seniors. they're the only ones left standing. and there will have to be cuts. real cuts. the docs, they made -- they made a deal. i just saw a letter from them that say they now support the bill. let's see, for a while they had a whole years worth of change in their pay. now they have two months where they will be paid what they think is less than adequate, but okay to stay in business. and evidently they think that even though the senate turned down because we couldn't afford to pay for it, $250 billion in adjustments to what they get paid because it wasn't paid for that we're going to come back and do that without it being paid for. it could have been paid for, it could have been paid for out of the medicare money using it for medicare only. mr. president, i'd ask unanimous consent to put some things in

the -- in the record. the presiding officer: without objection. mr. enzi: someone a december 2 article from the "caspar star tribune" by a nationally known columnist, cal thomas. he says, "there were two snow jobs in washington over the weekend. one came from the skies as a record december snowfall blanketed the city. the other came from capitol hill, where the senators passed a massive health care reform bill." the presiding officer: time has expired. mr. enzi: i'd ask that a floor statement i did on the job-killing tax be made a part of the record. the presiding officer: without objection. mr. enzi: i'd ask unanimous consent that the "wall street journal" article called "obama's longshoremen rules" be included in the record. the presiding officer: without objection. mr. enzi: it points out how the excise tax -- there be an excise tax in 17 states with the highest cost but yet we made an exception for a number of unions, particularly now adding the longshoremens union to not being subject to some of the taxes in the bill. i'd ask unanimous consent that a

letter from a number of contractors be included in the record. the presiding officer: without objection. mr. enzi: it points out that -- how most businesses have an exclusion of 50 employees or less but they've singled out the construction industry with an exemption of fewer than five employees. and i'd ask unanimous consent that a "wall street journal" article that covers that same topic be included in the record as well. the presiding officer: without objection. mr. enzi: i thank the chair and yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i have one unanimous consent request for a committee to meet during today's session of the senate. it has the approval of the majority and minority leaders. i ask this request be agreed to and this request be printed in the record. the presiding officer: without objection. mr. baucus: mr. president, i now yield to senator murray from washington -- i suggest she be recognized to speak for seven minutes. the presiding officer: the senator from washington. mrs. murray: thank you,

mr. president. mr. president, the health insurance system in our country has been broken for a very lone time. for far too long, families and businesses across my home state of washington have been forced to make some tough decisions, spending nights struggling or whispering after their kids go to bed about how to pay the bills and praying they don't get sick. i'm proud to say, mr. president, that's about to change. over the course of months of work on this issue, i've noticed it's very easy for this debate to tip into the realm of abstractions to focus on numbers and charts and to devolve into petty partisanship or ideological inflexibility. and too often, real people get left out of this conversation. mothers and fathers who are scared they're going to lose their jobs and families that are scared they're going to lose their insurance. people with preexisting conditions who can't get coverage and who know that they're just one hospital visit

aware from bankruptcy. small business owners who can't afford another premium increase and who want to cover their employees but they can't keep up with the rising costs. senior citizens who are forced to cut their pills in half to make them last twice as long. people who pay their premiums and like their doctors but when they get sick, they find out that some of the most personal choices in their lives are being made by their insurance companies. these are the real people who need real health insurance reform. mr. president, most americans seem to fall into one of those categories. over the past few months, i have tried to ensure that the struggles of people in my home state are represented in this debate. i told my colleagues the stories that i have received in over 10,000 letters and e-mails and at round-tables and on the phone, stories told to me too often by men and women with tears in their eyes or a quiver in their voice, people who are not looking for a handout for a free ride but who are pleading

for a fair system. a system that works for families or businesses like theirs. i shared the story of janet from seattle. she lost her job, lost her insurance and succumbed to cancer after being forced to wait six weeks to see a specialist after her throat began to hurt. janet's story is why we need to reform the health insurance system. i told my colleagues the story of joseph and his wife who was denied an m.r.i. after complaining of a pain in her chest and only after three years of fighting, thei their insurane company, were able to determine she had breast cancer and begin the treatment that she desperately needed. their story is why we need real health insurance reform. i told the story of mark peters, a man from port townsend, who owns a small technology company and he told me he's being crushed by skyrocketing premiums. he offers health insurance to his employees. he does the right thing. but he told me he just got a letter from his insurance company raising his rates by 2

25%. 25%. mark told me that his small business can't sustain increases like that. no business can. but in our current health insurance system, small businesses are often at the mercy of the insurance compan companies. this company's story is why we need to reform the health insurance system. and i told the story of patricia jackson from woodenville, who has private insurance but can't keep up with the rising premiums. to provide care for her family of four, patricia told me she paid $840 a month in 2007. the next year, $900 a month. and then $1,18 6 a month and again her rates were raised to a hike of $1,400 a month. that is an increase of over 66% in just three years. patricia and her family's story is why we need to reform the health insurance system.

mr. president, i told my colleagues the story of marcellas owens. now, marcellas owens is a young man i have thought about every single day since we started -- since i actually met him back in june. marcellas is only ten years old. he has two younger siblings that you can see here in the photo with him. this is his grandmother. but he and his siblings have been through a lot. two years ago, their mother, tiffany, lost her life because she was uninsured. she was 27 years old. tiffany was a single mom who worked as an assistant manager in a fast-food restaurant. she had health care coverage through her job, but in september of 2006, marcellas told me that she got sick, she lost her job, she lost her insurance, and ultimately she lost her life. and marcellas and his sisters

lost their mom. health insurance reform is coming too late for tiffany but her story and the story marcellas tells me is why we need to reform health insurance. real people, real stories, real needs -- that's why we're here now and that's why we've got to get this done. when we pass this bill, americans will be able to shop for coverage that meets their needs, and for the first time, insurance companies will have to compete for our business, for the business of the american people. when we pass this bill, we'll end discrimination based on preexisting conditions and make it illegal to drop people when they get sick. when we pass this bill, we're going to give tax credits to small businesses and help the self-employed afford care. when we piss this bill, we're going to make preventive services free, end lifetime coverage limits and cap out-of-pocket fees.

and we're going to extend the life of medicare without cutting guaranteed benefits while shrinking the doughnut hole gap in drug coverage for our seniors. whether we pass this bill, people like mark and patricia and joseph and his wife will be helped, and the memories of people like janet and tiffany will be honored. that's why we need to reform the health insurance system. mr. president, i want to thank the more than 10,000 people in my home state of washington who sent me their personal health care stories. their input has helped guide me as i worked on this bill and have served as a constant and welcome reminder about who i am here to represent. i urge my colleagues to stand with these families and with the families and small business owners in their states and across the country who desperately need this reform. health insurance reform has been a longtime coming, but today we stand closer than ever to making it reality. thank you, mr. president.

i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. balks: mr. president, i yield 18 minutes to -- mr. baucus: mr. president, i yield 18 minutes to the senator from minnesota, mr. franken. the presiding officer: the senator from minnesota. mr. franken: thank you. thank you, mr. president. we've been work this bill for a long time and i'm proud of what we're doing here. every senator has had his or her chance to speak up and help make this a better bill or to make a case against the bill. unfortunately, it's been a bit rancorous and i think that's too bad. there have been accusations flying back and forth, umbrage has been taken. this place as become annum barragan umbragefactory. i even took umbrage once and i feel bad about that. my colleagues across the aisle have taken great umbrage because we've accused them of using scare tactics. well, may i point out that the title of my friend from oklahoma's piece in last wednesday's "wall street journal" is: "the health bill is

scary." exhibit a. in our case that the other side has, indeed, used scare tactics, the op-ed entitled "the health bill is scary." but seriously, when you're talking about people's health, there's more than enough fear to go around. instead of scaring people, we should be debating the merits of the proposal in front of us. we've heard a lot of stories. we all know our health care system is screwed up. we can all agree on that. but the most important things to know about the bill are what is actually in it and will it help. you see, this bill is too important for us to hide what it would do -- to hide it from our bosses, the american people. we have a duty to let the american people know exactly what we're doing on their beha behalf. that's why i've been so disappointed when my friends and colleagues say -- and i actually

agree with them -- that americans are confused about what's in this bill. well, they wouldn't be so confused if everyone was being honest and forthright about what's in the bill. i have to say, i've heard a lot of misinformation over the last several weeks. some on the airwaves and unfortunately some right here on the floor. very early on monday morning, i heard a colleague on the floor say that this bill is going to add $2.5 trillion to our defic deficit. that's simply made up. the nonpartisan congressional budget office, the official score keeper of congress, says the bill reduces the debt by $132 billion in the next 10 years and then they estimate the bill lowers the debt by at least five times that am in the following decade. you see -- that amount in the following decade. you see, c.b.o. is like a referee and we all agree to let the ref make the calls about what things will cost. now, it's completely possible

that we'll disagree on different calls that the ref makes during the game. i don't always agree with c.b.o. for example, i don't think that they score prevention as saving enough. i may be wrong or i may be right but i accept the c.b.o. score because the c.b.o. is the ref. we wouldn't walk away from a basketball game saying we won if the other team scored more points and just say, "well, it was bad reffing; we really won." so we may not like how c.b.o. scores certain provisions but it's all we can go by. there -- these are the rules of the games that we agreed to, of the game. so if we're talking on the floor, you can't just say this bill will add $2.5 trillion to the debt when it isn't at all what the c.b.o. says. no wonder people are confused. people who are trying to kill health reform are deliberately

confusing americans and it's working. a recent study found that more than half of respondents to health care polls say they don't know enough about the bill to give an opinion. then opponents use the fact that people are confused as a reason to draw out this process. the american people is confused and opponents of this bill want more time to confuse them even more. i've heard a colleague on this floor say that this bill wouldn't add one day, he said, not one day to the solvency of medicare. well, that's simply not what the nonpartisan chief medicare actuary found. this is the same actuary who's often cited by opponents of the bill. he has determined that it keeps medicare solvent for an extra nine years. now, colleagues on my side are also making statements that might come under the heading of overselling, saying that for

most people, premiums will go down. well, it is true that for many, many americans, the out-of-pocket costs for better, more secure health insurance will go down. but it's also true that most health care premiums will continue to go up. it's just that they will go up at a slower rate than they would have if this bill weren't adopted. and that's a really good thing. but this bill is going to pass. and so we want people to understand what's happening here we are slowing the growth and the cost of health care. i want to be crystal clear because i don't want to be confusing people either. so today i'm going to try to cut through all this rhetoric and tell you about what's actually in the bill and how it will affect you. now, when i first spoke on this floor on health reform, i related three questions that i

hear most from minnesotans. i heard them when i was at the state fair, when i spoke with tea partiers. i heard them in st. paul, all across the state. first they say health care costs too much. what are we going to do about that? second they ask: what am i going to do if i get sick or my spouse or one of my kids get sick, and then someone in my family has a preexisting condition and then i lose my job? how am i going to get health insurance then? third, they ask: if something bad happens to me, am i going to lose everything? am i going to go bankrupt? now that we're about to pass this bill, let me take up each question and tell you how this will affect you, what this bill will do and what it won't do. remember, this legislation is an important first step but not the final word. first, what does this bill do about health care costing so much? well, let's take a look at a

point that dr. atul gawande de, a harvard physician makes, he points out almost half of this bill to try out programs to try out ways to lower costs and improve quality. some think this is a weakness of the bill but i think it is a strength. gawande points with a system as complex as ours, there is no onetime fix. there is not one simple solution. as much as i wish it were, the whole country can't be like the mayo clinic or other insurance companies in my state or inner mountain in utah. one size may not fit all. these pilots will fix the biggest problems. thanks to the efforts of maria cantwell and my colleague amy

klobuchar and others, for the first time ever we will include what's called the value index in the medicare payment structure. doctors and states that provide high-quality care at a reasonable cost will no longer be punished for that. instead they will be rewarded for being effective partners in their patient's care. the bill also calls for all health insurance companies to use a single, uniform standard for claims. just like we do now in minnesota and which will save our state $60 million just this year. there are lots of ideas, and we just don't know which ones yet will work the best. but the point is that all the key elements are here in this bill. one program in the bill that i'm particularly proud of is the diabetes prevention program at c.d.c. i worked on these provisions with my republican colleague,

dick lugar, from indiana, who is a hero of mine. the diabetes prevention program is based on what we learned in minnesota and in indiana. prediabetics can avoid becoming diabetic if they get access to community services like nutritional counseling and gym memberships. these are proven to cut the risk of developing diabetes in half so people can live healthier lives and their health care costs less. we'll replicate this program across the country. we'll also guarantee that routine checkups and recommended preventive care like colonoscopies and mammograms are covered by all insurance plans at no cost. no co-pays for preventive care. i'm also happy the bill requires a minimum medical loss ratio, something i've been fighting for with senator rockefeller. this is going to make health

insurance companies put at least 85% of their premiums toward actual health services, not administrative costs, marketing campaigns or profits or bloated c.e.o. salaries. advocates have been trying to get these profit restrictions in place in many states, but it's usually too hard to fight these companies on a local level. while i'm really disappointed we don't have a public option, the minimum medical loss ratio is a potent measure that will limit insurers' profits and put the brakes on skyrocketing premiums. diabetes prevention, minimum medical loss ratio, incentivizing value over volume, these are just a few of the innovative ways this bill will bring down costs. all the basic ingredients for success are here. dr. john gruber, professor of economics from m.i.t. agrees. this is what he said about our bill -- quote -- "it is really hard to figure out how to bend

the cost curve, but i can't think of a thing to try they didn't try. they really make the best effort anybody has ever made. everything is in here. i can't think of anything i do that they are not doing in this bill. so, when two of my colleagues said two days ago there's no health reform in this bill, that's just confusing. it's confusing. the next question i hear from minnesotans is: what if i get sick or lose my job, what will i do? this bill reforms insurance markets, guaranteeing that having health insurance equals security. some of these reforms will kick in when the bill passes. others will kick in four years from now. i wish we could do everything at once, but we're making a complex set of reforms and it will take time to implement them and generate the cost savings necessary to pay for the benefits you'll receive. for the minnesotans who just can't afford the coverage that they have because they're sick or have a preexisting condition,

what will this bill do for them? well, six months after this bill is passed, we'll get rid of all preexisting condition exclusions for kids, and young adults will be able to stay on their parents' insurance until they turn 27. that's big. within 90 days, families who get turned down because of preexisting conditions will have access to nonprofit insurance coverage designed to cover people who can't pay for insurance on their own. these are called high-risk pools, and many states like minnesota have these plans in some form. the good thing is that this bill will invest $5 billion to help people afford premiums in the high-risk pools. then in 2014, anybody who doesn't have an affordable plan through work or has been denied coverage will be able to go to the web site, to a web site and purchase coverage through a new insurance marketplace called the exchange. no one will be turned away or charged more because of their health status or because they

happen to be a woman. it will let you compare plans and prices, what you pay will be based on your income. no one will pay more than 10.2% of their income for premiums in the exchange. lower-income families will pay significantly less. and if the coverage offered through your employer costs you more than 8% of your income, you can go to the exchange. there are also many people who have insurance who are worried about losing what they have. like minnesotans who work for small businesses that are squeezed by growing health care costs. beginning in 2010, this bill will give small businesses tax credits to pay up to 35% of their employees' premiums. more small businesses will be able to cover more employees more affordably. and then in 2014, once these exchanges are up and running, small businesses can choose to go into the exchange so they can

pool their risks with other small businesses. these reforms will bring an additional 295,000 minnesotans, bring coverage to them by 2019. there should be no confusion, this is real reform. lastly, minnesotans ask me: will i go bankrupt from health care costs? i hear from a lot of minnesotans who have maxed out their health insurance or are getting uncomfortably close to their annual or lifetime limits. these arbitrary limits let insurance companies off the hook and leave you holding the bill when you're sick and need help the most. 50% of personal bankruptcies in this country are due to the health care crisis. the good news is that within six months of passing this bill, new plans will not have lifetime limits on benefits and will stop companies from posing annual limits on needed care. when the changes are operational, the use of annual limits will be banned entirely.

i'd like to ban all limits on all plans, new and existing, right away, but this is an example of how we've had to compromise in order to keep the cost of the bill down so that we're being fiscal skhreu sponsor and -- fiscally responsible and not adding to the debt. when this bill is fully implemented, it will give americans access to affordable health care so they can avoid going bankrupt when they get really sick. that's really good. and there's more. we'll start closing the medicare prescription doughnut hole in 2010, invest in home visits for new mothers, more loan forgiveness for primary care providers and for doctors to practice in rural areas. the public health investment fund, stronger antifraud laws, support for people with disabilities to stay out of nursing homes and funding for community health centers. i said at the beginning of this debate that there would be amendments to make it an even better bill and that there would

be amendments that would make it less to my liking, and, therefore, a less good bill, from my point of view. but i also said i would only support a bill if it makes quality health care available to tens of thousands of additional minnesotans and tens of millions of more americans. we've all compromised on many fronts, but the bill we have before us is real reform and deserves our support. the bill deserves our support because minnesotans and americans can't wait any longer. as martin luther king jr. once said, "of all the forms of inequality, injustice in health care is the most shocking and inhumane." we have the opportunity to express our humanity today, to make our country healthier and more secure for generations to come. i'd like to conclude by sharing a letter i received from john

goldfein in duluth, minnesota. john operates a business on the shores of lake superior and wrote to share a request he received to donate money from those suffering financial crisis because of the health care costs. john was asked to donate to a cancer benefit -- the presiding officer: the senator's time has expired. mr. franken: -- to a woman who has melanoma. may i have two more minutes? the presiding officer: without objection. mr. franken: thank you. john was asked to donate to a cancer benefit for a woman who's had melanoma, to attend a spaghetti dinner for an 11-year-old with brain cancer, a bake sail for -- bake sale for a woman in need for a kidney and pancake breakfast for a burn survivor. this is what john says: as a business owner in duluth, these are a few of the requests we've

received in the past few years. we've given a fund-raiser to help people pay for their medical expenses. as i travel the country and go into grocery stores, restaurants and convenience stores, i always take a minute to look at what is going on in the area. rare is the time that i do not see a fund-raiser to help someone with their health care bills and expenses. i know you know how wrong this is, but i am left wondering what some of your fellow congressmen and senators are thinking. maybe they need to go home and look at some of these community bulletin boards. every time i look at one of these, i want to cry. i know how hard this battle is, he writes. i know there will be more compromises, but please do not leave empty-handed. there are so many people out there that really need some help. i'm proud that i'm voting for this bill to help provide help to people who need it.

mr. president, thank you for the extra time, and i yield the floor. mr. durbin: mr. president, let me thank my colleague from minnesota. that letter from your constituent is heartfelt and should be an inspiration to all of us to get this job done. we've sacrificed. this is the 24th day of debating this bill. some of these sessions have been early in the morning, late at night, and i think the time has been well spent. people have come to the floor and spoken at great length, but no one more eloquently than your constituent who sent that letter. come tomorrow morning we will have the official vote very early in the morning. i'd like to say to my colleagues from west virginia and minnesota, we have a piece of news here. a lost what's been said on the floor has been said by others and said before, but this is a piece of news worth reporting. our bill, the health care reform bill, has been endorsed by the american medical association, the doctors, the largest physicians organization in this country. it's been endorsed by the american hospital association, the largest organization representing our hospitals. it's been endorsed by the

american association of retired persons, the largest senior citizens organization which focuses intensely on the future of medicare. but today we received the endorsement of what is regarded by most as the most highly respected medical profession in america. if you ask most americans who do you respect the most, it's the nurses. and you know why. because when you're in a hospital with someone you love or in the care of a doctor, it's the nurse who's with you those moments that make a lifetime. and the nurses today have issued their formal endorsement of this health care reform bill. rose gonzalez, who's director of government affairs for the american nurses association writes, "nurses across the country have waited decades for this historic moment and the time is at hand. once again the need for fundamental reform of the u.s. health care system is critical. the american nurses association and nurses around the country are ready to work with you toward enactment of the strongest possible health care reform legislation." for all of our critics from the

other side of the aisle, the simple fact is this: the people who are on the frontline of health care, the people that we turn to every day for critical care and critical treatment of the people we love endorse this measure. they have come out foursquare for it. i would rather have their endorsement than any political endorsement that we might find. now, let me tell you, this is significant. this bill will change many things. some on the other side have criticized the bill because it's too big. they want a small bill. i want a bill that's large enough to treat the problem. it's like saying to a doctor, you can give me a prescription but only give me one. i can only take one prescription at a time. in this bill, we address problems existing in our health care system that really go to the heart of the challenge that faces our nation. we have great doctors and hospitals and nurses but we spend twice as much, more than twice as much as any other nation on earth per health care

n. som.in some areas, many spena fraction of what we spend getting better results. and we know the cost of health care is getting beyond us. we know that a family of four with a health insurance plan now through their employer pays on average 12,000 a year for premiums. ten years ago, it was $6,000. it's projected to double again in just eight years. and think of it, the people would be working to earn $2,000 a month just to pay for health insurance. that's before you take the first penny home for your family. that's unsustainable. the first thing we do is address affordability, start bringing down the increase in costs in health care. that is our first responsibility and this bill does it. the second thing it does is extend the reach of health insurance protection. as i stand here, one out of every six americans has no health insurance. these are not lazy, schiffless people. these are people who can't afford it, who work at a place

that doesn't offer it, or happen to be unemployed. at the end of the day, 60% of those people, 30 million, will have the protection of health insurance. that is critically important. and this bill provides protections that people need who have health insurance. how many times have you heard about a friend or a family member who has to fight an insurance company for the payment for critical care that the doctor has ordered or over a prescription which the doctor believes will keep you healthy or make you well? those battles are now going to tip to the side of the consumers of america. health insurance companies won't be able to discriminate based on preexisting conditions or put caps on lifetime policies or tell your kids that at age 24, they can no longer be covered by your family health care plan. all of those things are changed in this bill, giving consumers across america a fighting chance when it comes to health insurance. i want to tell you, last night i met with several of my colleagues and they -- we talked over dinner about how america is going to react to this. it's hard enough for us to

digest the contents of this bill. to expect the average american, who has so many other concerns, to do it may be too much and too much to ask. but what i did to my staff this morning is i said, give me a list of the things that most americans can expect to see, the changes they can expect to see on a timely basis. not the long-term changes, where 4% of people -- 94% of people have health insurance or we have a better standing to fight health insurance companies when they discriminate. but what will we be able to see? and they came up with, conveniently, a top 10 list which frankly most of us are familiar with from a late-night television show. and let me tell you, within six months after this bill is enacted into law, here are the top 10 things americans will notice is changing. number one, if you own a small business, you will start receiving within six months tax credits to help your business pay for health insurance for their employees beginning with tax year 2010.

144,000 small businesses in my state of illinois will be eligible for this small business tax credit so that smaller businesses can afford to offer health insurance for the owners of the business and for their employees. that's number one. number two -- and this is all within 90 days of enactment. number two, we are going to create immediate options for people who can't get insurance today. we estimate that 8% of the people in my state have diabet diabetes, 28% have high blood pressure, and all of them could be denied coverage because of this so-called preexisting condition. we are going to put in place high-risk pools so that these people who can't buy health insurance today because of these preexisting conditions have an option, a place to turn to buy health insurance. that's number two. number three -- and this is good news for every family and every parent -- within six months after the enactment of this bi bill, the parents of loved ones, of 3.6 million kids in my state,

will sleep better knowing that whatever health insurance they have will be required to cover their child regardless of any preexisting condition. any child under the age of 18 with a diagnosis of diabetes or a history of cancer or asthma or whatever it may be cannot be denied coverage under your family plan within six months of this bill being enacted. number four, you'll no longer need to fear an insurance company drops you from coverage once you get sick. it's called rescission and it basically means as soon as you need the health insurance, the health insurance companies run away and say we're not covering you anymore, hire a lawyer and fight us if you don't like that. that comes to an end within six months after this bill passes. number five, you'll no longer need worry if you get sick or in an accident because you're out of town and out of the network of hospitals and doctors your insurance policy provides. this bill ensures access to emergency care in network and out of network without

additional cost sharing beginning six months after the date of enactment. number six, you will have the freedom to choose your doctor, the person you think is right for you and your family. this bill protects your choice by allowing plan members to pick any participating primary care provider and prohibit insurers from requiring prior authorization before a woman, for example, goes in for a gynecological examination. number seven, you will no longer fearinfear losing your home or g bankrupt because of a car accident or a serious illness like cancer. this bill, when it becomes law, will bar insurance companies from limiting lifetime benefits and severely restricting annual benefits under the health insurance policy. number eight, this bill will require providing preventive services and immunizations without co-pay. 41% of the people in my state have not had a colorectal cancer screening. 2% of the women in illinois over

the age of 50 have not had a mammogram in -- 22% of the women in illinois over the age of 50 have not had a mammogram in the last two years. passage of this bill will assure that people can access preventive care for free. it is an ounce of prevention, and it will be built into law six months after it passes. number nine, senior citizens are going to know the difference within six months. they will have access to dramatic discounts in the purchase of name-brand prescription drugs under medicare part-d beginning july 1, 2010. roughly 314,000 medicare beneficiaries in illinois hit the so-called doughnut hole, the gap in coverage. well, they're going to have protection that's going to be provided by this bill. and number 10, seniors across america will be eligible for one free wellness visit each year without charge. think about that. the peace of mind which it brings to you and to your family to know that you've had a checkup and the doctor says you're doing fine or takes care of a problem before it becomes

major. those are the top ten things to expect in the first six months and more to follow. this is a bill worth voting for. this is a bill which finally puts us on record as a nation that health care is not just a privilege of the lucky and the wealthy, it is a privilege of living in this great nation. it is a right that comes to all of us. if we truly want to enshrine that guarantee of life, let us enshrine in this bill guaranteed access to quality health care. we've had a long debate here. those on the other side have been critical of this bill. they have never offered an alternative, want one substitute, comprehensive alternative. they just can't do it and they won't. but we know we have the responsibility to do it. with some votes this afternoon in just a couple hours and then again tomorrow morning, we are going to make this bill a bill that has passed the senate on its way to conference with the house by the 1st of the year, this new coming year, we'll be able to offer that promise of

quality care which the american people are asking for. madam president, i yield the floor. mr. rockefeller: madam president? the presiding officer: the senator from west virginia. mr. rockefeller: i thank you. i rise today to join with my colleagues, in fact, to stand very proudly with my colleagues in support of the senate passage of groundbreaking, comprehensive health care reform, something that i've wanted to say for decades. it has taken not just the better part of a year. really, this is something which has gone back a full generation. the story of health care reform over the last 50 years has been one of narrow, incremental change. some quite meaningful. the children's health insurance program, for example. but none truly comprehensive in the way that americans want to have their health care. and it's a history of big ideas

left unrealized, for lack of political will, for lack of ti time, whatever. of leaders and lawmakers and the medical profession at large all trying boldly yet all failing badly. failing fundamentally to take away the fear of so many, the sheer terror of living and getting sick in america today. the terror of becoming sick in a country that holds itself out as a beacon of hope, a beacon of fairness yet denies men, women and children access to the doctors and nurses and the tests and medicines that we know will prevent illness or will make them well. a country that allows people, especially low-income people,

not only low-income people, however, to suffer, or watch a beloved family member suffer alone and outside the health care system. all at great cost to our national economy and our national productivity and our national sense of self-esteem. but even more importantly, to our national soul, to our moral compass, to our conscience. now, in the final days of 2009, we have a profound opportunity to deliver on years and years of unmet promises and to begin a new decade by building a strong, new foundation for the american people, for all of them. to wit: a more secure and

reliable health care system that works for virtually all americans, where those who really are uninsured finally have someplace to go for health care. where those with insurance know that the coverage they count on and pay for will be there when they need it. they'll know that. and where a profit-driven health insurance industry cannot play mercilessly with people's lives or steal their hope so that the health insurance company can have just a very prosperous future. a very gloomy chapter in our nation's business history. each of us brings to this moment shared stories about the tragic and trying personal experiences of our friends and neighbors back home. we're all motivated by this. we're all moved by this.

i know that west virginia struggles with the -- west virginia's struggles with the health care system are not unique in america but they are unique to me because i represent them, and they are what drive notice work so hard -- drive me to work so hard to make things better. that never changes. so i talk about the board fami family. the boards are two dedicated schoolteachers with health insurance through their employ employer, whose son samuel had leukemia and needed treatment well beyond the onerous annual insurance limits imposed upon him without his knowledge and, therefore, his health insurance stopped producing any care for him at all. at eight years old, what was he

to know? samuel's parents were desperate and they feared for the worst. when he hit his million-dollar cap on annual insurance, my office helped his parents to find some more resources, but those ran out too so the boards were left with two gut-wrenching suggestions. consider getting a divorce so that samuel would qualify for medicaid. or stop taking their other two children and giving them health care so that they could spend the money that they had been spending in part on samuel, take it all away from the other two children to help with samuel as best they could. people are desperate. they try anything. the choices are all cruel. so, it's right, i mean, you get

a divorce our choose one child's health care needs over another. that's not what parents want to be like. those are the choices our nation offered to these caring, hard-working parents with a sick child. how can that be? how can we allow that to be? the answer is, of course, that we cannot. they did everything in their power, but this fall samuel passed away. there are no words. it breaks my heart to think of what his parents went through. not only the pain of watching their son fight a terrible disease, but also the uncertainty of paying for his treatment as best as they could, and then have the coverage that they counted on and paid for suddenly cease to exist.

so, i say to my colleagues, when do we say collectively that enough is enough? when do we finally step in and try to solve such an enormous set of problems? so much is at stake. so many people's needs and expectations are so high, and so are mine and so are yours, i would say to the presiding officer. i know all too well that reform is not about shying away from the tough issues or the tough decisions. reform is not about reaching perfect agreements on a perfect piece of legislation. reform is making things better for people as much as you can for as long as you can with as much money as you can possibly collect to pay for it.

there are real and serious differences of opinion among us, among our esteemed colleagues in the house of representatives as well. the senate, the house, there are differences. within the senate, one side of the aisle, the other side, there are differences. within the democratic party, there are differences. so we have struggled to find solutions that will make a difference that we can afford. and we've had to negotiate and compromise. and now, madam chairman, mrs. president, now we vote in a few short hours. an extraordinary moment in history, nothing like it that i've ever seen. we vote, i believe, to improve access to affordable and meaningful coverage, to control runaway costs -- have to do that so the medicare trust fund doesn't run out -- and to rein

in the health insurance rapacious practices. i don't like them, and they don't like taking care of us. and they don't. aim disappointed that this legislation does not include a strong public option like the one i first introduced to keep private companies honest? am i disappoint it had does not include a sensible medicare buy-in provisions that should be a right for millions of americans? of course i am. does that mean that i turn my back and walk away from all of this because i didn't get everything that i wanted? of course not. i'm a public official. i represent people. i represent their interests. even as they maybe in the majority oppose what they're doing here because they know not

yet entirely what is in this bill. but when they do, they feel feel differently. am i disappointed that we're unable to expand medicaid even more for our most vulnerable americans? yeah, of course i was. i live in a state that in the average hospital, 85% of all patients are either under medicaid or medicare. and as my colleagues in the finance committee heard me say often, 50% of all babies born in west virginia are born under medicaid. it's the way it is there, the people i represent. so, yes, of course i'm disappointed that we don't have more. but i still believe those are among the best and right solutions in this bill for our health care system. they are the best that we can do at this particular time, and it is a great deal that we are

doing. and it is an unavoidable fact that this bill does not do everything that i had hoped for. but again, that would not justify turning my back on what the bill does achievement why is it that we always seek out the negative and avoid the positive? because the negative is easier to talk about, easier to criticize than to do, than to collect people together under an umbrella. the ultimate question cannot be what the bill does not do. it cannot end there because in so many ways what this bill does do is make good on the powerful promise of meaningful reform that millions of people have dreamt for, have prayed for, have fought for for so long. passing health care reform will mean 31 million previously

uninsured americans will now get health care coverage. excuse me? 31 million people? extraordinary. it's in the bill. passing health reform will extend medicaid so that vulnerable populations can get the health care that they need. passing health care reform will close almost the doughnut hole that hurts 3.4 million seniors enrolled in the medicare prescription drug program. 3.4 million seniors is a lot. so we close at least half the doughnut hole, and then we give people a bonus for this coming year. but by closing half, we're signaling that we're going to close it all. health care is now, will be done each year, every year to make things better. passing health care reform will mean the elimination of

preexisting condition exclusions right away for our children. and as soon as the exchanges are up and running, that will apply also to adults. passing health care reform will mean it is illegal for insurance companies to impose arbitrary limits as they did annually on samuel. or lifetime benefits, like the board family faced so courageously. passing health care reform will mean insurance companies are required to spend more of their money which comes from premiums, that we give them, on medical care. not fancy offices and executives' salaries. they will be required to achieve a medical loss ratio of 85% to 90%. we shall see. they will have to prove it.

we already have the numbers. we know where to go to get the numbers. nobody's done it. so they can play in their shifty darkness and deprive people of things, take things away and people don't know where to go to complain, and they just get referred somewhere else. this will be the very first time, madam president, that they are held accountable. and they will be held accountable. they will be held accountable by the law, by congressional oversight, by a ferocity of attention on what health insurance has done to hurt so many people, and how now they're going to behalf in a very different manner. whether they like it or whether they don't. passing health care reform will mean family coverage must khrup khrup -- must include dependent children up to the age of 26. that's exciting.

it's exciting because young people don't tend to get health insurance because they think nothing will ever happen to them. it actually doesn't work out like that, and when they get hurt somebody else has to pay. they should have their own health insurance. and so they're going to get it. they will not be outside of the health care system. they will be inside the health care system. passing health care reform will mean protecting the children's' health insurance program or chip, which john chafee and i wrote back in the mid-1990's, and ted kennedy and orrin hatch first established through the "help" committee in 1997. in a show of bipartisanship, which frankly, i am nostalgic for these days and which will cover more than 14 million children by the year 2013.

today chip covers 7 million, but it's run out of its ten years so it has to be reauthorized. then we add on two more years and the program will keep going on and on, and children will have health insurance forever. passing health care reform will mean guaranteed prevention and wellness benefits for seniors so that they can get the regular checkups that are so important. it's a big tkaoefplt somebody told me once -- it's a big deal. somebody told me once that there are about 9 million american seniors who live alone. in west virginia, it might be on the tops of hills. but they are basically alone, by themselves. they are aged. they have problems. does anybody check in on them? does anybody call them? do they have a telephone? have you eaten your food today? do you have food? are you okay?

did you fall down? did you break your hip? is there somebody to check? we have the to do a lot better than that, madam president, and through this bill we will. and passing health care reform will mean that we finally begin to get politics and lobbyists out of the business of deciding medicare payments. that's very important for me, because we can create new hope, perhaps our only hope, for kpaoepg medicare stable and solvent for the long term -- for keeping medicare stable and solvent for the long term. and the list goes on and on. real, meaningful, life-changing, and in some cases life-saeufrg new laws that will become policy. not since the creation of medicare and medicaid nearly 45 years ago has this body or the other body attempted to make a commitment as fundamental to our future in health care as we are

doing here. fortunately, this commitment won't end with the passage of this legislation. we won't have to wait another 15 to 20 years to take up the cause of reform because the intensity of the experience, the passion of the experience, the depth of the feeling in discussing the experience as we've talked become and forth with each other, this now becomes an annual commitment. we will be doing health care every single year until we get it exactly right. we have not gotten here by accident, madam president, or by chance. and we will not get all the way across the finish line without more hard work and hopefully goodwill. to those on the left who are disappointed in what this bill does not do and in some cases are even -- those focus are even

calling for its demise, i implore you to reconsider, to be a part of this solution even as we keep working on others, which i promise you i will do. and i think you know that i mean what i say when i say it. to those on the right, who in all these years somehow have not seen fit to accept any of the various options and ideas that are put on tables for comprehensive reform, i ask you to seek the facts, find the truth, follow the facts, follow the truth. there are legitimate disagreements between us about how best to solve the problems plaguing our health care system and hurting our people, but the status quo is unacceptable. claims that we are rushing this process or have operated in secret are absurd.

claims that we will hurt seniors close hospitals, take away people's choices are reckless and disingenuous. our work in this institution affects people's lives every single day in all the work we do, for good or for ill. in public life there's nothing neutral. you either do something that helps or you do something that hurts. and we have a solemn responsibility to help our people in their hour of need, and that's the reason we are here, madam president. it's the only reason we are here. to achieve meaningful reform not just in health care, but in all of their needs. as somebody who's been involved in this debate from the very beginning and fought for strong reforms in the senate finance committee, i know how far we have come to get here. and i, for one, am not going to

allow this moment and its great promise to end in failure. the progress here will be real and the greatly improved quality of life for millions of americans will be its measure. i thank the chair and yield the floor. the presiding officer: the senator from montana. mr. baucus: madam president, i ask unanimous consent that after senator hutchison raises a point of order that the reid substitute amendment number 2786 is in violation of the constitution, that the point of order be set aside until after all postcloture time expires. the presiding officer: is there objection? without objection, so ordered. mrs. hutchison: madam president? the presiding officer: the senator from texas. mrs. hutchison: madam president, i would just ask the distinguished senator from

montana if in the -- following the postcloture time, will my amendment be put in the queue for the votes if i ask for the yeas and nays? mr. baucus: madam president, that, i must say to my good friend from texas, that is my understanding. mrs. hutchison: thank you. thank you, and i thank the senator. madam president, we truly are in uncharted waters. this bill has been written by the majority under a veil of secrecy, and we are expected to vote on its final passage less than two days before families across the country will be sitting down for holiday celebrations. over the last weeks, my colleagues and i have spoken about some of the things that we know to be problematic, ranging from unsustainable cuts to

medicare that will result in scacatastrophic reductions in care -- make no mistake about that -- to oppressive new taxes on individuals, medical devices, prescription drugs, and insurance companies that will clearly raise costs to consumers and stifle innovation and taxes on small businesses at a time when we know our economy is on the brink, we are in a recession, we are asking business to hire people and yet we are forcing burdens on them, taxes on them that would have the opposite effect, it would cause them not to take a chance to hire someone that will have the result of new mandates that go beyond all of the expenses of an employee today.

so we've talked about that for the last three weeks. today i want to talk about the concerns that we have been able to have about three days to find in the -- and the constitutionality of parts of this bill. we haven't had too much time to consider this and certainly constitutional issues will take much thought, but we do believe that some of the bill's provisions do violence to our constitutional protections. members, staff and legal experts are scrambling by the majority's decision to draft a bill that we didn't have a chance to look at in detail because it only was released on saturday and we haven't had very much debate time on these legal issues. i want to commend many of my colleagues for identifying one of my biggest concerns.

the majority claims that the commerce clause of the constitution gives congress the authority to adopt much of what it is that we are looking at today in this substitute before us. what i disagree with and what i don't think has been mentioned is that the power to regulate interstate commerce has not been the basis for a robust role in insurance regulation. our states have the experience, they have the infrastructure in place to carry out this important regulatory role. in comparison, the federal role in regulating private insurance has been limited. in fact, following the decision by congress to exclude federal agencies from any antitrust role in the insurance market, it is our states that have been charged with providing this

regulatory oversight during the last 60 years. and yet usurping the role of the states in regulating health insurance is precisely what the bill before us, the substitute that has been put forward, will do: creating a big role for the federal government -- will do. creating a bill role for the federal government in u.s. health care will also usurp states' rights that have been in place for over 60 years. consider for a moment that the commerce clause is being suggested to allow congress to not only regulate a channel of commerce that historically has been addressed by the states but for congress to actually direct the american people to purchase a specific product or service. mr. president, everyone within the sound of my voice should be

alarmed that members of congress actually believe our constitution, which enumerates and protects our liberties and choices, can be perverted to require americans to purchase something they may not want. and may feel they do not need. such a view is totally at odds with our constitution. i believe strongly that the individual insurance mandates in this bill are unconstitutional. now, the person who has raised the point of order is also on the floor with me, senator ensign from nevada, and he is going to cover that area because i think it is essential that we address it. and i want to bring up another area where i think we also have transgressed over the constitution and that is the

trampling of the rights of our states under the 10th amendment. madam president, i taught constitutional law so i have studied the background of the constitution and i've looked at many facets of it. i'm -- i can't say i'm a constitutional scholar. i am a lawyer but i have taught this subject. i want to read the very clear and simple 10th amendment. the 10th amendment has made clear the following. this is the 10th amendment. that the powers not delegated to the united states by the constitution nor prohibited by it to the states are reserved to the states respectively or to the people.

the beauty of our constitution, mr. president, is that it is a very limiting document. that's why it is short, because everything not specifically given to the federal government is reserved to the states or to the people. that is the beauty of our constitution. and the reason it is short is because the powers were meant to be limited. what was reserved was meant to be limited because our founders knew that the government closest to the people and the people should be responsible for most of the laws of our country. so today, in the bill that we have before us, we have a state like my state of texas and many states across our country, which has taken full responsibility for creating, maintaining and providing oversight for a health insurance plan will now have to

ask permission of federal bureaucrats to alter the terms of the insurance plan. my state of texas has created a fully self-insured plan for state employees and for our teachers so that creation, administration, and oversight will be within the realm of the state. i believe it is very important when we look at the bill before us to see that the states now are going to be required, like every insurance provider, to justify with the federal government changes in premiums regardless of whether that premium might be justified by the federal government.

the states are going to have to now put forward all of the background, what they are doing in their self-insured plans, and justify it before the states apparently will be able to go forward. now, of course, there's going to be a book written on the meaning of "justify." i can see it coming. what exactly does "justify" mean? but, you know, madam president, i don't think we have to go that far to write the book on what "justify" means because this is an encroachment on the rights of states guaranteed by the 10th amendment. it not only walks away from the words themselves of the 10th amendment but walks away from what the founding fathers

intended. and that is that it is the prerogative of the states that make the laws or affect the people. and even congress for the last 60 years has kept the federal government restrained. pretty much -- not completely but pretty much from mandates and regulation of insurance plans. now, there is some but it has largely been left to the states, and the states have provided the infrastructure for what can be offered in a state. but here we go on what is supposed to be the reform of our health care system, we are taking away the rights, the prerogatives of the states and also the expertise that the states have come to -- to --

that they have put together and formed through the years, and the big federal government takeover is going to begin. let me just mention a 1992 case by the supreme court which stated in new york v. united states, the framers explicitly chose a constitution that confers upon congress the power to regulate individuals, not states. so, madam president, i have asked the attorney general of texas to use every resource at his disposal to investigate the provisions in this legislation and to challenge any unconstitutional attempt to limit the authority of texas to carry out its regulatory responsibilities in the insurance market or to provide for the insurance needs of its employees and the teachers of texas through the state health insurance plans.

the attorney general of texas has already said that he is going to challenge the constitutionality of treating one state different from all the other 49 states and the taxation of our residents in texas because of the exemption of the state of nebraska from the medicaid responsibilities that every other state is going to have. and so, of course, every other state will pick up the tab for this nebraska exemption. the attorney general from texas is on it, just like the attorney general of south carolina and probably many more by the time that we will end this day. but i think it is very important that we also stand up on the 10th amendment grounds for the

states to be able to put forward a self-insurance plan or its employees without the permission of the federal government and i feel dutybound to question the constitutionality of this bill on 10th amendment ground. and, therefore, madam president, i make a constitutional point of order against the substitute amendments on the grounds that it violates the 10th amendment of the constitution, and i ask for the yeas and nays. the presiding officer: under the precedents and practices of the senate, the chair has no power or authority to pass on such a point of order. the chair, therefore, under the precedents of the senate, submits the question to the senate: is the point of order well taken? the yeas and nays have been requested. is there a sufficient second? there appears to be. the yeas and nays are ordered. mrs. hutchison: thank you,

madam president. the presiding officer: and under the previous order, the vote on this question will occur after all postcloture time expires. mrs. hutchison: thank you, madam president. that is my understanding. and i very much appreciate the opportunity to bring this forward. i think now that we are finally beginning to digest this bill, we are seeing several areas where points of order have been raised. and i hope that some of these will send this bill back to the drawing board, where it belongs, to have health care reform that will do what we intend it to do when we started, and that is bring down the cost of health care, make more affordable health care possible for more people in this country, and if we could do that on a bipartisan basis, i think the people of america, as they sit down for their holiday celebrations with their families, would have been

well served. madam president, i implore my colleagues to look at the points of order that will be voted on postcloture today and think about the consequences of passing this monstrous piece of legislation that is going to alter the quality of life for every individual, every family, every small business in this country. let's start again and do it right. doing it fast should not be the goal. doing it right is what we should pursue. and i hope my colleagues, before we finish this process, will come back with something that we can all be proud of and not something that is going to pass on a strictly partisan vote. thank you, madam president, and i yield the floor. the presiding officer: the senator from nevada. mr. ensign: madam president, i want to first compliment the

senator from texas on her raising a different constitutional point of order. there are several problems where i believe that this bill goes against the constitution. i have raised a constitutional point of order where i believe that it violates the enumerated powers under article 1, section 8, of the constitution as well as under the fifth amendment takings clause of the constitution. i see the senior senator from utah is here. he is going to talk about several other places in the -- in this bill that is before us today where there are other places where it violates the constitution. this is a -- the constitution of the united states. it's actually, there are several other -- several other documents in here. but that's how small the constitution of the united states is. this small, little document that

limits the powers of the federal government because our founders were afraid of a powerful central government. so they put down on paper the powers that they wanted to enumerate to give this body here, the house of representatives, the federal government, the national government, when each one of us comes to this floor after we're elected, we raise our right hand, put our hand on the bible and take an oath to defend and protect the constitution of the united states. we in no way take an oath to reform health care or do anything else that we think is good to do, anything on health care or any other good provision that we want to do around here has to fit within the powers that are listed within the constitution of the united

states. that's the oath, the solem oath that each and every senator takes. and that's what each and every one of us needs to think about when we're voting on this constitutional point of order. i want to make a couple of points very briefly of where i -- one area where i think on the individual mandate, how this bill violates the united states constitution. nowhere, at no time has this government, this federal government ever passed a law that tells somebody what to do when they're not doing something. in other words, today if you choose in this bill, or after this bill passes -- if it passes -- if you choose not to buy health insurance, this bill requires you to do that.

and if you don't do it, it charges you up to 2% of your income. so it's telling you just because you exist as a citizen of the united states, you must do something. the united states has never in its history ever passed something like this. this will dramatically expand the powers of the federal government. if this bill is passed and if, god forbid, the supreme court upholds this piece of legislation. i've read a lot of articles, and i submitted several of them by constitutional scholars yesterday where they believe that this bill is unconstitutional. even folks who believe it's constitutional, folks on the left, are saying that there are legitimate arguments and there is potential that it's

unconstitutional. so this isn't some, you know, wild-eyed, radical debate. this is a legitimate debate about what this document, this constitution of the united states, actually means. i'm not a lawyer like a lot of the other folks around here are, so i take a pretty plain reading. let me read the preamble of the united states. it says "we, the people of the united states, in order to form a more perfect union, establish justice, ensure domestic tranquillity, provide for the common defense, promote the general welfare and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this constitution of the united states." you see this "promote the general welfare"? that's where a lot of folks in this body have taken and expanded the powers of the federal government. notice what it said there right

before that. it said, "to provide for the common defense." it never said to provide for the general welfare. within the enumerated powers within the fifth amendment, there are limitations on what this congress can do. and the supreme court has held that the interstate commerce clause, for instance, which this body has absolutely the power to regulate, that even activity of an individual, if you're going to regulate it, it has to somehow affect inter state commerce, not intrastate, which is within the state. this bill goes beyond regulating any kind of activity. it goes to regulating eupbl

activity. it says if you choose not to do something, we're going to regulate you, we're going to tax you. and if we allow that type of precedent -- i made the point yesterday. others have made this point. why did we need a cash for clunkers bill if we had the power to tell people go out and buy a car? see, the government is allowed to provide incentives for people to do activity that maybe they weren't going to do, but it does not have the power to actually tell them what to do in that case to regulate activity. otherwise, we could just say grow this crop. even though you're going to use that crop just for yourself, you're going to grow tomatoes for your house. there's too many tomatoes in this country. even though you're going to grow those tomatoes for yourself, we

want to you grow something else. there are all kinds of things this government could tell people what to do if something like this precedent is held up today. this is incredibly dangerous, and the people of america need to wake up. and the people who are voting for this bill need to analyze the unintended consequences and the expansion of power that this bill will provide for in this bill passes and if the supreme court doesn't strike it down. so, madam president, i'm going to yield because i've listened to the senior senator from utah talk eloquently about the provisions that are unconstitutional. he's much more of a constitutional scholar than i would ever dream to be, and i hope that everybody pays close attention to what he is saying and really think about that oath that each one of us, when we raised our right hand to defend

and uphold the constitution, are we really doing that if we vote for this bill? i yield the floor. mr. hatch: madam president? the presiding officer: the senator from utah. mr. hatch: madam president, i thank my gracious colleague, and i am grateful for his kind words. madam president, i ask unanimous consent that i submit this statement honoring mayor lewis kay billings. the presiding officer: without objection. mr. hatch: i also ask unanimous consent that another statement regarding the constitutional point of order following the distinguished senator from nevada's remarks. the presiding officer: without objection. mr. hatch: madam president, there's a lot -- there's a lot of talk from the majority about why passing this bill is the right thing to do for the american people. it's the decision of conscience for them. well, let us take a closer look at these decisions of conscience. after weeks of closed-door, clandestine negotiations,

senator reid finally emerged with a 383-page christmas list. this bill is a dark example of everything that is wrong with washington today. despite all the promises of accountability and transparency, this bill is a tkpwrag pwab of chicago -- grab bag of chicago-style buy-offs. it is hrerts make a deal -- it's let's make a deal for special interest groups. who won and who lost in this dame? let's take a closer look. the aarp issued a strong statement of support for this bill. the reid bill slashes medicare by almost a half a trillion dollars to finance additional government spending. so why would the nation's largest lobbying organization avow to protect the interests of seniors supporting this legislation? to find the answer, like anything else in washington, just follow the money. aarp takes in more than half of its $1 phoeu -- $1.1 billion

budget in royalty fees and other vendors. the medigap plans make up a major sthaeur of -- share of this royalty revenue. aarp has a direct interest in selling more medigap policies or plans. however, there is a strong competitor to medigap policies, and that happens to be the medicare advantage plans. these private plans provide comprehensive coverage, including vision and dental care, at lower premiums for nearly 11 million seniors across the country. seniors enrolled in medicare advantage do not need medigap policies. so what happens when the reid bill slashes this program by almost $120 billion? that's with a "b." just look at the "washington post" front page story from october 27 questioning whether aarp has a conflict of interest. i quote "democratic proposals to

slash reimbursements for medicare advantage are expected to drive up demand for medigap policies like the ones offered by aarp according to health care experts, legislative aides and documents." unquote. that's from "the washington post." one of the most disturbing elements in the reid bill has been the perpetuation and doubling of the unconstitutional mandate tax from $8 billion to $15 billion. you heard me right. this unconstitutional mandate tax actually doubled behind closed doors. i have long argued that forcing americans to either buy a level of coverage or face a tax penalty collected through the internal revenue service is highly unconstitutional. we hear a lot of rhetoric from the other side about republicans defending the big evil insurance companies while they are the defenders of american families. the insurance mandate is a clear example of this partisan hypocrisy. let me ask one simple question:

who would benefit the most from this unprecedented unconstitutional mandate to purchase insurance or face a stiff penalty enforced by our friends at the internal revenue service? the answer is pretty simple. there are two clear winners under this draconian policy, and neither is the american family. the first winner is the federal government which could easily use this authority to increase the penalty or kpwhroes similar once -- impose similar ones to create new streams of revenue to fund more out-of-control spending. second the insurance companies are the most winners under this mandate because it would force millions of americans who would not otherwise do so to become their customers. i can't think of a bigger giveaway for insurance companies than the federal government ordering americans to buy their

insurance products. if you do not believe me, look at the stock prices of the insurance companies that have recently shot to their 52-week highs. jane hampshire, publisher of the liberal blog "fire dog link" said the following: having to pay 2% of their income in annual fines for refusing to comply with the i.r.s. acting as the collection agency might wind up being the most widely hated legislation of the decade. barack obama might just achieve the bipartisan unity on health care he always wanted. democrats and republicans are coming together to say "kill this bill." now that we clearly understand the huge windfalls the reid bill provides aarp and insurance companies, let me take a moment to talk about the winners and losers in the so-called abortion compromise. the lange twoi language to prevr dollars from being used to fund abortions is completely

unacceptable. the new abortion provisions are significantly weaker than the amendment i introduced with senator ben nelson to ensure that the hyde amendment, which prohibits auto us of federal dollar -- prohibitsuse of federr elective abortions, is worse than anything in this bill. the so-called abortion compromise does not stop here -- or there. the reid bill creates a state opt-out charade. however, this bill does nothing about one state's tax dollars from paying for abortions in other states. tax dollars from nebraska can pay for abortions in california or new york. this bill also creates a new public option run by the office of personnel management that will, for the first time, create a federally funded and managed plan that will cover elective abortions. when you have senator boxer, the distinguished senator from california, and speaker pelosi, the distinguished speaker of the house house -- the speaker of

the house house, two of the largest pro-abortion advocates in the -- the house of representatives, two of the largest proceed abortion advocates supporting this so-called sham compromise, and the national right to life committee and family research council opposing it, there's only one clear loser and that's the majority of americans who believe in the sanctity of life and oppose the use of federal dollars for abortions -- for elective abortions. last but not least, i would like to spend a few -- a couple of minutes to talk about the numerous special deals conferred on states in this $2.5 trillion spending bill. how hefty are the price tags for decisions of conscience? here are some highlights. $300 million for louisiana. $600 million for vermont. $500 million for massachusetts. $100 million for nebraska. and that's just the beginning. at a recent news conference, when the authors of this legislation were asked about the nebraska earmark for medicaid funding, the majority leader

simply replied -- quote -- "a number of states are treated differently than other states. that's what legislation is all about. that's compromise." now, the next logical question is pretty straightforward. who will pay for these special deals? the answer is simple: every other state in the union will pay for these special deals, including my home state of utah. all of these states who are collectively facing $200 billion in deficits and are cutting jobs and educational services to survive will now pay to support these special deals. according to the congressional budget office, the medicaid expansion in the reid bill creates a $26 billion unfunded mandate on our cash-strapped states. coincidentally, only one state avoids this unfunded mandate and that is the state of nebraska. of course, let us not forget about the biggest loser in this bill: the hard-working american

taxpayer. this bill imposes over half a trillion dollars worth of new taxes, fees, and penalties on individuals, families, and businesses. the new fees begin in 2010 while the major coverage provisions do not start until 2014. almost $57 billion in new taxes are collected before any american sees the major benefits of this bill, which are largely delayed until 2014, assuming that they are benefits at all. it's also no coincidence that through the use of these budget gimmicks, the majority can claim this bill reduces our national deficit one when we all know these reductions will never, ever be realized. based on data from the joint committee on taxation, the nonpartisan congressional score keeper, this bill would break another one of president obama's campaign promises by increasing taxes on 42 million individuals and families making less than

$250,000 a year. at a time when we are struggling to fight a double-digit unemployment rate, the reid bill not only increases payroll taxes by nearly $87 billion but also imposes $28 billion in new taxes on employers that do not provide government-approved health plans. these new taxes will ultimately be paid by american workers in the form of reduced wages and lost jobs. however, it is hard to say we didn't see these new taxes coming. for years now, many of us have warned that the out-of-control spending in washington will eventually have to be repaid on the backs of the american families. in this bill, the repayment comes in the form of stifled economic growth, lost jobs, and new and increasing taxes, and they are just the first installment of what will be a long and painful extortion of taxpayers if congress doesn't stand up and stop these terrible bills. according to a recent study of similar proposals by the

heritage foundation, these new job-killing taxes will place approximately 5.2 million low-income workers at risk of losing their jobs or having their hours reduced and an additional 10.2 million workers would see lower wages and reduced benefits. poll after poll tells us about the growing opposition against this tax-and-spend health care bill. the latest rasmussen poll shows that 55% of americans are now opposed to this bill. the cnn poll is even higher at 61%. among senior citizens, the group most likely to use the health care system, only 33% are in favor, while 60% are opposed. independent voters are also opposed 2-1. opposition in certain state polls, like nebraska, is even higher, at 67%. so what is the majority doing to address these concerns? nothing. in fact, despite the efforts by many of us here on this side of the aisle to express our

substantive policy disagreements for months, one senator recently said the following -- quote -- "they are desperate to break this president. they have ardent supporters who are nearly hysterical at the very election of president barack obama. the birthers, fanatics, the people running around in right-wing ma laish and aryan support groups, it is unbearable to them that president obama should exist." now, that statement was outrageous. it was made by a very dear friend of mine and i know that he probably didn't mean it the way it comes out but it's outrageous. instead of listening to the policy concerns of a majority of americans, the other side is simply dismissing them as rants from the far right. if the majority refuses to listen to what americans are telling them now, i'm sure they're going to have a rude wake-up call waiting for them later t. should come as no surprise -- it should come as no surprise to anyone that that kind of arrogance of power has led to congressional approval ratings rivaling the most hated institutions on the planet, at a

dismal 22% and falling. one of the biggest tragedies of letting this bill move forward is that it will do nothing to address the fundamental issue of rising health care costs in this country. according to the congressional budget office, c.b.o., this bill will actually raise our national health care costs by $200 billion. the administration's own actuary at the centers for medicare and medicaid services, c.m.s., agrees with this assessment. when this bill fails to work, americans will no longer have any faith in congress to effectively address the issue of health care reform. the opportunity to save medicare and medicaid from their impending financial collapse will be lost for another generation. the historic blizzard in washington earlier this month was a perfect symbol of the anger and frustration brewing in the hearts of the american people against this bill. i urge the majority once ghosn listen to the voices of the american people -- once again to listen to the voices of the american people. every vote for this bill is the 60th vote.

let me repeat that again. every vote for this bill is the 60th vote. my republican colleagues and i are united with the american people in our fight against this $2.5 trillion tax-and-spend bill. now, i implore my colleagues not to do this to the american people. don't foreclose on their futur futures. don't stick them with even more government spending and more government intrusion. we can fix health care. many of us have been working to do just that for many years. a truly bipartisan bill that would garner 75 to 80 votes has always been the case in the past on these major pieces of legislation in the senate would be fiscally sound and provide the american people with the fixes they are asking for in the health care marketplace and it would be easily achievable if we would just open our hearts and work together. many of us are standing at the ready and have been for months to step forward and pass meaningful health care reform that truly would help american families and please american taxpayers. to date, we've been rebuffed by an unfailing determination by a

few to pursue a nearly socialist agenda. i would ask my colleagues on the other side of the aisle who do not believe in the europeanization of america, who believe in doing truly bipartisan work here in the senate to step forward and vote against advancing this bill and work with those of us on this side of the aisle who are committed to making a difference to craft a health care reform bill that they can be proud to support. now, having said that, i do praise my friend and colleague from montana, senator baucus, who literally did try for months in many, many meetings with first the gang. seven -- i was in that -- and then finally decided i could not support what they were going to have to have come up with and expressed to my colleagues that i would in good conscience have to leave the negotiations. but he really tried. but he was restricted in what he really could do here that in the end no republican supported what was done. and even then, we had a totally democrat bill in the "help"

committee, a total democrat bill, in the pelosi bill, in the house, and the reid bill has been done in back rooms here with the white house, with very few even democrats involved. and many of the things that some of our friends worked so hard to get in the bill were no longer in it. let me just say that there are good people in this body on both sides of the floor, but i've suggested in times past -- and i suggest it again -- if you can't get 75 or 80 votes for a bill that affects every american, that is one-sixth of the american economy, then you know that bill's a lousy bill. and there many on our side of the aisle who have stood ready, willing and able to try and -- and do something in a bipartisan way. i've spent 33 years here and i've participated in a bipartisan way to help bring

together both sides on all kinds of health care bills that work. this would work too if we would just work in a bipartisan way. i yield the floor. the presiding officer: the senator from nevada. mr. ensign: madam president, i want to make a couple other points regarding the constitutional point of order that i have raised on the individual mandate. some folks have said, statesman date car insurance, that people carry car insurance. therefore, the federal government can mandate purchasing of health insurance to individuals. well, i think that should be pretty obvious. states can do things the federal government cannot. in the constitution, it limits the federal government, what it can do and it reserves the power for the states and/or the peop people -- for instance, what senator hutchison on her constitutional point of order talked about, the 10th

amendment. so the -- this mandate of buying car insurance, comparing it to the mandate to buy health insurance from the federal government is a false comparison. it actually should argue against why this is not constitutional, because the federal government cannot mandate you to buy car insurance nor can it mandate you to buy health insurance. it is not within the enumerated powers given to this body and to this federal government in the constitution. this bill is a real threat to liberty because of the precedent that it sets on the federal government being able to tell individuals what to do. i want to quote just from a couple of articles that have been written. this one was written by david rifkin and lee casey. i'm quoting: "but congress cannot so simply avoid the constitutional limits on its power. taxation can favor one industry

or course of action over another, but a tax that falls exclusively on anyone who is uninsured is a penalty beyond congress's authority. if the rule were otherwise, congress could evade all constitutional limits by taxing anyone who doesn't follow an order of any kind whether to obtain health insurance in this case or join a health club or exercise regularly or even to eat your vegetables. it literally sets the precedent to dramatically expand the powers of the federal government far beyond anything that our founders wrote and limited this congress to doing in the constitution. and i see the republican whip here, and i want to yield to him because of his expertise on the constitution. but i want to make just a real quick point. and reading from another

article, i would commend this article to our colleagues. written by ran tker -- randy barnett anded to garziano. "never in the nation's history has the power been used by a person who does nothing to engage in economic activity. there are constitutional experts out there telling us that this bill is doing something that the federal government has never done in its history." so i go back to this united states constitution. when we take an oath to defend this constitution, we better take that as a solemn oath and think about whether we're violating that oath that we swore to uphold and defend this constitution when we're voting for this bill. i would say that you must vote to uphold this constitutional

point of order. it isn't just up to the supreme court. it's up to us. we don't just say we'll pass anything, whether we think it's constitutional or not and let the supreme court decide. it's our responsibility. that's the oath that we take, is to defend and uphold the constitution of the united states. so we must think when we're passing something haoerbgs that's the reason we have this authority to bring a constitutional point of order, is so this body considers whether it's constitutional or not. that's what we must consider. the consequences to greatly expanding the powers of the federal government in this bill are so dramatic that the threat to liberty is very, very real. i would yield the floor to the republican whip so he can make some comments. mr. kyl: thank you. madam president, i do want to compliment my colleague for -- the presiding officer: the senator from arizona. mr. kyl: thank you, madam president. my colleague has raised a most important constitutional point here.

and it is true that as senators, we have an obligation not just to throw questions to the supreme court, but to use our best judgment as to whether we would be violating the constitution by adopting them. and i think that the point of order that he raises with respect to the 10th amendment is a very, very important question, should be carefully considered by our colleagues. i think you can onlydom one conclusion -- only come to one conclusion so i support what he is trying to do here. i also would like to make another point, madam president, and that is around the country people are calling in and raising questions about other aspects of the bill, also raising similar questions. the imposition of a supermajority rule, for example. can one congress bind another in that regard. and we're only now learning of all of these things, and our constituents are only learning of them because this most recent amendment was filed just a few days ago. and as we read through it and begin to realize what its

implications are, a lot of questions are being raised. the question that i want to raise today goes right to the heart of the claim that supporters have made for this legislation, and that is it reduces the federal budget deficit. many of my colleagues on the other side of the aisle have said, "i could not vote for this bill if it did not reduce the federal budget deficit, or at least if it were not deficit-neutral." it turns out that from information received today from the congressional budget office, it is not deficit-neutral. in fact, it adds at least $170 billion to the deficit. which, of course, is very important since tomorrow we're going to be asked to increase the temporary debt ceiling. this legislation will add to our federal debt, not make the situation better, as many of our colleagues have claimed. and i'm going to describe why that's so. i heard another one of my colleagues on the other side of the aisle on a talk show, on television this morning say "we're going to extend the

fiscal life of medicare by nine years." and that is the claim that directly conflicts with the claim that the bill is budget-neutral. what both the c.m.s. actuary and the congressional budget office have now said is, no, both are not true. there is only one sum of money. you can either extend the life of medicare with that money or you can buy a new entitlement under the bill with that money. but you can't do both. so if that money is spent on the new entitlement, for example, it cannot extend the life of medicare. it cannot show a budget surplus of $130 billion. in effect, they're saying you can't sell the same pony twice. now here's exactly what the congressional budget office had to say about this this morning.

and, incidentally, we were tipped off to this by a comment that was in the body of a letter from the c.m.s. actuary last week, or actually december 10. and as we read through this and then tried to analyze the new amendment that was just filed, it suddenly became clear that in effect that is precisely what is being done by the other side. and i'm not suggesting duplicity. what i'm suggesting is that they too have been misled by the arcane accounting language here. and until it became crystal clear with the language today, i can understand why there would be confusion. but no longer. you cannot vote for this bill this afternoon and claim not to have known that it both buys an extension of the trust fund for medicare and claims to buy a surplus of $130 billion. here's what the c.b.o. says

today -- december 23 -- posted on their web site -- quote -- "the key point is that the savings to the h.i. trust fund under this bill would be received by the government only once, so they cannot be set aside to pay for future medicare spending and at the same time pay for current spending on other parts of the legislation. in other words, the new entitlements that are allegedly paid for under the bill. and here's the last sentence. to describe the full amount of the h.i. trust fund savings as both improving the government's ability to pay future medicare benefits and financing new spending outside of medicare would essentially double count a large share of those savings and, thus, overstate the improvement in the government's fiscal position. what essentially -- would essentially double count the money. that's the point that senator

gregg and senator sessions and i tried to make earlier this morning. now, this is new information, i grant you, but it's an illustration of why we shouldn't be trying to force this bill to a vote before christmas when people aren't paying attention, we haven't had time to figure out what all of this means and the american people haven't had an opportunity to react to it. i just quoted to you from the congressional budget office, the nonpartisan office that tells us what the fiscal impact is. here's what tipped us off: the centers for medicare and medicaid services, richard foster, the chief actuary, had sent a letter, and this phrase caught our attention. he said "in practice the improved part-a financing cannot be simultaneously used to finance other federal outlays such as the cover expansion under this bill, and to extend the trust fund. despite the appearance of this result from the expectant accounting conventions."

in other words, despite the fact that it appears that you can do both the way the government accounting is, the truth is it's only one pot of money and you can't use it both to extend the life of medicare, on the one hand, and buy these new entitlements and show a budget surplus on the other. madam president, this is what happens when you try to rush a bill like this too quickly. many of my colleagues on the other side of the aisle have said, "i will not vote for a bill that is not budget-neutral or creates a budget surplus." then they can't vote for this legislation now that c.b.o. has said what it has said. some of them won't realize that, but that's why i came to the floor now. that's why i compliment senator sessions for talking to the director of the budget office last night, confirming this, asking him if he would put it in writing, which he did. and i think this is a game changerer, my friends. if now that you have this knowledge, you still go forward

and vote for the legislation, those of you who have made the pledge not to do so will be violating that pledge. you can't use the same pot of money to do two separate things, as the c.b.o. again said, to describe it this way that you can do both of these things would essentially double count a large share of that savings. and, thus, overstate the situation. mr. sessions: mr. president, would the senator yield for a question? i noticed this morning that the statement from c.b.o. earlier that the legislation would result in reducing the deficit by $132 billion was cited i think more than once, several times. that was before, was it not, the statement -- the statement obviously was before the statement issued today.

and in boiling it down -- you're an accomplished lawyer and know how to read this language, but boiling it down, does not this say that there is a misimpression created by that previous statement and that this statement today clarifies it, making absolutely clear that it is not creating a surplus or reducing the debt but in fact increasing the debt? mr. kyl: madam president, that's exactly right. the title of the document is effects of the patient protection affordable care act on the federal budget and the balance in the hospital insurance trust fund. he starts out by saying that c.b.o. has been asked for additional information -- mr. baucus: would the senator yield for a question? the presiding officer: the senator from montana. mr. kyl: madam president, i haven't yielded yet for a question. the presiding officer: the senator from arizona has the floor. mr. kyl: what i think i need to do is to ask unanimous consent that both this letter from the congressional budget office that i quoted from and just cited and the c.m.s. report

dated december 10 be inserted in this record following the colloquy so people can follow what has been done. the presiding officer: without objection. the senator from montana. mr. baucus: i'd like to ask my friend from arizona is it not true that the last statement from the c.b.o. on the degree to which this underlying legislation does or does not reduce the deficit, stated that the legislation reduced the deficit by $132 billion. that is the last statement from c.b.o. ever addressing the deficit and also stating the second decade, the deficit will be reduced between $630 billion or $1.3 trillion. isn't that true that's the last statement from c.b.o. addressing the question. in fact, concluded it decrease the deficit, is that not true? mr. kyl: madam president, i don't know the document that my

friend is referring to. i think that the document dated december 23 today is -- mr. baucus: it would be one a day or two ago. is the c.b.o. letter commenting on the modification? mr. kyl: and, i don't know. but my point is this. that the document released today in order to clarify the situation, again, said the key point is that you can't do both. the government only gets the money once. and that, therefore, they say to describe the full amount as both providing a savings to medicare and providing a surplus essentially double counts the money and, thus, overstates -- mr. baucus: madam president, if the senator would yield for a question. the presiding officer: the senator from montana. the senator from air hairs the - from arizona has the floor. mr. sessions: would the senator

yield for a question? mr. kyl: just one second. the time is going to expire in a second. i ask unanimous consent that a statement that i prepared, but not presented yet, on the increase in the insurance premiums be inserted in the bill at the conclusion of my remarks. the presiding officer: without objection. mr. kyl: thank you. and also i've been given a "washington post" article, op-ed by david gearson, and ask unanimous consent that that is entered into the record. the presiding officer: without objection. the senator from alabama. mr. sessions: i understand the time on this side through the leader time is up through six minutes after the hour. is that correct? the presiding officer: the republican leader has 6 1/2 minutes reserved. mr. sessions: which -- senator kyl, isn't it the c.b.o. report this morning essentially says you cannot count the same money twice?

mr. kyl: mr. president, it doesn't say you cannot. it just says that that's what would happen if you attempted to apply the money both to the trust fund and to the additional spending. they said -- and i'm -- quoting -- "would essentially double count" and, thus, overstate. it doesn't say you can't do it. but what they're saying is you only have one pot of money to pay for two things. they're saying, you can't do that -- mr. sessions: that's essentially correct. i would ask, madam president, the senator may not know. i understand that the request of democratic colleagues they have returned to c.b.o. and gotten another statement this morning, perhaps, to -- so they can continue to make the argument

that somehow this creates a surplus. but having -- staff having examined that, i'm informed that it in no way refutes this morning's statement that this cannot simultaneously fund a new program and strengthen medicare at the same time. and so i think it's a matter, wouldn't you not agree, senator kyl, that i'm not afraid to talk about it and if we need to slow down before we vote, so be it. but don't you think that -- first of all, are you convinced, as senator gregg indicated this morning, and the c.b.o. does, that we are, in fact, passing a bill that would, if it passes, that bill would add to the debt approximately $170 billion as staff has calculated based on this letter and would not reduce

the debt -- the debt b by $132 billion. mr. kyl: mr. president, i'm absolutely convinced of that, yes. mr. sessions: i don't think there's any dispute about it. i think that's the fact. the president looked us in the eye, in a joint session of congress distribution he not, senator kyl, and said that this legislation would not add one dime or one dollar to the debt of the united states? mr. kyl: it's my recollection that's pretty close to what the president said. i guess this wouldn't be such a big deal unless you're trying to do two things with the same pot of money. as long as the other side is claiming that we're also extending the life of medicare, which i heard one of my colleagues do on television this morning, you can't make this -- you can claim one or the other, but you can't claim both and that is precisely what the head of c.b.o. said here. i'm -- quoting -- "to describe the full amount of -- the social

-- excuse me -- the medicare trust fund savings as both paying for future medicare benefits and financing the new outside of medicare and thus overstate the improvement in the government's financial position. mr. sessions: and to followup on that, isn't it true and president obama monday -- president obama on monday flatly stated in one press conference that it would increase -- it would reduce our deficit over 10 years by $130 billion and extend the medicare program by nine years, which is patently false, it would appear. i'm not sure he understood the complexities of all of the accounting. but, in fact, i think he misspoke at that point, would you not agree? mr. kyl: mr. president, i

obviously can't get into the president's mind here. but i must say that all of us had missed this point and i said before, i ascribe no ill will to anybody on the other side. this is hard to understand and accounting can be arcane. that's why statement from the c.m.s. was a little troubling to us when we first read it, they said despite the appearance of this result from the respected accounting conventions, which is a fancy way of saying accountants have their way of showing things and that might have confused you, but in practice they said improved party financing cannot be simultaneously used to finance other federal outlays. you can't use the same pot of money of $10 to pie two different $10 benefits. you know, you can buy one or the other or half of each, but you can't buy both. the saying goes, you can't sell the same pony twice. mr. sessions: think say, do they not, kearnt kyl, in the c. --

senator kyl, in the c.m.s. letter they said it was a fact despite the appearance of the result of the respected accounting conventions. weren't they warning us that it can appear this way, but it cannot be that way. mr. kyl: senator gregg pointed out why that is so and my colleague from from alabama can do so as well. it's two different systems of accounting from two different parts of the government. the only way to do that is by sending an i.o.u. to the social security trust fund but the i.o.u. comes from the funds of the taxpayers. even though it shows up on the accounting books as an obligation satisfied. mr. baucus: would the senator yield for a simple question? this morning was the senator aware that the c.b.o. director at 9:57 sent an e-mail to all relevant staff that the estimates with regard to budget

deficit reduction still stands, still holds, the c.b.o. still estimates that this legislation results in $132 billion deficit deduction? is the senator aware of that e-mail? mr. kyl: mr. president, i did not see that e-mail. i assume that is the same communique that the senator from alabama is talking about it shows why it is so confusing and why i'm concerned about the polpoll-- about the c.b.o. if after that they show it as a surplus, what he also has to be saying is and therefore it does not extend the life of the social security trust fund. you can do one or the other or roughly half of each, but you can't do both. if he's choosing to say it's supplied to one -- the presiding officer: the senator's time has expired. mr. kyl: that it applies to the other. the presiding officer: the majority leader's recognized.

mr. reid: mr. president, i ask unanimous consent that the baucus motion to waive be set aside. the presiding officer: without objection, so ordered. mr. reid: mr. president, i want to take just a moment to talk about the motion to table the appeal by senator cornyn that no point of order lies under rule 44. senator cornyn's appeal is not about transparency. and it's certainly not about disclosure, it's about delay and obstruction. that's what the whole tenor of all of the republican statements have been regarding this legislation. the goal is to create a new point of order even though the senate rules does not allow a point of order. they want to rewrite the rules at a whim. not for purpose of disclosure of transparency, but for purpose of delay and obstruction.

the legislative history of the honest leadership addresses the issue of whether a point of order lies in this instance. quote, if the rule -- if rule 44 does not expressly provide for a point of order with respect to a provision, then no point of order shall lie under the provision. it would open a pandora's box if we reversed the rule by the chair. what happens to the health care bill? who decides the answers to these questions? if we overrule the chair, we will set a dangerous precedence that points of order lie even if not provided for in the senate rules standing orders or procedures. it's clear the purpose of this, mr. president, is to obstruct and delay. so i urge all senators to table the cornyn appeal of the ruling. now, mr. president -- a senator: would the senator yield for a question? mr. reid: no, i won't.

the health care votes have been procedural. each has been a party line vote. much of this is focused on politics. health reform is not about procedure or partisanship or politics. it's about people. people like the thousands who write us every day. mr. president, at my desk we have just a few of the letters that we have picked up the last day or so. i'm sorry that staff had to lift that and i didn't. but this is just -- just a few that we've gotten, mr. president. look at this. and they're all basically the same. each of these letters right here represents a story, a tragedy, a life, a death, but most of all, mr. president, a person. a person. people who wake up every morning an struggle to get health care, struggle to hold on to what they have.

people who second guess the agonizing decisionings of what they have to sacrifice just to stay healthy. mr. president, here's a letter that was written to senator bob casey of pennsylvania. listen to what this woman said. dear senator casey, in a country like the united states we shouldn't need a tip jar at an ice cream shop to raise money for a kid with leukemia. jennifer wood. here's another one of those letters. this one's from a father in north las vegas, nevada. quote, can you imagine what it is like to have a doctor look you in the eye while you hold your 1-year-old child and be told that you'll likely outlive your son? he goes on to say, i am certain my story is not unique, but it is real. stop forcing americans to use

the most expensive point of service, the emergency room, to get what -- the system -- to get what the system won't give them. let's make all americans equal in the eyes of health care, please. close quote. mr. president, this legislation is not about the number of pages of this bill. it's about the number of people -- people like the man i just read, who was told by a doctor that he would likely will outlive his son. it's a number -- it's about the number of people. the number of people who this bill will help. that's what this is all about, mr. president. it's about fairness. so people when they're hurt or sick can go see somebody that can help them, not lay awake at night wondering if they're going to outlive their 1-year-old son.

a senator: mada mr. president? mr. reid: how much time is left? the presiding officer: a minute and a half. mr. reid: i would like to -- mr. president, i ask unanimous consent prior to each vote today there be two minutes of debate equally divide and controlled in the usual form. the presiding officer: without objection, so ordered. the presiding officer: there are now two minutes equally divided. mr. reid: mr. president? the presiding officer: the majority leader. mr. reid: yes. mr. president, stop the two

minutes from running. i do want to explain. we're going to have a -- we'll have shortly a series of up to seven votes as we noted in the last few days if members remain at their desk, the votes can can be concluded much earlier. the presiding officer: there are now two minutes of debate equally divided prior to a vote on the constitutional point much order. -- point of order offered by the senator from nevada, mr. ensign. who yields time? the majority leader. mr. reid: the vote sequence will be as follows: ensign constitutional point of order; corker unfunded mandate point of order, baucus, motion to table the cornyn ruling of the chair, hutchison constitutional point of order. at that time, mr. president, i've been advised that one of the republican senators will

move to suspend the rules so he can offer his amendment under rule 22. he is going to be allowed 10 minutes. and this is -- this will require 67 votes. this one because it's an effort to change the rules. following that we'll have adoption of the substitute amendment. and cloture on each of -- on h.r. 3590. a series of one, two, three, four, five, six, seven votes. the presiding officer: who yields time? a senator: mr. president? the presiding officer: the senator from nevada's recognized. mr. ensign: the constitutional point of order i raised because i'm concerned that the health care reform bill violates the congress's enumerated powers under articl article 1 section . each one of us has taken an oath to defend the constitution of the united states. we do not take an oath to reform health care.

we don't take an oath to do anything else here but to defend the constitution of these united states. health care reform needs to fit within the constitution. it limits the powers that we have and the -- and the congress, the united states government, has never enacted anything that would regulate someone's inactivity. anything we've ever done, somebody actually had to have an action before we tax it. in this case, if you choose to not do something -- in other words, if you don't choose health insurance, this bill will actually tax you. it will act as a tax. so for the first time in the history of the united states, this bill will do something the federal government has never done before. the presiding officer: the senator's time has expired. the senator from montana. mr. baucus: mr. president, our committee and the "help" committee, we have all given a

lot of thought to the provisions in this legislation. we also give a lot of thought to the constitutionality of the provisions, how they work in a relationship between the power of congress and states -- what states will be doing, particularly under the commerce clause and the tax and spending powers of the constitution. it is very strongly in our considered judgment, and that makes constitutional scholars who have looked at these provisions, many articles we have put in the record, clearly these are constitutional, the tax and spending clause, the provisions clearly are constitutional. i yield back my time. the presiding officer: the question occurs on the constitutional point of order made by the senator from nevada, mr. ensign, that the amendment violates article 1, section 8, of the constitution and the fifth amendment. the question is is the point of

order well taken? the yeas and nays have been ordered. the clerk will call the roll. vote:

vote:

vote: the presiding officer: are there any senators in the chamber wishing to vote or to change a vote? will the senate please come to order. any senators wishing to vote or

to change a vote? if not, the yeas are 39. the nays are 60. the point of order is not well taken. there are now two minutes equally divided prior to the vote on the motion to waive the point of order raised by the senator from tennessee, mr. corker. who yields time? will the senate please come to order. who yields time? mr. corker: mr. president? the presiding officer: the senator from tennessee is recognized. mr. baucus: the senate is not in order. the senate is clearly not in order. the presiding officer: will the senate please come to order. will the gentlemen and ladies in the well please remove their conversations. the senator from tennessee is entitled to be heard. the senate will be in order. the senator from tennessee is recognized. mr. corker: mr. president,

thank you so much. there's almost nothing held in lower esteem than for us to pass walls in this body that cause mayors and governors to have budgetary problems because we create unfunded mandates. many of you have been mayors and governors. and for that reason, in 1995 in a bipartisan way, a law was created -- the presiding officer: the senator will suspend. the senate will come to order. the senator from tennessee. mr. corker: in 1995 a law was created. 15 senators on the other side of the aisle that are now serving supported this law to keep us from passing unfunded mandates. c.b.o. has said without a doubt, this bill violates that. i urge you to vote against this motion to waive that. it's important. it says everything about the way we do business here in washington. please let's do not pass another huge unfunded mandate to states at a time when they all are having budgetary problems.

this speaks to the essence of who we are and the arrogance that many people perceive us to have here in washington. thank you. mr. baucus: mr. president? the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, this point of order challenges legislation for imposing an obligation on states to extend their coverage of medicaid. under existing law on average, the federal government pays about 57 cents on the dollar for every dollar spent under medicaid. under this legislation, the federal government will pay 100% of that obligation for newly enrolled beneficiaries up through the year 2016. afterwards, the federal government will pay on average 90% of the cost of new enrollees thereafter. i think this is a fair deal for states, a very fair deal for states. therefore, i urge my colleagues to waive the point of order. mr. president, i also ask consent that this vote and all subsequent votes in this sequence be ten-minute votes.

the presiding officer: is there objection? without objection, so ordered. the question occurs on the motion to waive the budget act point of order raised under section 425-a-2. the yeas and nays were previously ordered. the clerk will call the roll. vote:

vote: the presiding officer: are there any senators who have not yet voted or wish to change their vote? on this vote the yeas are 55, the nays are 44. the motion to waive section 425e-2 requiring a simple majority is agreed to. the majority leader. the senate will be in order. the presiding officerthepoint o.

mr. reid: i've spoken to the republican leader. senators on both sides feel it would be to their advantage if we had the vote on christmas even at 7:00 a.m. rather than 8:00 a.m. that being the case, i ask that the votes start at 7:00 a.m. on christmas eve rather than 8:00 a.m. the presiding officer: is there objection? was that an objection? no objection. so ordered. a senator: mr. president? could i address a question to the distinguished majority leader? the presiding officer: the senator from vermont. mr. leahy: it's not going to affect my travel plans, because i long ago decided that we would be stuck here -- mr. reid: if i could say to my friend, quit while you're ahead. mr. leahy: while you have your agreement on this, is there any possibility knowing that those

traveling in the midwest are going to face horrendous problems, we'd have that vote this evening? it will affect a lot of senators, republicans and democrat alike, who have to fly through the midwest to get where they're going. the presiding officer: regular order has been asked for. there are now two minutes equally divided prior to a vote on the motion to table the appeal of the ruling of the chair. a senator: mr. president? the presiding officer: the senator from texas. mr. cornyn: mr. president, upon passage of the honest leadership -- mr. baucus: mr. president, the senate is not in order. the presiding officer: the senate will be in order. the senator from texas. mr. cornyn: mr. president, upon

passage of the honest leadership and open government act the majority leader said and i quote -- "i believe last november americans asked us to make government honest. we have done that. this is the toughest reform bill in the history of this body as it relates to ethics and lawmaking. mr. president, this is an appeal from the ruling of the chair that that provision of rule 44 is unenforceable. why in the world would anyone in this body who voted overwhelmingly to make this the toughest reform bill in the history of the body render this rule toothless by -- by agreeing with the -- with the attempt to set this aside and to waive its effect? i ask my colleagues to make sure that we vote for transparency, for honesty, for open government, and vote no on this motion to waive. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, the plain text, the language of rule

44 provides that no point of order lies against amendments. that's the way the draftees intended it, that's the way they wrote rule 44, and that's why the presiding officer ruled that way. we should support the chair and the parliamentarian and vote for the motion to appeal the ruling of the chair. and i yield back my time. a senator: how much time remains? the presiding officer: one second. mr. cornyn: i ask my colleagues vote no on the motion to waive. the presiding officer: the question occurs on the motion to table the appeal of the ruling of the chair that there is no point of order under rule 44 paragraph 4-a. the yeas and nays were previously ordered. the clerk will call the roll. vote:

the presiding officer: is there any senator who has not yet voted or wishes to change his or her vote? if not, on this vote the ayes are 57, the noes are 42. the motion to table is agreed to. without objection. there are now two minutes equally divided prior to a vote on the constitutional point of order made by the senator from texas, mrs. hutchison. the senate will be in order. the presiding officer: the senator from texas.

mrs. hutchison: mr. president, the tenth amendment says that the powers not delegated to the united states by the constitution are reserved to the states. in this bill, a state like texas and many other states that have taken full responsibility for insurance plans for their employees and teachers will have to justify any change in those terms to the federal government. the majority claims the commerce clause gives them the power to do what is in this bill, but what they fail to mention is the power to regulate interstate commerce has not been the basis for a robust role in insurance regulation. mr. president, this is an encroachment of the federal government into a role left to the states in the constitution. the tenth amendment is being eroded by an activist congress, and it is time to stop it now. i urge a vote to uphold this point of order.

the presiding officer: the senator from montana. mr. baucus: mr. president, the bill before us is clearly an appropriate exercise of the commerce clause. we further believe congress has power to enact this legislation pursuant to the taxing and spending power. the bill does not violate the tenth amendment because it is an appropriate exercise of powers delegated to the united states and because our bill fundamentally gives states the choice to participate in the exchanges themselves, or if they do not choose to do so, to allow the federal government to set up the exchanges fully within the provisions as determined by the supreme court under the tenth amendment. i urge my colleagues to vote against the point of order. the presiding officer: the question occurs on the constitutional point of order made by the senator from texas, mrs. hutchison, that the amendment violates the tenth amendment. the question is is the point of order well taken? the yeas and nays have been

ordered. the clerk will call the roll. vote:

vote: the presiding officer: is there any senator who has not voted or wishes to change h his or her vote? on this, the ayes are 39, the nays are 60. the point of order is not well taken. mr. demint: mr. president? mr. president? the presiding officer: the senator from south carolina. mr. demint: thank you, mr. president. since i have -- the presiding officer: the senate will be in order. mr. demint: mr. president? mr. baucus: mr. president, the senate is still not in order. mr. demint: since i have not used or yielded ten minutes, i ask to be recognized for up to ten minutes under rule 22, paragraph 2. the presiding officer: the senator has that right.the senator from south carolina. mr. demint: thank you, mr. president. in just a moment, i will move to suspend the rules for offering an amendment that would ban the

practice of trading earmarks for votes. while i want to be careful not to suggest wrongdoing by any member, there has been growing public concern that earmarks were used to buy votes for this legislation. it has been argued by some that this practice is acceptable because it's nose get things done in the senate. i reject that argument and i urge my colleagues to put an end to business as usual here in the united states senate. mr. president, the house of representatives has a rule prohibiting the use of earmarks to buy votes for legislation. if we were in the house considering this bill, vote trading would be a direct violation of the ethics rules. unfortunately, a vote trading rule does not exist in the senate. during the debate on the lobbying and ethics reform bill in the 110th congress, the senior senator from illinois,

senator durbin, and i offered an earmark reform amendment which contained the following language. a member may not condition the inclusion of language to provide funding for a congressional earmark on any vote cast by another member. mr. president, the durbin-demint amendment was written to mirror speaker pelosi's earmark reforms in the house. the durbin-demint amendment passed the senate by a vote of 98-0 and was included in s. 1 the honest leadership and open government act, which passed the senate by a vote of 96-2. the rule against trading votes for earmarks was in the bill when it left the senate. but then the bill moved to a closed-door negotiation. somehow at some point in these closed-door negotiations, someone dropped the earmark

language. i have no idea who it was and we may never know. remember, this bill was called "the honest leadership and open government act." in any case, the vote trading rule was dropped by the bill -- or from the bill, which then passed the senate and was signed by the president. just to confirm all of this, i want to make a parliamentary inquiry to the chair. is the chair aware of any prohibition in the standing rules of the senate, such as the previously referenced rule called in the durbin-demint amendment or in the rules of the house of representatives? the presiding officer: no such rule exists in the senate. mr. demint: no such rule exists. mr. president, i have an amendment which would correct this error. it mirrors the durbin-demint language which passed the senate 98-0, and i'll read the relevant parts. and i quote -- "it shall not be in order in the senate to consider a congressionally

directed spending item if a senator has conditioned the inclusion of the language on any vote cast by any member." mr. president, this language had unanimous bipartisan support in 2007 and it should be part of the rules today. this rule would provide needed accountability and allow any senator to raise a point of order to strike any earmark that has been used to buy votes. this point of order could be waived and the ruling of the chair could be appealed with the support of two-thirds of the senators here and voting. before i make the motion and we vote on this amendment, i want to make a few things absolutely clear. first, the rule has already won a unanimous vote in the senate in 2007 so it is not controversial. second, this rule only applies to earmarks used by votes in the future. it will not, unfortunately, apply to the earmarks in this bill. third, this vote is not a trick.

the amendment is written as a standing order so it will not increase the number of votes required to pass this legislation. it will not slow down the health care bill in any way. the only reason for senators to oppose this amendment is if they want to use earmarks to buy votes for legislation. it's that simple. if you support business as usu usual, then oppose this motion. but if you want to start to clean this place up and bring some integrity back to the legislative process, then please support the motion. mr. president, i move to suspend the provisions of rule 22, including germaneness requirements, for the purpose of proposing and considering my amendment number 3297, and i ask for the yeas and nays. the presiding officer: is there a sufficient second? mr. baucus: mr. president?

the presiding officer: at this moment, there i is not. the senator from montana. the presiding officer: is there a sufficient second? it appears there is a sufficient second. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, this proposed new point of order may sound good in theory but it has many, many flaws in fact when you just stop and think about it. you think the senate's tied up in knots now, if this were in effect, the current situation would pale in comparison to what the effect of this amendment would be. it is written in a way that wouldal trough to become an endless source of delay. senators could make one point of order after another under this provision, pointing to different provisions or indicting the integrity of different senators. the amendment provides no way of determining how to rule on a point of order raised under it. a point of order cannot be decided without solid guidance. points of order make the most sense when they're based on objective criteria.

the proposed amendment to rule 22 would ask the chair and the parliamentarian to sort through purely subjective concepts, like the basis for senators' vote or the intent behind the inclusion of a provision. how would the chair be able to rule on such point of order? would the parliamentarian have to question the chairman of a committee or a senator that offers the amendment under oath? would the parliamentarian have every senator that requested a congressionally directed spending item under oath to ensure that they did not condition their support on the inclusion of the item? the rule may sound good in theory. it is totally unworkable as a practical matter. and, mr. president, i move to table the demint motion and ask for the yeas and nays. the presiding officer: there is one minute left for those who favor the motion. who yields time? is all time -- mr. demint: mr. president? thank you. the presiding officer: the senator from south carolina. one minute. mr. demint: i would answer the questions by the senator just by suggesting that senator durbin,

who wrote the amendment, perhaps may want to make a couple of comments about it because this is the mirror -- mr. durbin: are you yielding time? i don't understand how this amendment would work. if the senator happens to have a hurricane in his state and needs disaster aid and we put money in the bill, then do we have to question your motive for voting for the bill? i think it goes entirely too far and i support this effort to table. mr. demint: senator, this was the demint-durbin amendment. it is mirrored after the speaker -- speaker pelosi's bill. they have this rule in the house. they can make it workable. certainly the integrity of this body is worth considering. i would encourage my colleagues, at this point when the public is looking at us, asking for some trust and integrity, we can make this bill work. i -- i ask my colleagues to support my amendment and oppose the tabling motion. mr. baucus: mr. president, i move to table the amendment and ask for yeas and nays. the presiding officer: is there a sufficient second? is there a sufficient second?

there appears to be a sufficient second. the question is on the motion to table to suspend the rules -- the motion to suspend the rules. the yeas and nays have been ordered. the clerk will call the roll. vote:

vote:

the presiding officer: is there any senator who has not yet voted or wishs to change his or her vote? if not, on this vote, the yeas are 53, the nays are 46. the motion to table is agreed to. mr. reid: move to lay that on the table. the presiding officer: without objection. mr. reid: mr. president, i ask -- the presiding officeri ask unant amendment 2878 be withdrawn. the presiding officer: is there objection? without objection, so ordered. mr. reid: what then the pending business? the presiding officer: there are now two minutes of debate prior to a vote on amendment 2786 as amendment -- as amended. the question -- a senator: mr. president?

mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: this is a vote to adopt the substitute. it is another vote on whether we wish to reform health care or not. i urge my colleagues to voat aye and move this process forward. i yield back my time. mr. reid: i ask for the yeas and nays. the presiding officer: the yeas and nays have been ordered. who yields time in opposition. mr. reid: yield back the time on behalf of my republican colleague. the presiding officer: without objection. the question is on the adoption of the substitute as amended. the yeas and nays having been ordered, the clerk will call the roll. vote:

the presiding officer: are there any senators who wish to vote or who wish to change their votes? if not, the ayes are 60, and the nays are 39. the adoption of the reid substitute amendment is agreed to. majority leader reid. mr. reid: lay on the table. the presiding officer: without objection, the motion to table is agreed to. the clerk -- the clerk will

report the motion to invoke cloture. the clerk: we the undersigned senators in accordance with provisions of rule 22 of the standing rules of the senate hereby move to bring to a close the debate on h.r. 3590, the patient protection and affordable care act, signed by 17 senators. the presiding officer: by unanimous consent, the mandatory quorum is waived. the question is is it the sense of the senate the debate on h.r. 3590, the service members homeownership tax act of 2009, shall be brought to a close. the yeas and nays are mandatory under the rule. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators who wish to vote or change their vote? if not, on this vote, the yeas are 60, the nays are 39. three-fifths of the senators duly chosen and sworn having voted in the affirmative, the motion to invoke cloture on the underlying bill is agreed to. the majority leader. mr. reid: i ask unanimous consent there now be alternating blocks of time as follows: sorry about that. i ask unanimous consent that there be alternating blocks of times as follows: the first hour under the control of the republicans, further, that after the first two hours, then there be alternating blocks of 30 minutes with the republicans controlling the first 30 minutes. the presiding officer: is there

objection? without objection, so ordered. mr. harkin: mr. president? the presiding officer: the senator from iowa. mr. harkin: mr. president, there's been a lot of conversations on this floor in the last couple of hours. there's a lot of people who are facing really tough timetables tomorrow. i know of one person who's -- one senator -- a senator: regular order. mr. harkin: mr. president? mr. vitter: mr. president, regular order. mr. harkin: mr. president, i -- the presiding officer: regular order -- mr. harkin: mr. president, i ask consent i be given two minutes. the presiding officer: is there objection? mr. vitter: mr. president, reserving the right to object. i'd be happy for those two minutes to out of the democrats' block of time in one hour but i'd ask for regular order at this time. mr. harkin: that's fine. that's fine. the presiding officer: without objection. it is so ordered. mr. harkin: so, mr. president, i

know one senator whose family is with their in-laws. the husband is from english glarntiond the kids are over there, can't make for christmas dinner tomorrow night. i know other person who has to get out to the west because -- and there's a lot of storms out there, if they can get that early flight, they can make two legs and get home. if they have to go later in the day, they have to do three legs and they may not make it. there's a lot of people around here that are having a lot of problems with that. we're all here. there's no -- really no reason to hold over the vote. so i'm going to ask unanimous consent that the vote on the passage of the bill and the -- and the vote on the -- on the debt limit bill occur at 6:00 p.m. this evening. the presiding officer: is there objection? mr. vitter: mr. president? the presiding officer: senator vitter. mr. vitter: that request has not been cleared on this side so on behalf of my colleagues, i will object. and if the senator would like to talk to all of his colleagues about it, that would be fine. but in the meantime, i would

object. the presiding officer: objection is heard. mr. harkin: mr. president, then i would further ask unanimous consent that the stleets are going to occur at 7:00 a.m. tomorrow occur at 12:15 a.m. in the morning. the presiding officer: is there objection? mr. vitter: mr. president, my response would be the same and i would object in the same vain. the presiding officer: objection is heard. mr. harkin: well, i just want people to know who's keeping us here. a senator: mr. president? mr. president? the presiding officer: the senator from idaho is recognized. a senator: mr. president, i ask unanimous consent that the vote that -- referred to by senator harkin take place at 2:00 p.m. on january 20, 2010, when we return. the presiding officer: is there objection? there are objections. mr. vitter: mr. president? the presiding officer: the senator from louisiana is recognized. mr. vitter: mr. president, i ask unanimous consent that this first block of time on the minority side be divided equally

dweebetween the following senat: myself, senators coburn, thune, sessions, kyl and ensign. the presiding officer: without objection, it is so ordered. mr. vitter: thank you, mr. president. mr. president, i'd ask for order on the floor before i begin speaking. the presiding officer: the senate will be in order. mr. vitter: mr. president, i just ask that time not be counted against me until the floor is in order.

the presiding officer: the senator will not be charged with that. the senator from louisiana is recognized. mr. vitter: thank you, mr. president. mr. president, i rise to talk about this important health care issue but also to talk about another vitally important issue directly connected which is spending and debt, because we will also have an enormously important vote tomorrow morning on increasing the debt limit. it's already over $12 trillion, but the proposal is to increase it further. in starting, mr. president, let me refer back to a couple of comments and parts of the debate yesterday because i think it will provide a good segue into this important debate. first of all, yesterday, as we were debating health care, my colleague from louisiana, the distinguished senior senator, senator landrieu, was on c-span's "washington journal."

and in discussing the health care bill, my participation came up and she said -- quote -- "senator vitter has not lifted a finger to pass this bill." i just want to say that that is a very kind and positive and generous comment of the senator and i take it as a nice christmas overture and i accept it in that vain and i wish her all the best this christmas season as well. it's obviously very true and i take it as a very positive comment, and i would go further. i've fought hard against this bill. i've fought hard for alternative reforms, focused reforms, reforms focused like a laser beam on real solutions in health care, to real problems like preexisting conditions. and i would simply add that i don't think this invite is over by a long shot and i'll continue fighting and i'll continue offering those alternatives.

with regard to the bill and this enormously important issue of spending and debt, as i was leaving the floor to go to meetings in my office after speaking yesterday, senator baucus took issue apparently with some of my comments. i think specifically my comments about medicare. i had suggested that this bill cuts medicare by $467 billion, almost half a trillion dollars, and although i needed to go to meetings, i think senator baucus took issue with that and characterized that as actual extending the life -- actually extending the life of medicare. well, mr. president, the congressional budget office answered that debate far better than i could have. they answered that debate in the last 24 hours with their report. and they outline very clearly -- and we've been talking about it earlier today -- that, in fact,

medicare money and other pools of money are double-counted in this analysis about the health care bill. quote -- "the key point is that the savings to the h.i. trust fund under the health care bill would be received by the government only once so they cannot be set aside to pay for future medicare spending and at the same time pay for current spending on other parts of the legislation or on other programs." the same congressional budget office report says -- quote -- "to describe the full amount of h.i. trust fund savings as both improving the government's ability to pay future medicare benefits and financing new spending outside of medicare would essentially double-count a large share of those savings." and so this answers the

senator's comments directly. you can't have it both ways. you can't say that we have a bill that is paid for and also a bill that strengthens medicare and extends solvency for additional years. that's double counting. that's exactly what the c.b.o. is saying. and the american people, in a much more basic commonsense way, mr. president, know better. they know this bill isn't paid for. they know this bill is going to expand the deficit and put us on an even worse fiscal road. they know that in their gut. they know that with their common sense. and, of course, mr. president, that gets us to the other big vote tomorrow, extending the debt limit yet again well beyond $12 trillion. these issues are connected, mr. president. they're connected in the technical way i just suggested

and these issues are certainly connected in the hearts and minds of the american people. the american people have responded to this debate because health care is so vitally important and the health care issue is so personal. but there's even an overarching larger reason the american people have responded so much to this debate. it's because they're connecting the dots. they're putting this as part of a larger pattern. and they're connecting the dots between bailing out and taking over insurance companies and financial companies and car companies hiring and firing the c.e.o. from the oval office to potentially one-sixth of the u.s. economy in health care. and they're connecting those dots in terms of spending and debt as well because that's been the dominant trend over the last

12 months at least. we have a debt limit today. it's over $12 trillion today and the motion tomorrow suggests that's not enough. we need to go higher. the american people are connecting the dots, particularly in the last year and they are scared to death about where it leads. how did we get this -- this way? how did we come to this $12 trillion-plus point? well, in july 2008, fannie mae and freddie mac were given an unlimited line of credit from the treasury and that has so far been $400 billion. that bill also increased the debt limit from $9.8 trillion to $10.6 trillion. but that wasn't enough. only three months later, in october 2008 came the wall

street bailouts, the $700 billion tarp program that will raise the debt limit -- that did raise the debt limit even further, to $11.3 trillion. but we we -- but we weren't doing -- done yet. in this year we passed the stimulus bill. then the debt limit was raised to $12.1 trillion. then we passed an omnibus spending bill earlier this year that increased spending about 8% over the previous fiscal year. this month we passed another omnibus spending bill that increased spending another 12% on top of that. that's what's leading to tomorrow's debt limit vote. that's what's leading to the statement that our debt limit is

now above $12 trillion. but that's not enough. apparently we need to go further. mr. president, the american people are connecting the dots. they see this trend which has accelerated dramatically over the last 12 months, and they're truly scared for our collective future, for their kids and their grandkids' future. and all of these things i mentioned plus this health care bill are part of that. because, again, mr. president, the american people know in their gut they may not understand all of the congressional budget office technicalities, but they know in their gut you can't have it both ways. you can't count $467 billion of medicare cuts as both helping pay for the other spending in the bill and strengthening medicare.

it's one or the other. it can't be both. it's the same thing in the health care bill with regard to social security. $52 billion double counted. but you can't have that both ways. it's the same thing in this health care bill with regard to the class act. $72 billion double counted. you can't have that both ways. and those factors alone put this bill out of balance, adding to the deficit, adding to the debt. what about the doc fix, the fix of reimbursement rates under medicare to health care professionals like doctors, which is clearly needed, was taken out of the health care bill. why? because that would cost money. so it was taken out. it was just pushed down the road. the can was kicked down the road. and that has to be revisited by

march 1 of next year. if a real ten-year or more docs fix is passed, that will be another $200 billion unpaid for, more deficit and more debt. mr. president, again, the american people get it. they know in their hearts, in their gut that we're on an unsustainable course. they know that all of these bailouts and so-called stimulus acts, all of these spending bills and now this enormous health care bill are part of that unsustainable course, and they're crying out and they're saying we must reverse course. we must save our nation. i hope we do that, mr. president, starting here, starting now. i yield the floor. a senator: mr. president? the presiding officer: the senator from oklahoma, senator coburn, is recognized. mr. coburn: i'd like to ask unanimous consent to have three minutes outside of the time allotted to make a point of

personal privilege. and i'd ask unanimous consent for that. the presiding officer: is there -- mr. coburn: i would say that the reason is today's my 41st wedding anniversary, and i was going to discuss that. the presiding officer: is there objection? without objection. mr. coburn: in 1953 i met a young lady -- actually it was 1954, a young lady when she was six years of age. her name was caroline. i went through grade school with this young lady. i went through junior high with this young lady. i went through high school with this young lady. the only serious dating relationship i ever had in my life was this young girl named caroline denton, and she became one of my best friends in high school. and it just so happened one weekend i couldn't get a date and she didn't have one, and i asked her out. and from that point forward, i fell in love with somebody i've been married to for 41 years --

my wife caroline coburn. and on this day of significant votes in the senate and tomorrow, i wanted to take a moment to say how much i appreciate what she has meant to me the past 41 years, how much stronger she has made me as a man, how she has completed every aspect of my life in being my partner as we walk through life, and the gift she gave me of three wonderful daughters. to my wife, caroline, in front of the body, i tell you thank you and happy anniversary. and now i'd like to go to my prepared remarks. i spent five years in the senate talking to my colleagues about spending. and we find ourselves in front of us another opportunity to do the wrong thing. and we have a debt limit increase. and yet, in those five years,

after hundreds and hundreds of amendments that the body has refused to agree to that would cut spending, we're going to increase the debt limit but we're not going to make any effort to cut the spending. and i have given seven complete speeches on the floor about the significant amount of waste in the federal government. i won't repeat that now. but that number is now annualizeed to $380 billion a year. every year $380 billion worth of waste, $380 billion, part of it's fraud. but a large part of it is duplication. and let me just give some examples of the duplication, because i think when americans hear this, they don't understand why. the government accountability office found that there's 13 federal agencies spent $3

billion to fund 207 federal programs, 207 different programs to encourage student standards in the fields of math and science. 13 different agencies, 207 different programs. we could have spent a tenth of that amount of money, had exactly the same results and saved $2.7 trillion. but we won't do it. another example, according to g.a.o., to the tune of $30 billion, the federal government funds more than 44 job training programs administered by nine different federal agencies across the federal bureaucracy according to the catalog of federal assistance we have 14 departments within the federal government and have 49 independent agencies that implement exchange and study abroad programs.

we have 49 programs instead of 1. i have tons of other examples just like that. we have failed to do our job. and the easiest thing in the world is to spend somebody else's money. and increasing the debt limit without having a rescission to get rid of programs just like this and have one program that's effective and efficient, that has metrics on it that measures its goals and is accountable instead of 49 or 72 or 64 through a large number of different agencies, we can do that. but there's no will here to do that. and as a consequence, what we do is instead of make the federal government more efficient, we just raise the debt limit. and i'm not about to be a part of that anymore. and i know my colleagues get upset with me as i come to the floor year after year talking about what we do and the fact that we don't affect the real

problems. i have been rather hard to get along with by my colleagues in terms of them advancing new programs when we don't eliminate the programs that are already doing the same thing. and so i think at this time of christmas, one of the things we ought to be doing is telling the american public is that we will change, that next year instead of creating new programs, we're going to look at all the programs and consolidate them and have one that does math and science, that one that is a work-study program abroad, not the numerous numbers we have that have no accountability. america recognizes our incompetence, but we're going to spell it out. and in this new year that comes forward, there's not going to be a week comes by that i don't come to the floor and show another example to the american people of how we're not doing our work. and, to me, it grieves me not

for me but for my children and everybody else's children, for my grandchildren and everybody else's grandchildren that we in fact fail to treat the real symptoms of our debt. and that is we won't do the hard work of oversight. we should be condemned for that. we are failing the american people. it out not to be. and with that, i yield the floor. a senator: mr. president? madam president? mr. president? the presiding officer: the senator from south dakota is recognized. the senator from thune. mr. thune: mr. president i appreciate both my colleagues from louisiana and oklahoma touching on an issue that i think is becoming increasingly important to a lot of americans. i was listening this morning to one of my colleagues on the other side as he came down here and talked about how all the spending problems and all these debt problems were all inherited from the previous administration. there's this sort of bush phobia or something around here among

members on the other side, because they don't want to own up for the decisions that they have made. granted, i would be the first one to admit when republicans were in control of the congress, that we didn't do it right all the time and that we lost our way a little bit with regard to spending. but having said that, mr. president, we now have, since 2006, a democrat congress. and i need to remind my colleagues that the president doesn't spend a dime under our constitution. congress has the power of the purse. congress appropriates funds. and so if you look at the last several years in terms of appropriations going back to the last couple of years that the republicans were in control of the congress here, the amount of spending in the non-defense part of the budget was a negative 1% in 2007, 5% in 2006 and 8% in 2005. that's non-defense discretionary

spending in our annual appropriations. if you go to total growth, which includes defense, you're talking about in 2005 that number was 8%. 2006 it was 5%,, 2007 it was 2%. more than we need to be spending in appropriations bills. but the democrats took control of the congress after the 2006 election, so they started writing the budgets. we have ownership for the 2007 budget, but the democrats have ownership for 2008, 2009 and 2010. the 2008 budget, mr. president, grew at 9% total growth. non-defense discretionary spending grew at 6%. if you look at non-defense discretionary spending in 2009, the last fiscal year, it was 12%. and in this fiscal year, 2010, the estimate is that we will spend 17% over the previous year. so year-over-year spending in

non-defense discretionary appropriations here in the united states congress will have grown in the last two years almost 30%. now, that's not a problem that was created by the bush administration. in a's not a problem obviously that the republican majority was responsible for. that is the democrats when they took control of the congress after the 2006 elections, beginning in 2007, they write the budgets, they approve the appropriations bill. and obviously as you can see, mr. president, the numbers have gone up dramatically. 12% in the 2009 budget kwraoerbgs 2010 estimate for which we are now funding appropriations bills, and we have funded most of them now with the omnibus or the smaller appropriations bill, six bills that was passed just a week or two ago. looking at 17% year-over-year spending in appropriations. almost 30% in the last two budget years.

that's not a problem that the previous administration, that the other side can hold the previous administration responsible for or attack them for. the other thing i'll mention, mr. president, is that the $1 trillion that was approved earlier this year in the stimulus funding was approved on almost party lines. there were a couple of republicans who supported that, but for the most part that was something that was approved by the democrat majority. it was proposed by the president of the united states. that is not spending for which the former president is responsible. at some point around here people have to own up and take responsibility for their own decisions. you cannot blame the past administration. you cannot blame inherited problems for all these spending that is going on right here, right now. the last year, as i said, appropriations spending and this year, again, are by any stretch way above anything that we've seen or should see at a time when we've got an economy in