mr. reid: mr. president? the presiding officer: mr. majority leader. mr. reid: i ask unanimous

consent that we vitiate the quorum thatre now under. the presiding officer: without objection. mr. reid: mr. president, i now move to adjourn until 3:05 p.m. today, and i ask for the yeas and nays. the presiding officer: is there a sufficient second? is there a sufficient second? there appears to be a sufficient second. the clerk will call the roll. vote:

vote: the presiding officer: any senator wishing to vote or change their vote of? seeing and hearing none, the

ayes are 57, the nays are 39. the motion to adjourn is agreed to. pursuant to the motion to adjourn, theenate stands adjourned.

the presiding officer: the senate reconvenes in a new legislative day. the clerk will read the communication to the senate. the clerk: washington, d.c., march 23, 2010. to the senate: under the proightsdz of rule 1 -- provisions of rule 1, paragraph 3, the standing rules of the senate, i hereby appoint the honorable mark begich, a senator from the state of alaska, to perform the duties of the chair.

signed robert c. byrd, president pro tempore. the presiding officer: mr. majority leader. mr. reid: mr. president, i ask unanimous consent the journal of proceedings be approved to date and the morning hour expired. i understand there are three bills at the desk due for their second reading the presiding officer: the clerk will read the bills for the second time. the clerk: h.r. 4872, an act to provide for reconciliation pr siewnt to title 2 -- pursuant to title 2 of the fiscal year 2010 budget, s. con. res. 2013. s. 1592, a bill to repeal the patient protection and affordable care act. s. 3153, a bill to provide a fully offset temporary extension of certain programs so as not to increase the deficit and for other purposes. mr. reid: mr. president, i would object to any further proceedings en bloc to those three bills. the presiding officer: objection having been heard, the three bills will be placed on the calendar. mr. reid: mr. president, i now move to proceed to h.r. 4872, and i ask for the yeas and nays. the presiding officer: is there a sufficient second? mr. mcconnell: mr. president, if i may --

the presiding officer: the republican leader. mr. mcconnell: if the chair would just indulge me a couple of parliamentary inquiries which won't delay the process very long. as i understand, it the budget resolution instructed two senate committees to report changes in law to reduce the deficit by a billion dollars each over the next five years. the reconciliation instruction states that they were to report those changes by october 15, 2009, and that those measures are then sent to the budget committee to report the final measure. it is my understanding that nothing has been reported to date and, therefore, my inquiry is: has the budget committee reported any reconciliation legislation to the senate pursuant to the current budget resolution, s. con. res. 13?

the presiding officer: it has not. mr. mcconnell: mr. president, one -- the answer is "no," it has not? the presiding officer: correct. mr. mcconnell: one other parliamentary inquiry. my understanding is that each time the senate has taken up a reconciliation bill on the floor, a senate committee has reported a bill to the senate, either through the budget committee or directly from the committee instructed. therefore, my question to the chair is: is this the first time in history that the senate will consider a reconciliation even though no senate committee has reported a bill to the senate? the presiding officer: it's the first time that the chair is aware of it. mr. mcconnell: i thank the chair. the presiding officer: is there a sufficient second? there appears to be. the clerk will c vote:

vote:

the presiding officer: any senators wishing to vote or change their vote? if not, on this vote the yeas are 56, the nays are 40. the motion to proceed is agreed to. a senator: move to table. a senator: move to reconsider. the presiding officer: without objection. who yields time? mr. baucus: mad president? the presiding officer: the senator from montana. mr. baucus: madam president, i ask consent that the following staff be allowed floor privileges during consideration of the pending bill: randy osenburg, aslin baker, mary baker, scott berkowitz, ivy english, andrew fishburn, laura hoffmeister, scott mathews, mena

sharma, max updike. mr. president? the presiding officer: would the senators hold for a moment. the clerk will report the bill. the clerk: calendar number 331, h.r. 4872, an act to provide for reconciliation pursuant to title 2 of the current resolution on the budget for fiscal year 2010, s. con res. 13. the presiding officer: the senator from montana. mr. baucus: madam president, for the information of all senators -- i might ask the senator from new hampshire if he agrees, it is probably best to alternate time back and forth, each side, say, roughly one half-hour blocks of time, if that meets the approval -- mr. gregg: madam president, i would suggest we do that for the first two hours at least, until we see how this is evolving. so the first half-hour would go to the majority, then the second half-hour would go to the republican side, third half-hour to the majority --

mr. baucus: that would be my intention. the presiding officer: without objection. mr. baucus: madam president, this morning president obama signed a law that will guarantee meaningful insurance reform, like coverage for people with preexisting conditions. he signed comprehensive health care reform into law. many of us have dreamed of that day for years. now it is a fact. now it is law. now it is history. indeed, it's historic. he signed a law that will insure that average people without insurance will get health insurance choices just like members of congress. this morning president obama signed a law that will control the growth of health care costs in years to come. today we have before us a bill to approve the new law. we do not have before us the whole health care reform bill. we do not have to reopen every argument that we had over the

last two years. we do not have to say everything that we said about health care one more time. rather, we have a bill before us, a bill that will do a few good things. we have before us a bill that will improve affordability by increasing tax credits to help pay for insurance premiums, increase those tax credits. we have before us a bill that will help with out-of-pocket costs for lower- and middle-income families. that is raise it. that is raise the assistance. we have before us a bill that will increase aid to states to help them shoulder the costs of covering americans under medicaid. we have before us a bill that will give additional help to states, that took extra steps to cover the uninsured before foreman took place.

these -- before reform took place. we have before us a bill that will make sure that no state is singled out for special treatment. we have before us a bill that will completely close the doughnut hole -- that is the coverage gap -- for medicare prescription drug coverage. that's closed by the end of the budget window. we have before us a bill that will start with a $250 increase in federal assistance toward coverage of the doughnut hole right away -- this year, 2010. we have before us a bill that will fight fraud, fight waste and abuse in medicare and medicaid. that's the bill we have before us today. this is not the whole health care reform bill. this is a set of commonsense improvements to that new law signed by the president earlier today. i do not expect opponents of the bill to talk about these

commonsense improvements. frankly, it's pretty difficult to understand why senators would want to oppose these commonsense improvements. rather, if this debate is anything like the debate so far, opponents of this bill will try to change the subject. when people look at what health reform really does, they're more likely to support it. when they separate truth from fiction, separate the wheat from the chaff. so i suspect opponents of this bill will try to distract observers from what's really going on. rather than talk about commonsense improvements to this bill, opponents will talk about the process. over the two years that we have been working on health care reform, there have been many on the other side who have sought to make the debate about process, not about what's in the bill, what improves people's lives; but about the process,

the legislative process. they have sought to emphasize how messy the legislative process is, and sometimes it is a bit messy, and of course criticizing how congress works is a heck of a lot easier than improving health care for the american people. many opponents of health care reform are obsessed with process and procedure. i am much more focused on the people whom health care reform will help. i'm focused on people like pat and her late husband, dan, from lincoln county in the northwestern corner of montana. pat and dan used to have a ranch in southwestern lincoln county. dan was the fourth generation of his family to run the ranch. he grew up on the ranch, and he worked very hard every day of his life. in 2000, the doctors told dan that he had hodgkin's lymphoma,

but pat and dan did not have health insurance. dan never took a handout, and pat and dan thought that they could handle their bills on their own. that's the way they always lived. it's the way a lot of people, i dare say most people live. but then the medical bills started piling up. swallowing his pride, dan made what he called the hardest decision of his life. he filed for medicaid. the state told him that the only way they could be eligible for medicaid was to put a lien on the ranch. as dan's medical bills piled out of control, pat and dan were forced to sell their land. pat said that the cancer ravaged her husband's body, but selling their ranch to pay for medical costs broke his spirit. that's why we need to enact health care reform. most bankruptcies in america these days are related to

medical costs. just think of that. most bankruptcies in america today are related to medical costs. no one in america should have to sell everything that they have no one should have to go bankrupt to pay medical bills. i'm not going to let the opponents charge us about -- the idea that health care reform has been some sort of rushed job is a myth. it's a myth that deserves busting. the facts are that the finance committee and the "help" committee each went through a full and transparent process to consider health care reform legislation. by that, i mean fully open, totally open to the public at all points. this has been the fullest an most transparent process for any piece of legislation in memory. i might say, madam president, a journalist once approached me about a year ago and said, senator, you're starting a -- are you starting a new trend

here with openness an transparency, putting all of the amendments up on the web, is that a new approach that the senate's going to pursue from now on? i said, i don't know, but i think it's right thing to do. from the start i wanted to develop a bipartisan consensus package. i wanted to work together. if someone gets ill or cancer, you're not a member of one party or another. it's personal. we've got to work together because that's what the american public want. that's what i tried so hard to do. i want a bill that would brought political support across the political spectrum there is a long tradition in the republican party. that tradition stretches back to theodore roosevelt. to richard nixon, to bob dole and to john j.a.v.e.e. i believe what we have set out to do and what we have done fits comfortably in at it digs of

what -- in at it digs of what those republican leaders sought to do. on may 6, 2008, we held our first hearing on health care reform. in fact, the finance committee held a hearing in 2008 alone. we held those hearings to help the senators come to a commonsense understranding of the health care crisis. help to explain why we're in such a crisis. what needs to be done. how the various parts of our health care system works and how various parts don't work. i held it from a point of view to educate all of us in the committee to get us ready for 2009, a year where it was clear that this congress would work hard and pass health care reform. we sought in the middle of the klass congress to lay the groundwork for passing a bill in this congress. on june 16, 2008, nearly two

years ago, senator grassley and i, my good friend and ranking member of the committee, convened a bipartisan health care reform summit in the congress. we called it prepare for launch, health care reform summit of 2008. chairman ben bernanke was there, other notables were there a full day of conference, members of the finance committee, both sides of the aisle to help us better understand how 0 solve our -- to solve our health care reform crisis. i was impressed virtually all day long, most senators stayed all afternoon, i counted most on both sides still asking questions from experts. senator grassley and i brought some of the best minds in country together to discuss health care reform. senators from both sides of the aisle engaged in open and constructive discussion. then right after 2008 election, on november 12, 2008, this

senator released an 89-page blueprint for health care reform. i have it right here. we named it, call to action, health care reform 2009. it was a comprehensive framework for health care reform. we posted that blueprint on the internet for all to read. the ideas in that white paper reflected a broad consensus of thinking among health care experts p we searched far and wide, what's the best thinking. what do other countries do? looking at what other countries do, we wanted to look at what america can do. we're america, we're not canada, great britain, we're america. we spent $2.5 trillion in health care in america with public medicaid, medicare, and the children's health insurance and the commercial health insurance. i want to maintain that same balance with the uniquely american solution that reflected this white paper.

the ideas of that white paper remain the foundations of health care reform that became law this morning. now, that's a strong statement to make, but it's true. almost all the ideas that all committees on both sides of the congress have enacted and are in the bill that the president signed today. now, of course, there are changes here and there. but the basic foundation in that white paper -- this white paper right here was put together november 2008, remain the foundation of health care reform that became law this morning. the ideas behind our health care reform legislation have been available for all senators and the public to consider for more than 16 months. "the washington post" called our white paper, and i quote -- "striking in both its timing and scope." "the washington post" said -- quote -- "rarely, if ever, has a lawmaker with his clout moved to early eight days after the

election of a president to press for such an enormous undertaking." in april and may last year senator grassley and i released health care reform policy papers on three major areas of reform. what are they? first delivery system reform. second insurance coverage. and, third, options for financing. once again, we made these papers public and posted them on the finance committee's website. senator grassley and i convened three open, televised bipartisan round ittable discussions with experts on those subjects. we held several day-long meetings with finance senator to discuss the topics of those papers. on april 30, 2009 "the new york times" reported -- quote -- "in setting forth detailed policy option, and inviting public comment, mr. baucus and mr. grassley set a precedent for

openness. "scption on may 18, 2009, the newspaper ploit ploit said that the freak reports included discussions about keeping peace in the delicate alliance of republicans democrats, industry, labor, physicians and consumer advocates. from the outset i worked hard to keep the groups talking to each other. that was coming back from the 1990's when health care reform fell apart when the groups opposed the bill. by the groups, i mean consumer groups, i mean hospitals, labor, medical advice manufacturers, nursing homes. all the groups. i kawd up their c.e.o.'s, kept talking to them constantly. what do you think? a problem here, make an adjustment there. stay at the table. don't walk away from the stable. suspend judgment if only for

five minutes, for everybody's best interest and america's best interest if this passed. i had 142 meetings to discuss health care reform with senators on both sides of the aisle. in all those meetings added up to more than 150 hours of discussions. i tried to work out a bipartisan package in the finance committee. i started, as i always do with the ranking republican member in the finance committee, my good friend, chuck grassley. and since the finance committee and the "help" committee share a jurisdiction over health care, senator grassley and i agreed that we wanted to include the ranking member of the republican committee, mike enzi, and our colleague jeff bingaman. as well we reached out to the chairman of the budget committee, senator conrad and the ranking republican member of the committee, senator snowe, both members of the finance

committee. both senators conrad and snowe have a long history of working across the aisle to reach consensus. we also reached out to senator kennedy, chairman of the "help" committee, meetings with him and all of the chairmen and ranking members together, with senator kennedy, how gracious he was and trying to work together. he wasn't trying to do this for ted kennedy. he was trying to do it for people who needed health care. it was very, very touching. we had six groups -- a group of six senators, three democrats and three republicans. we worked hard, rolled up our sleeves and met 31 times for 63 hours over the course of four months. many have said that we met too long. many said that i should have broken off my discussions with my colleagues. but i wanted to go the extra mile. i wanted to try. i wanted to bend over backwards. i wanted to do everything i could to reach a bipartisan

consensus. why? because that's right thing to do. that group of six senators came very close to an agreement. we did not end up in -- or reach an agreement among all six of us, but i took the product of those bipartisan discussions, our areas of tentative discussions, our areas of tentative agreement and made them the starting point for our committee mark yuvment that is, the group of -- markup. that is, the group of six helped forge through immense hours of discussions major improvements on our thinking. we corn vertd that product into -- converted that product into a committee mark. i made it public and posted it online on the committee's website on september 16, 2009. that was four days longer than the committee rules required. for the first time in history on seapt 19, the finance committee posted online every amendment submitted to the clerk.

we posted the full text of all 564 amendments. members of the committee and the public had three days to review the amendments and prepare for markup. our finance committee markup stretched over eight days, fully public. worked well past 10:00 p.m. on most of those days. the markup was the longest that the finance committee conducted on any bill in 22 years. prior to the markup, i accepted 122 amendments as part after modified chairman's mark. 26 of those amendments incorporated into the markup came from republican colleagues. during the markup, the committee considered 135 amendments. committee accepted 41 amendments and rejected 55. on october 2, 2209, a full 11 days prior to the committee vote on the bill, i posted online the mark as amended.

and on october 13, 2009, the finance committee ordered the bill reported, the bipartisan vote of 14-9. the majority leader then melded the finance committee and "help" committee work products into a single bill. the majority leader proceeded to move to the bill on november 19 of last year. we had a full and open debate of the bill on the senate floor. on december 24, christmas eve, more than a month later, the senate finally passed health care reform. now, i have taken some time to detail the long legislative history of this effort. and i did so because i believe any fair observer of this legislative history would draw three conclusions. one, we tried mightily to work with our republican colleagues to reach a broad consensus bill. we went the extra might we bent over backwards. and for a variety of reasons, our republican colleagues simply

did not want to be part in the end of this effort. two, nobody rushed this bill. this has been a full and deliberative process. about two years. there is no way the health care reform was -- quote --"rammed through the congress." no way. not true. three, we conduct add process more open than that for any other piece of legislation in the modern senate. but opponents of the bill have tried to raise as many charges as they can. they are tried to throw as much mud at this effort as they can hoping that something sticks. their latest attack has been to criticize the use of the budget reconciliation process for the bill before us today. some have charged that using reconciliation is somehow unusual. they argue that using budget reconciliation for health care is somehow unheard of.

and they argue that we never use reconciliation for major matters. nothing thereto, could be further from the truth. is reconciliation unusual? the answer is clearly no. budget reconciliation is a pretty common process here in congress. since congress began using the budget reconciliation process in 1980, some 30 years ago, congress has passed some 23 reconciliation bills. 23 in the last 30 years. as most years have seen reconciliation bills. it is an exceptional year when congress does not pass a reconciliation bill. now what about health care? is health care something insurance for reconciliation? once again, the answer is no. the nonpartisan congressional research service did a survey of the 22 reconciliation bills that made it through congress to the

president's desk. of those 22 reconciliation bills, c.r.s., congressional research service, identified 12 of them with titles or other major legislative components pertaining to medicare or medicaid programs. in other words, most reconciliation bills have addressed health care. once again, it is the exceptional case where a reconciliation bill does not contain health care matters. now, what about major health care legislation? is major health care legislation in reconciliation unusual? once again, the answer is no. c.r.s. counted the number of pages in the law books on health care that the reconciliation process has put there. it is not a small number. c.r.s. found that bills enacted using the reconciliation process contributed some 1,366 pages on health care to the statutes at

large. c.r.s. found that the average reconciliation bill with health care in it contributed some 124 pages to the statutes at large. pages in the statutes at large have more words than bills do, mr. president, so these pages reflect far more pages in bill text. let's consider some of the major changes to health care that congress has enacted in the last 30 years. well, there is cobra. the health insurance program for people who lose their jobs. congress enacted the cobra health insurance program as part of a reconciliation bill. now, cobra stands for the consolidated omnibus budget reconciliation act. reconciliation. a republican-controlled senate passed the cobra health insurance program as part of reconciliation in 1986. since then, three later reconciliation bills have amended the cobra continuation coverage rules.

congress changed cobra in reconciliation bills in the years 1989, 1990, and again in 1993. another one of the largest health care expansions that congress enacted in the last 30 years was the children's health insurance program otherwise known as chip. once again, we enacted it -- you got it right -- in reconciliation. congress enacted chip as part of the balanced budget act of 1997. once again, it was a republican-controlled senate that passed the children's health insurance program as part of reconciliation in 1997. then there is the medicare advantage program, medicare advantage or medicare plus choice as they called it then was a major change in software, introducing private insurance companies into the system. once again, the republican-controlled senate passed that in reconciliation in 1997. so it's hard to think of a major

health insurance expansion that does not involve reconciliation. sure, there were some, but it is the exceptional case where congress enacts major changes to health care outside of reconciliation. and when you think about it, that makes more sense. congress created the budget reconciliation process to affect the budget, and any competent budget economist will tell you that health care costs growth is the biggest financial challenge facing our nation. the president and other commentators in our fiscal plight make that statement repeatedly. if you want to address the budget in a significant way, you need to address health care. health care is exactly the sort of thing that the budgetary process was designed to address. why did congress create the budget process this way? it's simple.

congress created the budget process so that congress could make fiscal policy with a simple majority vote. the congress that created reconciliation wanted to ensure that future congresses could vote budget matters up or down, yes or no. now, is it unusual for anything this large to have been passed in reconciliation? once again, the answer is no. in terms of dollars and cents, the biggest reconciliation bill by far was the 2001 bush tax cuts. the 2001 reconciliation bill worsened the deficit by more than $550 billion over the first five years. that was the reconciliation bill. not far behind was the 2003 bush tax cut. that reconciliation bill worsened the deficit by more than $430 billion over the first five years. in terms of policy changes, it's hard to match the two bush tax

cuts. but another measure that came close was the 1996 welfare reform bill. once again, that was a reconciliation bill. the 1996 welfare reform bill was the most sweeping revision of poverty programs since the great society. once again, that reconciliation bill was passed by the republican-controlled senate. it's hard to say that we have not done big things in reconciliation. in sum, it's not as though we snuck health care reform through the senate. we passed it with an exhaustive, open process, and the senate passed health care reform with a supermajority. we passed it with 60 votes. now, all that remains to be done to complete health care reform is an up-or-down vote on this final bill. this last step in health care reform deserves to have a simple majority vote. that's all that needs to be done

to finish the job of reforming health care reform. and let me return to what this bill would do. this bill would help to make health care more affordable for people who don't have it and improve upon the senate bill which the president signed this morning. we do it for people like car men men -- carmen and her daughter marilee from paulson, montana. carmen had insurance, but she still had problems with coverage and costs. before march, 2008, carmen had insurance with a $5,000 deductible. she found herself avoiding care because of the high deductible. she and her daughter marilee waited until they knew that they needed help before they went to a doctor. certainly with a deductible that high, 5,000 bucks. at one point, carmen's daughter contracted aure nary tract infection. wanting to avoid the high

deductible, carmen and her daughter decided to wait a day and see how it would go. but her daughter did not get better. she needed to get care. since it was saturday, there was no urgent care open for 50 miles. the only option was to go to the emergency room. the hospital billed carmen for $500 but her insurance company refused to pay it. carmen appealed, asking them to pay the $70 insurance would normally pay for urgent care and carmen would pay the remaining balance, but the insurance company still denied her claim. when carmen broke her fingers, her insurance company refused to pay for treatment. the insurance company paid only for x-rays even though carmen was entitled to $650 coverage for accidents. carmen paid for her own treatment but she gave up on the therapy because it cost too much. carmen's fingers will never

fully heal. in march, 2008, carmen switched to another insurance company and lowered her deductible to to $2,500. remember, the last policy had a deductible of $5,000. the last month, carmen received notice that her premiums would go up by about 32%. carmen will have to keep her premiums down by decreasing her coverage. it's a strategy that she has been using for years. we fight for health care for people like carmen and marilee. we fight for health care for people like erin and william redlock. erin lost her father william because their insurance company denied and delayed his bone marrow transplant until it was too late. william taught school for more than 30 years. he thought he had a good insurance through his retirement package. the doctors told william that he had leukemia, but the doctors were able to treat it with oral

chemotherapy for a long time. in 2002, the doctors determined that william would need more advanced chemotherapy. keep him on chemotherapy as long as they could. then the doctors determined he would need a bone marrow transplant. the insurance company paid for all of the preparations, testing and treatment leading up to the transplant, but the insurance company denied the procedure itself. mr. president, i note that my -- i'm at the end of my half-hour here. let me just say that -- i conclude here by noting that this is why we fight for people. this is why this health care bill is here before us. people like carmen, marilee, pat, and many people across this country deserve much better. we're at the very end here. we're about ready to pass this legislation. the president signed the bill this morning. this is just to make it even a little bit better. it's a normal process, open

process. i urge all my colleagues to quickly pass this so we can help a lot of people and get on to other matters, and i thank the chair. mr. gregg: mr. preside? the presiding officer: the senator from new hampshire. mr. gregg: i wish i could stand here and agree with the senator from montana. i wish that as i looked at these bills that have just passed the house and now that we're getting the trailer bill, the bill that was used to purchase the votes in the house and pass the big bill that i could say that america's children are going to be better off, that the people who have health care issues in this country are going to be better off, but that's impossible to say. why is it impossible to say? because this bill as it passed the house was an atrocity. it was an explosion of government the likes of which we have never seen in this country before. it grows the government by by $2.6 trillion. in the process, it will interfere with almost every american who has private health

insurance and how they get their insurance. and it will take americans who have health insurance today and it will push them out of that health insurance as the small employers across this country decide that they can no longer afford it. and it will say to medicare recipients we're going to cut your medicare by a trillion dollars when this is fully implemented, a trillion dollars, and we're going to take that money and we're going to use it to fund a brand-new entitlement over here for people who aren't on medicare, who aren't seniors, and we're going to use it to expand other entitlements for people who aren't on medicare and who aren't seniors, and then the medicare recipients who have seen their program reduced by a trillion dollars are going to be left with a program that remains on a path to insolvency, a path which will inevitably lead to lesser quality of care for people who get medicare because providers will find themselves forced out of the system.

and people who are on medicare advantage will virtually find that that insurance plan is eliminated. so this bill has a lot of major problems, the big bill that passed the house, and now we get this trailer bill, this buy-it bill which was used for the purposes of getting votes in the house. and this bill aggravates the fundamental problems of the bigger bill that the president signed today. this bill adds more costs, creates more taxes and will reduce medicare viability in a more significant way, and yet it's called good policy. very hard to understand that. when you look at these bills as a combination, especially when you put it in a con text that thrown on this train was the

nationalization of the student loan program where 19 million students today are going to be forced into the process of getting their loans through the federal government instead of through their local banks or community banks. and when you look at this in that context, what this bill is really about -- and the president has been very forthright about this -- is a massive explosion in the size of the government. growing the government for one fundamental purpose because this administration believes that a bigger government creates prosperity. well, we don't believe that on our side of the aisle. we believe that there is a lot of good things that could have been done to make health care better. i have offered a proposal to do that. other senators, senator barrasso has a proposal to do that. they would have all addressed the health insurance issues of making sure that everybody could get coverage if you have a pre-existing condition. all these straw doings that are being thrown up is the -- as the reasons why this bill would have to be passed, they would have

all had to be taken care of if a more reasonable bill had been passed, but what wouldn't have happened, there wouldn't have been this massive explosion in the size of the federal government which we will inevitably pass on to our children, a government they cannot afford. under this bill, the costs to the federal government, which has tara dishly been about 20% of our -- what has traditionally been about 20% of our gross national product will jump up to about 25% of our gross national product. it will be unaffordable as a result of that. but they claim they pay for it, and the way they claim they pay for it primarily is to cut medicare by a trillion dollars when fully implemented. now, this seems fundamentally unfair to the people on our side of the aisle. we all recognize that medicare has serious problems. it's got a $38 trillion -- or or $36 trillion unfunded liability. we all

recognize that medicare recipients depend on that program. and so if we're going to adjust medicare payments, cut them, as they do in this bill, eliminate programs like medicare advanta advantage, for all intents and purposes, then those savings as a matter of fairness, should stay in the medicare system. i mean, that's what should happen. those savings, which are huge in this bill. and i respect the fact that my colleagues on the other side of the aisle stepped up and made this massive attempt to cut medicare. i mean, that was quite a decision on their part. but what they did was they took those savings, which should have gone to giving senior citizens a stronger and more vibrant program, and they took them and they started brand-new programs, brand-new entitlements programs, neither of which have anything to do with medicare or senior citizens. so essentially they're funding this program in large part on

the backs of the seniors of this country, without doing anything substantive, which in the long run will make medicare more solvent. and, in fact, they've basically doubled down on the problem, because we know medicare is headed into insolvency. then they created these new entitlements. and we know the record of the government around here on the issue of entitlements -- we always underfund them. the promises are made but they're never kept. and so this will all end up rolling into a giant ball like a -- like a huge, massive asteroid headed to earth which is basically going to land on our children's heads as debt. that's what we're headed towards here we already know we have a government we can't afford. the debt of this country is going to double in the next five years under the president's budget, it's going to triple in the next ten years under the president's budget. it's going to get to a level of unsustainability qun five to

seven years. we're already seeing the warning signs. the china are telling us they may not want to buy our debt, and they're the ones who are financing us. moody's says we may have to have our ratings looked at. even warren buffett's debt today, this week for the first time, sold at a better premium than the united states debt. what does that mean? people have more confidence warren buffett will pay them back than the united states. that's a pretty serious sign when the united states is supposed to be the best creditor in the world. and yet what this bill does at its core on fiscal policy is to radically expand the size of government, and we all know it won't be paid for, and so we all know that it will significantly, probably radically expand the debt that our children are going to bear. we are inevitably not going to pass on to our children a healthier country fiscally, we're going to pass on to our children a sicker country fiscally. and are we going to get better health care for it? i seriously doubt it. i think we're hale from

dr. barrasso about how he sees this affecting -- we'll hear from dr. barrasso about how he sees this affecting our health care and others who have expertise in this area. because when you have these government programs which essentially amount to quite eye nationalization of different areas of our economy, you end up with less quality. it's unhairnt in havin un-- inhe government run thing. so the first amendment we're going to offer here today is to try to straighten out this incredible inequity that we should paying on for these new -- that we would be paying for these new entitlements, these uninsured americans and for people on medicare, with senior citizens' dollars by cutting the medicare program by over a trillion dollars when fully implemented. and so we have an amendment which says essentially this: you cannot reduce the medicare spending if c.b.o. cannot tell us that the other expenditures

in this bill are paid for with something other than medicare. it is a hard-and-fast commitment that medicare savings will go to benefit medicare, and that should be our purpose. i know some of my other colleagues wish to talk on this, so i would ask -- first, i would send an amendment to the desk. the presiding officer: the clerk will report. the clerk: the senator from new hampshire, mr. gregg, proposes an amendment numbered 3567. mr. gregg: mr. president, i ask further reading be dispensed with. i have defined what the purpose is to make sure that reductions in this bill, things that directly affect seniors, like reducing their medicare payments, so probably fewer doctors will see them, or eliminating things or dramatically reducing medicare advantage. if we're going to do that as a congress, those savings have to go to benefit medicare, not to

create new programs no matter how worthy they may be. i see many of my colleagues rising, wishing to talk about this, and -- i would ask unanimous consent that we be able to proceed as if in a colloquy. the presiding officer: without objection. mr. alexander: mr. president, if i may ask a question of the senator from new hampshire. mr. gregg: yes. mr. alexander: senator gregg, the president's budget said it would cost, i believe, $371 billion over ten years to pay -- to properly pay for doctors who see medicare patients. i believe the congressional budget office said the number was over $200 billion. can you imagine a comprehensive health care bill that -- that improves medicare without paying doctors to serve medicare patients, and can you explain to me how you can possibly say that the -- that the medicare -- that the bill does not add to the federal deficit if it does not include paying doctors to serve medicare patients?

mr. gregg: well, the senator from tennessee has asked an excellent question, which is, how can you pass a health care reform bill and leave off the reform that's necessary to pay the doctors to see their patients and claim that you are actually covering the costs of health care? and c.b.o. has scored that at about $250 billion, it may be as high as $350 billion. it's simply ignored. you know, it's as if -- as if paying doctors is not part of health care reform and, therefore, it's been ignored by the majority. but if you want to properly score the cost of this bill, you've got to add back in that $250 billion to $350 billion, and, obviously, that puts it in a very significant debt situation, deficit situation even under the gamesmanship which were used to get to the score in the first place, which we all remember was you scored ten years of income, ten years of taxes, ten years of spending cuts against six years of actual programs. that's how they got the score that they -- they claim. the real score on this bill is $2.6 trillion of new spending

and it is a massive expansion in the deficit, much of which will be caused by the failure to fix the doctor issue. mrs. hutchison: mr. president, i would just ask the senator from new hampshire how it is that we can cut back on medicare for our seniors. and i'd like for him to talk about the impact especially in rural hospitals, because rural hospitals serve a larger number percentage-wise of medicare patients, and in my home state of text teb texas, 29% of all or hospitals are located in rural areas. and i received a letter from the texas organization of rural and community hospitals, which represents 150 rural hospitals in the state, saying, "we fear the medicare cuts as proposed could disproportionately hurt rural hospitals, which are the

health care safety net for more than 2 million rural texans." now, i would just ask the senator from new hampshire if in his state and what he is hearing from other states, if they are also, likewise, concerned about the impact on our rural residents who are medicare patients and the cuts to hospitals that are going to be really disproportionate which you look at the big picture and for -- for what purpose? fewer people served and that's supposed to be health care reform? mr. gregg: well, the senator is absolutely right, this is going to have a huge impact, especially on rural hospitals whop have heavy medicare populations because those populations will find that their providers are no longer able to make enough money to exist. and we actually have one of the leading members of the senate here who is a doctor, who was a -- who provided health care in a rural setting and is just recently out of the field, so to say, who might be able to comment with even more expertise

on that. mr. barrasso: i would absolutely like to do that, because wyoming clearly is a rural state, long distances between patients and the hospitals. and just this sunday, just two days ago, i was visiting the elk horn valley rehab hospital in caspar, wyoming, down the road from the wyoming medical center, to see a friend of mine, ted l lee. ted is now in his 80's. ted is a veteran of world war ii. ted actually drove a jeep for eisenhower, who was a general at the time. and ted has been back to washington as part of the honor flights, as we honor our world war ii veterans. ted had fallen at home on the wyoming ice and snow and had broken his hip. his wife jackie called my wife bobbi and i at home over the weekend to say ted was in the hospital, would you stop by. ted's a terrific guy, i repaired his shoulder, i operated on his leg when at the age of 70 he jumped from an airplane to show

he could jump out of an airplane with a parachute. and i replaced both of jackie's knees. i know these people like hospital, and i wanfamily,and id and -- i went to the hospital to see ted and said, what are those people in washington thinking. what are they thinking? he said, i paid in, i put my money into medicare, he said, why are they taking my medicare not to save medicare but to start a whole new government program, a whole new government program who didn't pay into the system, didn't fight for their country, on and on? what is wrong with the people in washington? what are they thinking? don't they realize it's our money, we paid in, we're expecting care? and now all of a sudden they're going to take medicare money and start a new government program? and ted said -- expens, i mean, this is a guy that follows this. he said they're going to take it from the hospital -- he's just been in the hospital -- they're going to take from t from medicare advantage, $120 billion, because there are a lot of people in wyoming who

see the advantages of medicare advantage, and they're going to take it from home health care agencies, because ted is going to need a home health care when he gets out of the hospital, and he also knows it's going to cut a lot of money from nursing homes, and we're trying to keep ted out of a nursing home. but he understands clearly that these medicare cuts are going to affect doctors, hospitals, nursing homes, home health agencies, even hospice providers and all of that money's being taken away not to save medicare, which he knows is going to be broke in 2017, but to start a whole new government program. and when we get to the specifics of rural hospitals and rural health -- and i see my colleague here from nebraska who's a former governor of nebraska. there was a front-page story in "the new york times" a few months back, "for rural elderly, times are distinctly harder." "times are distinctly harder." and they quote a woman from

oshkosh, nebraska, who says, "one foot in the grave, the other sliding." "one foot in the grave, the other sliding." so i ask my colleague and friend from nebraska, who's served as governor, lots of rural areas in nebraska, do you in nebraska see these same concerns, where folks here in washington are taking money away from our seniors on medicare, money they depend upon for their health care, to start a whole new government program and it is fundamentally not right and that's why we're bringing this amendment? mr. johanns: i so appreciate the opportunity to speak to this issue, because this is enormously important for our rural states. we took a look at this bill. we tried it give it a good, fair look in terms of its impact on nebraska. let me, if i might, cite some statistics, and you could repeat these statistics whether you were in texas or tennessee or wyoming or wherever. two-thirds of our home health

agencies, if this bill -- well, this bill became law today -- two-thirds will be operating in the red by 2016. home health agencies. so what does that mean? here's what it means. back home in nebraska, if you're in a major city like omaha, lincoln, carnie, whatever, it appears to me that you're probably going to get through this pretty reasonably. however, if you are in a rural area, you're going to lose services. they're going to pull in on the services to these rural areas. why? because they can't afford to send a home health person out 50 or 75 or a hundred miles. we asked ourselves, what would be the impact of this bill on nursing homes. again, we have rural nursing homes all over our state. this is exactly what has

happened in other states. people would to spend their elderly years in their community or near their community. these nursing homes are fighting to stay open today. they'rthey'll take a $93 millio. we're going to have nursing homes close in nebraska. nursing homes and home health care and hospice will also experience cuts. those who are on medicare advantage, 35,000 nebraskans are going to see a cut in the amount of money that they receive, only exacerbated by what we are talking about today. now, if i might, let me anticipate an argument. i know, because i've been watching this, somebody from the other side's going to get up and say, "oh, come on, mike. look, this is the way it works.

we extend the life of medicare." and do you know what? the actuary in c.b.o. has looked at that in a rather amazing analysis -- and in a rather amazing analysis, they said, yeah, right, what you are doing is double counting the same dollar. let me quote. this is th comes from c.b.o. but i can take it the same from c.m.s. c.b.o. said the key point is that the savings to the h-1 trust fund under the patient projection and affordable care act 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 -- unquote. and, you know, that's exactly what they tried to do here. mr. gregg: i think it is important to go on to say what scr b.o. said. "in effect, the majority of the

h-1 trust fund savings and the reconciliation proposal would be used to pay for other spending and therefore would not enhance the ability of the government to pay for the future of medicare benefits." the amendment we have at the desk does just the opposite. it will allow us to use any savings to pay for medicare benefits and enhance the strength of the medicare trust fund. mr. johanns: that's exactly why i stand today. and i'll conclude my comments with this thought: it's exactly why i stand today to bring honesty to the accounting. if you bring honesty to the accounting, you can see what we're doing to the american people. a former c.b.o. director recently said, fantasy in, fantasy out. they will only score what is laid in front of them, and they got this gimmick laid in front of them which is what they have to score, and i want to applaud what this amendment does because

what it is saying is, look, let's just cut through all of this. let's score this honestly. if we have savings in comairks let's keep that money in medicare, and i -- believe me, that is the right way to go about this. this idea of double-counting the same double makes no sense whatsoever. mr. gregg: i think the senator is right. it is important to note that one program under medicare will be absolutely devastated. i understand texas has a lot of people that are in that program. maybe the senator from texas could note that. mrs. hutchison: the senator new hampshire is correct, that's why i am so strongly supporting the amendment that is at the desk because it will wipe out medicare advantage. make no mistake about it. texas has 500,000 people who pay into medicare advantage because it gives them extra things that they don't get under medicare like eye care and eyeglasses and things that are so important. and, in fact, what is so interesting about the bill

before us -- the reconciliation bill -- is it actually increases the cuts in medicare advantage over and above what was in the senate bill. mr. gregg: if the chairwoman would yield there, it takes that money out of medicare and uses it to fund a new entitlement for people that were not on medicare. mrs. hutchison: exactly. taking it away from our seniors who try to do something better for themselves, and mostly in rural arks and it cuts them even -- and mostly in rural areas, and it cuts them even more than the senate bill that the president signed today -- $200 billion in cuts to medicare advantage. it will obliterate the medicare advantage program, which so many of our seniors in the millions across our country. in fact here is a statistic. between 2003 and 2007, more than 600,000 beneficiaries in ruler areas joined the medicare advantage program, a 420% increase in medicare advantage,

because seniors saw that it was a better deal for them, and they decided to take it. mr. alexander: i was wondering if i might ask the senator from new hampshire, i hear often said about supporters of the bill which became law today that we on the republican side are overstating it when we say there are medicaid -- medicare cuts. don't i remember that the director of the congressional budget office testified that fully half of those on medicare advantage would see their benefits cut by a bill like the one that became law today? a understand don't one out of four -- and don't one out of four recipients of medicare in this country, aren't they subscribers to medicare advantage? so can we not expect for at least those one out of four medicare advantage beneficiaries that their benefits will actually be affected by this law? mr. gregg: the senator is

absolutely right. the original number of the original bill that was signed by the president today was 11 million seniors would lose their medicare advantage. that number has to go up now because if this bill passes, it increases the cut to medicare advantage. again it thacks that money and funds -- again it takes that money and funds people who are not on medicare paid and have never paid into the medicare trust fund. i see the senator from idaho rising. does he are issu he wish to tak- mr. risch: i can't understand this. it amazes me that the other side thinks that the american people are so stupid that they are going to believe that you can take $500 billion out of medicare part-d and it is going to be good for the american people and it is going to be booed for the american people. in addition to that, what's been discussed here about this phoning knee smoke-and-mirrors

accounting, the money people understand this. most importantly, we have heard from the american people over and over again, don't touch our medicare. and when they say "our medicare," they mean our medicare. this isn't a gift from the federal government. there was a bipartisan coalition of republicans and democrats who brought the medicare system online here in america. and they made a contract with the american people. if you work, you are going to contribute into the medicare trust fund. and your employer is going to contribute into the medicare trust fund. and it's going to be there for you to be used when it's necessary for medicare purposes. my office is flooded with phone calls saying, you politicians leave your hands off of our comaimplet i've watched this process over the years and seen

people try to raid medicare for substantially less than what we're talking about here. we're talking about a half a trillion dollars that is being stolen from medicare. where's the media on this? you know, this bill -- they count this bill about how -- they tout this bill about oh, it's going to do this and that. nobody ever talks about the down side of a half a trillion dollar theft from medicare. the american people are smart. they understand what's being done here. and anyone -- anyone who supports this is going to pay the price for this in november because i guarantee you your seniors at home, even young people and people who are middle-aged who are looking forward to comairks are going to ask you, did you vote to steal money from my medicare? and you beshting ready -- and you better be ready to answer that question. and don't say that by double counting, somehow taking a half a trillion dollars out is going

to make medicare better. the american people are smarter than this and you're going to find that out this fall. i yield back to my good friend from new hampshire. mr. gregg: the only way that can be avoided -- the only way that this bill and the bill that was just passed today -- signed today by the president -- can be kept from taking medicare funds to fund new initiatives that much nothing to do with medicare, such as the expansion of medicaid, is to pass this amendment. this is it. you know, if you don't vote for this amendment, then you're voting to raid medicare for the purposes of using that money for some other purpose, which has nothing at all to do with medicare. and you're funding this bill on the seniors -- on the backs of seniors basically. how much time do we have remaining? the presiding officer: the senator has one minute remaining. mr. gregg: i know the senator from tennessee wanted to conclude. mr. alexander: well, i would only conclude by congratulating the senator from new hampshire for a very straightforward

amendment. as i understand it, it says, if you're going to take any money out of medicare, it has to be spent on medicare. and it can't be taken and spent on some new government program. mr. gregg: -- a new program until you can priests a being spent with something other than medicare money. money. mr. alexander: and you emphasize that it will affect one-fourth of those who have medicare advantage. and what you're trying to do is simply say, if there's savings in medicare, spend it on medicare. because medicare is going broke and this will help keep it solvent. mr. gregg: that's the only fair thing to do for the seniors of america which is face ago system which has very significant unfunded liability and which they have paid into all their lives and not have it used as a piggy bank for other programs which the other side of the aisle thinks are important

but which have nothing to do with medicare. i yield the floor. the democratic side now has a half an hour and then we have a half an hour. is that correct? the presiding officer: that's correct. mr. baucus: mr. president, senator harkin wishes to speak next. while waiting for the chairman of the "help" committee, chairman harkin, who wants to give his opening statement, let me just make a few points clear here. the amendment offered by the senator from new hampshire is a killer amendment. it kills the bill. it's that simple. it's basically the amendment -- basically the amendment kills the health care reform bill that just became law, that the president signed this morning. and this is debate we had when we were on the bill. the senate has already considered the arguments made by the senator from new hampshire and others. the senate decided against those arguments. the senate has decided to pass

health care reform, as has the house of representatives, as has -- and the president signed it. so this in a certain sense is a stale argument. this is an argument after the bill has already been passed. it would make more sense to make these arguments beforehand, not afterwards. second, what's the effect of it? the effect is -- let me read from the amendment. "it says the secretary of treasury and secretary of health and human sstleses are prohibited from implementing any spending increase revenue provision reductions in the bill just signed by the president, lest certain conditions occur." that means no spending to fill up the doughnut hole. that means seniors will have to spend more on drugs. to means no spending to help states cover medicaid expenses for the expanded population. that means states are really going to be left high and dry. that means no primary care payments to doctors, the primary care physicians, whether it is

medicaid or medicare. that means no tax credits for americans who are struggling to buy health insurance. that means no payments to help struggling americans make out-of-pocket costs. it just -- it just makes no sense. just examples of why this is a killer amendment. and i just would strongly urge my colleagues to recognize that we've had this debate already. this is not new here. they've not said anything new. that debate occurred while we were considering health care reform, and the senate has considered those amendments -- that'those arguments. it has listened to those arguments. we debated this amendment already back and forth and the senate decided by a vote not to accept those arguments. that's -- so we're talking about something that's history. iters a already passed. in a certain -- it's already

passed. in a certain sense, it's irrelevant. this is an teement kill the bill. -- this is an attempt to kill the bill. i strongly urge my colleagues to reject the amendment. let's not forget our bill includes financial incentives for doctors and hospitals to can collaborate and coordinate care for seniors. i thought that's something we wanted. this says no, no, no, can't do that. we can't come up with financial incentives for doctors and hospitals to collaborate. this has not happened often enough in medicare today. we need to have more collaboration. we need doctors and hospitals to work better together. we need some demonstration systems. we need some pilot projects to help us find ways to better pay doctors and hospitals based on quality of care, less on quantity of care. there's nobody who disagrees with that statement. at least anybody that's give an lot of thought to health care reform. this amendment would stop that.

it would prevent us from trying to find way to real estate duce health care costs in this country which are eating us alive, eating up family budgets, eating up company budgets, and also public budgets in terms of medicare and medicaid unless we get health care costs under control and the way toughed tha- and the only way to do that is to change the delivery system. but, no, no, no, this amendment says you can't do that. you can't begin to take the steps necessary to in the long term start reducing health care costs. our bill also -- the underlying bill, which this amendment would kill -- the underlying bill reduces medicare spend by reducing hospital readmissions. i thought we wanted to do that? i thought we wanted to reduce hospital readmissions? this amendment would effectively say, no, can't do that. better coordination

of care means patients don't have to come back to the hospital because of complications, because of the allergies and problems post surgery. what else does the kwrupbtd lying bill -- underlying bill do? it keeps more money by making smart reforms. fewer dollars will be spent by paying doctors for quality of care and not quantity care, by cutting out of the wasteful payments to providers and by creating an innovation center for the medicare program for groundbreaking ways to deliver health care better are discovered more often and put in place without delay. that is a very important point, mr. president. we need to have ways, by creating an innovation center within the medicare program, so we can find groundbreaking ways to deliver health care better. we have to spend some money on these new demonstrations and pilot projects so that we can have a much better health care system. mr. president, i now yield the

balance of time in this half-hour back to the chairman of the "help" committee. i yield time from time under the control on the bill. the presiding officer: the senator from iowa. mr. harkin: mr. president, thank you very much. i thank chairman baucus for yielding me this time. mr. president, i listened with great interest to the distinguished senior senator from montana as he recounted the extraordinary lengths to which democrats went on his committee in soliciting bipartisan republican support in their drafting of the health reform bill in the finance committee. on both the finance committee which senator baucus chairs and on the kph*t on health, education, labor, and pensions, the majority party insisted on a party which was open, transparent and inclue seufplt at every step the democratic majority acted in good faith. republican senators were fully involved in republican hearings and markups as well as private discussions and negotiations. the ideas and amendments of republican members helped to

shape the substance of the bill in a multitude of ways. in the "help" committee, in 2008 and 2009, we held 47 bipartisan meetings on health reform, including 14 bipartisan round tables, 13 bipartisan committee hearings and 20 bipartisan walkthroughs on the bill. then the "help" committee spent nearly three weeks during june and july marking up the bill, june and july of last year. to be exact, our markup spent 13 days and a total of 54 hours. we went out of our way to accommodate our republican colleagues who offered over 200 amendments. we adopted or accepted 161 republican amendments on our bill. mr. president, by any standards, this was an extraordinarily open and inclusive process, and i must point out that democrats in

good faith and in the best spirit of bipartisanship insisted on this inclusive process despite numerous public statements by some republican senators to the effect that their game plan was to delay and obstruct and filibuster and kill the bill. indeed, the junior senator from south carolina famously said if we're able to stop obama on this, it will be his waterloo, it will break him. even in the face of that, we said nonetheless, that's just one person. we're going to have an open and inclusive process. many critics have said democrats pursued inclusion and bipartisanship to a fault. they criticized us for consuming many months negotiating with republicans, accepting their amendments, accommodating their ideas and objections, even in the teeth of their public declarations that they intended to kill the bill. for the record, i am proud of the fact that we went the extra mile to include republican

senators and to incorporate their ideas and input. it was the right thing to do, even if the hand of cooperation and bipartisanship that we extended was rejected. mr. president, with passage of the patient protection and affordable care act, the 111th congress has made history. just as previous congresses did in 1935 by passing social security and 1965 passing the law creating medicare. each of those bills marked a giant step forward for the american people, and each was stridently opposed by defenders of the status quo. but in the end, mr. president, a critical mass of senators and representatives rose to the historic occasion. they voted their hopes and not their fears. and as we now know in retrospect, they passed laws that transformed america in profoundly positive ways. the health reform law that

president obama signed earlier today will also transform america in profound and positive ways. indeed it already has. despite all the talk recently about how our nation has become divided and ungovernable, we have proved not only that we are governable, but also that we still have the capacity to take charge of our destiny and to act with boldness and vision. one prominent comment taeurt said that passage -- commentator said passage of the health care is -- and i quote -- "a victory for america's soul." i couldn't agree more. yet this new law is fully paid for. it helps reduce the deficit by $143 billion in the first decade. and by a whopping $1.2 trillion in the second decade. that's deficit reduction. yes, this new law includes important and long overdue measures to crack down on abuses by health insurance companies, abuses that leave all americans,

including those with insurance, just one illness away from financial catastrophe. no longer will health insurance companies be able to cancel your insurance when you get a serious illness. no longer will they be able to impose lifetime caps or annual caps on their payoffs. no longer will they be able to systematically discriminate against women by charging higher premiums just because -- just because you're a woman. no longer once this bill becomes fully operational will they be able to deny coverage based on preexisting conditions. in addition, the new law includes a whole array of provisions promoting wellness, prevention and public health; something that i have personally championed for many years. this will finally begin to change the paradigm from our current sick-care system to a true health care system, one that keeps people healthy and out of the hospital in the first

place. this bill will begin to re-create america as a wellness society, focused on healthful lifestyles, good nutrition, physical activity, preventing the chronic diseases that take such a toll on our bodies and on our budgets. there's been a lot of talk about bending the cost curve in health care, and there's been a lot of different ways people have suggested on how we bend the costs. quite frankly, mr. president, i think the one biggest way we're going to be able to bend the cost curve is by focusing more on prevention. we know how to do it. we know what works. we know what saves money. we have good data on this. if you don't believe me, ask pitney bowes and what they did to their bottom line. ask safeway corporation what happened to their bottom line in terms of health care costs when they put in place widespread

prevention and wellness policies. so we have private companies out there that are doing wonderful things that we can be doing nationwide. and we can have the same kind of savings nationally for america as these private companies have for their bottom line. and there's one more critical reform in this new law. it includes the community first choice option which represents a major advance in allowing people with disabilities and older americans with chronic conditions to remain in their homes and with their family and community. and it will increase access to medical examinations and diagnostic equipment designed to accommodate people with disabilities. and here i want to speak to all of my friends in the disability community in america. after the passage of the americans with disabilities act in 1990, the next big hurdle was

to break down the discrimination that exists in federal law with -- that pertains to people who are eligible for institutional care but who would rather live in their own homes and in their community. right now under federal law, if you qualify for institutional care, medicaid must pay for that. must pay for that. if, however, you don't want to live in an institution and you want to live on your own, near your friends on your family in the community, medicaid doesn't have to pay for that. and yet, we know that for every one person in a nursing home, we can support three people with disabilities living in the community. and so, this we've tried ever since 1990 to change this. we had the first bill in the

mid-1990's. it was called mcasa, medicaid community attendant support and services act. tried for a long time to get that through, and we could never get it done. and then the last few years we changed the name of it to the community choice act, and we still couldn't get that done. last year about this time i paid my first visit to then-president obama in the white house. i wanted a personal meeting with him to talk about this one issue, that if we're going to do health care reform, we cannot leave people with disabilities behind. and the one thing that matters most is to ensure that people with disabilities have their own choice about where they want to live. if they want to live in an institution, fine. but if they'd rather live by themselves, live in the community with their family and their friends, they ought to have that choice. president obama agreed with that. and so began the long process.

there's one part of this bill that not too many people know about. and i say to my friends in the disability community, we have finally overcome the obstacle. in this bill is the community first -- community choice first option which then will allow the federal government beginning in october of 2011 to begin to pay to states an increased part of their medicaid payment so that people with disabilities can choose where they want to live, not where the government tells them they have to live. to me, this is a profound change in how we're going to treat people with disabilities in our society. this is one of the landmark disability rights parts of this bill. and not too many people know about it, but i think that after the signing of the bill today people in the disability community all over america will

know that it's in there. so, mr. president, these are important landmark reforms that benefit all americans. as the commentator put it, the new health reform laws is also a victory for america's soul. at long last we are realizing senator kennedy's dream of extending access to quality affordable health insurance to every american. we're ending the last shameful bastion of legal discrimination and exclusion in our country. i have stated this before and people said what are you talking about? discrimination? well, over the decades, we have outlawed discrimination in our country on the basis of race, color, national origin, based on gender. we've outlawed discrimination also based on disability, the americans with disabilities act 1990. but until now, think about it, it's been perfectly legal to discriminate against our fellow

americans because of illness, because of sickness, to exclude tens of millions of our citizens from decent health care simply because they can't afford it. think about that. i hear some people talking about setting up pools. we're going to have a pool here and a pool here, a pool for the elderly, a pool for high-risk, a pool here and a pool there and different people get in these different pools. my friends, that is nothing more or less than blatant discrimination. are we not all one american family? that's what we said when we passed the americans with disabilities act. this is our family. we shouldn't be shunted aside, separated out. we said the same thing on the basis of race years ago with the civil rights act. on the basis of women, national origin. well, now with the signing of the bill today, we have said no longer are we going to discriminate against people because they're sick. think about that. no longer are we going to

discriminate against people simply because they're sick. this is a profound change in the way that we are going to deal with each other as a society. so when president obama signed that bill this