator back here, i've also fought against unfunded and underfunded federal mandates. and this was in fact exactly that. while we weren't able to get in this legislation an actual opt-out or opt-in for a state-based decision, what we did get was at least a line, if you will, so that in the future other states are going to be able to come forward and say, hey, either the federal government pays for that into the future or the state will have the opportunity to decide not to continue that so that we don't have an unfunded federal mandate. so i'm surprised.

i'm shocked. actually i'm not shocked. i'm disappointed that this would be used and misused in this fashion not only defensively against a great company in nebraska, i'm also disappointed that my colleague would use the name in a colloquy. i'm surprised this colleague went on without understanding the facts of what this so-called carveout, which is not a carveout, truly consisted of. there is no carveout. each state between now and 2017, two-thirds plus of a decade will have an opportunity to come back in and get this bill changed. governors asked for relief. as governors we ask for relief against these continuing uncommon -- unfunded mandates time and time again.

we fought against them, and this was one more opportunity to fund. as a matter of fact, the governor of nebraska spotted this and wrote me a letter on december 16 and said, among other things, "the state of nebraska cannot afford an unfunded mandate, an uncontrolled spending of this magnitude. additionally, nebraskans are very concerned." and he goes on to say a number of other things about the bill, but he makes the point that this is an unfunded federal mandate and wanted me to do something about it. so i sent him back a letter on the same date saying thank you and please be advised that i propose that the senate bill be modified to include an opt-in mechanism to allow states to avoid the issues that you've raised. under my proposal, nebraska prefers not to opt in to a reformed health care system. it would have that rhode island now, my colleagues khrao*eg and

others know that this is the case. they know that this is the case, but they choose to ignore it. they choose to ignore the facts. on the 20th of december i again wrote to the governor asking -- shared with him my concern about this unfunded mandate. and i pointed out that within hours after the amendment was filed, my colleague from nebraska objected to the inclusion of these funds. as a result, i'm prepared to ask that this provision be removed from the amendment in conference if it's the governor's desire. i got a letter back on the day after, on december 21, talking about this as a special deal. it's not a special deal for nebraska. it is in fact an opportunity to get rid of an unfunded federal mandate for all the states. let me repeat that. for all the states. there's nothing special about it, and it's fair. what we've done is we've drawn a

line in the sand and said this is unacceptable, and it's unacceptable for all states as well. i just can't believe that this sort of a situation would continue. there's no -- there's no misunderstanding here. i think it's just an opportunity to mislead, distort and, unfortunately, confuse the american public all the more and to use the state of nebraska and the name of a good company for political, partisan political purposes on the other side of the aisle. now, my colleagues know that i am not a deeply partisan person and that i rarely come to the floor to speak. and that when i come to the floor it's for something like this, to take exception with the misuse of information for partisan purposes. and that's exactly what has been done with this situation. i'm prepared to fight for the state of nebraska, and i hope my colleague is as well. obviously the governor was prepared to fight for the state of nebraska by bringing to my

attention. but i am not prepared to fight tpo get a special deal for the state of nebraska. i did not, and i refuse to accept that kind of responsibility or that kind of a suggestion from anyone on that side of the aisle or anyone else. and then as it relates to abortion, i think my colleagues know that we introduced legislation that is comparable to the stupak legislation in the house dealing with barring the use of federal funds for elective abortions. we introduced it over here. it was bipartisan. it was hatch -- it was nelson nelson-hatch-casey, and it didn't pass. so i began the process of trying to find other solutions that i thought equally walled off the use of federal funds and made it clear that no federal funds would be used. now, apparently i didn't say "mother may i" in the process of writing that language because

others took issue with it, even though they cannot constructively point out how it doesn't prohibit the use of federal funds or wall off those funds or keep them totally segregated. they just didn't like the language. well, you know, if in the conference the stupak-nelson-hatch-casey language passes, i'll be happy, and so will congressman stupak and so would, i would imagine, those who signed on to that legislation. you know, it's unfortunate, though, to continue to distort and misrepresent what happens here in the body of the senate. it's difficult enough to have comity t.'s difficult enough to have cooperation. it's difficult enough to have collegiality. when politics are put above policy and productivity, this is what we get. mr. president, i'm very disappointed, somewhat disillusioned by the use of this

method and this technology or this approach that would undermine the good name of a company in nebraska as well as the name of the state of nebraska by associating it with something that is not -- that has not been done, was not intended and didn't result. mr. president, with that, i yield the floor. the presiding officer: who seeks recognition? mr. baucus: mr. president? i yield 15 minutes to the senator from delaware. mr. carper: i express my thanks for 17 minutes. i would ask the chair to please advise me when i've used 15 of those. the presiding officer: i will do so. mr. carper: listening to the debate today reminds me of, among others, a famous quotation from winston churchill, who i believe said the worst form of government divides by one of many. he was talking about democracy. he said it was the worst form of

government divides by wit of man. and they he adds except for the rest. we like to advise the afghanis on how to run a democracy and we still struggle with it after more than 200 years. i've never seen the struggle as much as we have on the issue of health care. part of the reason why is it's enormously complex and it's confusing. people following the debate, if you listen to the folks on the political left, postally in our party, what we hear is, you know, no public option, no medicare buy-in, we're not doing enough to make health care affordable. what we hear from the right, mostly on the other side of the aisle, is this is government-run, this is government-funded, this is a government takeover. so you have the two extremes out here taking shots at one another. those of us in the middle are

collateral damage or road kill. at the end of the day, a lot of times the left or the right is entirely pleased with the outcome, sometimes that suggests the outcome isn't all that bad. i'm not saying this is a perfect balance, but it's not a bad pwafplt for those, especially in our party who feel like we should have done more, i'm sure in 1965 when lyndon johnson signed into law medicare legislation that there were probably some who maybe thought, who didn't vote for it. i'm told it was mostly democrats who voted for it. not so much our republican friends. i'm not sure how many democrats who voted for medicare at the time said, you know, this doesn't do enough for our senior citizens. it doesn't provide for hospice care. it doesn't provide for home health care. it doesn't provide for disability benefits for those who are under the age of 65. there's no prescription drug program. there's nothing for outpatient surgery. none of those things in the original medicare legislation.

over time they have been added, and the medicare legislation and medicare law has, i think, been improved to make it a better program. now we face a day when the medicare program is literally running out of money. and one of the less told secrets in the legislation that's before us is the medicare trust fund, whose life has been down to about seven or eight years, i understand thanks to the reforms that are in this legislation are going to be pretty much doubled. that's not good enough, but we're going to stretch by about 100% the useful remaining life of the medicare program. another fact sort of lost in all the debate and -- tumult is what this does with respect to budget deficits. i'm told by the neutral congressional budget office, which is neither democrat nor republican, nonpartisan, that the legislation, if we adopt it in its current form will reduce deficits over the next ten years by about $130 billion, or as

much as maybe $1.3 trillion in the second ten years beyond that. in terms of what's going to happen in the cost of premiums, we're told again by the nonpartisan congressional budget office, that rather than spiking premiums, we're actually going to see people get somewhat better coverage for frankly not more money in terms of their premiums. and in terms of for those of us who just love the health insurance that we have, who are just delighted with the coverage and the amount that we pay for it, i would just remind all of us a couple things. one, we have spent more money by far than any nation on earth for health care. about one and a half times more than the next closest country. we don't get better results, and in many cases we get worse results. we've got about 14,000 people who work up with health care coverage this morning. they'll wake up tomorrow morning and they won't have it. they will have lost it. finally, we've got big companies like g.m. and chrysler that have

gone bankrupt because they can't compete with foreign competitors because of the price of their health care. a lot of smaller companies as well. and the idea of doing nothing is, to my mind, not a very smart thing to do. we've got to do a number of things to accomplish three goals: number one, rein in the cost of health care costs. two or three times the rate of inflation. frankly, if we don't rein in the growth of health care costs, neither will be sustainable the cost of people who have it today. the third thing we try to work on in this legislation to the extent we can, but a lot of interesting things are going on in the private sector, very interesting things going on in the private sector regarding how to instill personal responsibility in employees and how to get better transparency and better costs through the health care delivery system that are going to be a part of this as well. we've got to figure out a way to provide better outcomes, and there's a lot of good examples