he's been a leader in the fight for prevention. will now be -- get prevention in their benefits, for the average american who's recently gotten sick or who might in the future. they don't have to worry that their insurance company will take away the benefits. they will not be able to do that the way they have now. we won't have to hear stories anymore of health insurers looking for any excuse to cut sick people off from their insurance. what about those tens of millions on medicare who, again, have been scared and worried that medicare will change? yes, medicare will change. it will get stronger and still preserve the exact same benefit to every person on medicare. before this bill was signed into law, medicare was going to go broke in seven years. it's been given an extra decade.

that should be a huge load off the shoulders of people who worry about medicare. and, in addition, the doughnut hole will be closed so all those medicare recipients on prescription drugs will get relief. more relief. so for the average senior citizens, as they learn about this bill, they're going to like this bill. they're going to say this was a great thing. it kept medicare as is, surviving much longer than previously predicted. if we had done nothing and medicare was about to go broke, guess who would have paid the price. those senior citizens on it. what about young women looking for health insurance. health reform means she won't be charged a premium, 150% more than a young man's. health reform ends that gender discrimination to the millions of young women in america. the presiding officer: the senator's time has expired.

mr. schumer: in conclusion, mr. president, i would just say this: in november this bill will be a positive -- a strong positive for those who supported it, those who were in favor of it will benefit, those who opposed it will come to regret their opposition as america learns about what is in and what is not in this bill. it is not just a triumph for history. it's a triumph for the average american. a senator: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, i'd like to yield to the chairman of the "help" committee -- i now yield to another distinguished chairman. this is -- one not of the "help" committee but of the energy committee, senator bingaman, for five minutes. mr. bingaman: mr. president -- the presiding officer: the senator from new mexico is recognized. mr. bingaman: let me thank my friend and chairman of our

finance committee, senator baucus, and congratulate him on his leadership on this issue for many, many months. first i'd ask unanimous consent that nasim and jason akelson, both who are fellows in my office, be granted the privilege to be on the floor during the pendancey of h.r. 4872. the presiding officer: without objection, it is so ordered. mr. bingaman: this health reconciliation bill. mr. president, i rise in strong support of the reconciliation bill that's before us. it's a historic time for our nation. i'm very glad that after decades of effort, national health reform has become law and that we are considering this set of changes to the law through this reconciliation bill. there's considerable confusion

about what health reform, in fact, will accomplish. it's not surprising that there's confusion when you consider all of the nefarious charges that have been made and charges -- claims of nefarious provisions within the legislation. i'm glad to see that most americans, according to polling, believe that the actual provisions that their -- that are described to them, that are contained in the bill, are meritorious and deserve support. simply stated the law has four main goals. it reforms health insurance markets to ensure that americans have access to affordable care that meets their needs. second, the bill improves the efficiency and quality of health care. does it in a way that helps contain rapidly rising costs. third, the bill improves access

to primary care and preventive services. and, fourth, the bill significantly reduces the federal deficit over the coming decades. i think we need to focus on what will the effect of the legislation be on particular individuals and families in our states. and i look at our circumstance in new mexico, which i'm proud to represent, and let me just pick out a few examples. first, there are families there that are very happy with their current coverage. and for these folks reform ensures that they can keep that coverage. they do not have to purchase any new coverage offered through health insurance exchanges. reform will help protect their coverage. it introduces important policy to put downward pressure on the cost of premiums. requirements that the coverage continues to be meaningful and significant improvements in the overall quality of and their access to health care.

small business owners or the people who work for small businesses, they're a third of the people in my home state who fall into that category. for whose who do offer coverage, we know that without reform, they have difficulty affording and keeping meaningful and affordable coverage for their employees. premiums are rising quickly. these costs threaten the financial stability of these small businesses. c.b.o. tells us that for small businesses the impact on reform will be very significant. first, the businesses would have the option to come to the new health exchange -- health insurance exchange and would have a guaranteed source of meaningful coverage for themselves and their employees. in addition, these small businesses may qualify for tax credits for up to 50% of the cost of the coverage. for businesses receiving tax

credits and their employees premiums would decrease by 8% to 11% compared to their cost under current law. so small businesses and their employees do well. what about individuals purchasing coverage in the individual market? this is particularly important in my home state where over half of the workers in my state are not offered employer-sponsored coverage. we have the highest percentage of workers without coverage of any state in the union. and like small businesses, individuals today have great difficulty in navigating insurance policies, securing affordable and meaningful coverage. this reform will provide these individuals with the option to come to new health insurance exchanges and have a guaranteed source of meaningful coverage for themselves and their families. congressional budget office predicts that the subsidies that enrollees would pay would be roughly -- would reduce the

premiums that they otherwise would have to pay by 50% to 60%. mr. president, let me conclude by asking that the balance of my statement be included in the record. and let me also compliment my other committee chair, who is here on the floor, senator harkin, who worked tirelessly to get this legislation through the "help" committee. he deserves great credit for his leadership on this bill as does senator baucus. thank you. the presiding officer: without objection, it is so ordered. mr. baucus: mr. president? the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, that's a good introduction of the next speaker, th senator harkin. the presiding officer: the senator from iowa's recognized. you're recognized. so you get the floor, senator. you're recognized. mr. harkin: i thank the presiding officer. i want to say to my friend from

new mexico, i thank him for his kind words an all that he did to get us to this point as a member of the "help" committee. mr. president, i have a limited amount of time. i wanted to respond to the motion to recommit made by the senator from tennessee yesterday that would reduce our investment in pell grants and replace them with low student interest rates. well, now, we all want lower student interest rates. i'm -- i'm, quite frankly, surprised. i don't remember my colleague from tennessee or other colleagues on that side of the aisle raising much contain around here -- cain when the bankers and sally may were charging students over 20% interest. i didn't hear a peep from the other side. we capped all of those interest rates and we're changing that program to a direct loan program to cut the middle man out. by cutting out the middle man, by cutting out the huge subsidies to the bankers, we're able to save over $61 billion

over the next 10 years. $61 billion, which we are using, again, to put into the -- into the pell grant program to help our students. now, mr. president, i said yesterday, and i repeat again, you think about the present at t itus quo with -- status quo with this indirect guaranteed student loan program. think about how bizarre it really is. the federal government pays fees to private banks to make entirely risk-free loans using taxpayer dollars. the loans, which are already guaranteed by the federal government, are then sold back to the federal government. the banks then pocket tens of billions of dollars, taxpayers' dollars in fees and easy profits at absolutely no risk to them whatsoever. this has been going on for far too long. what this bill does is it ends

that, takes all those savings that otherwise would go to sally may and to the bankers and puts it into pell grants. and so, again, while i would agree that our students have too much debt, way too much debt, 73% of four-year college graduates in my state of iowa graduated with a debt that averaged over $28,000 - over $28,000 -- $28,174. the national average is $23,200 for a student graduating from college. my iowa students have the second highest debt loads in the nation. well, we're taking charge of that. three years ago we in the college cost reduction and access act of 2007, we created the income base repayment program. what that bill said is that a borrower's payment would be capped at 15% of their net income after adjustments were made for living expenses and

provided total loan forgiveness after 25 years. and we targeted assistance to those people having the most difficult time repaying their loans. well, more can be done. now here's what can be done in this bill, we have right now starting in 2014 new borrower's monthly payment will be capped at 10% of their net income. they'll be eligible for total loan forgiveness after 20 years. so this is going to make college much more affordable for students even after they graduate. now, again, if my friend from tennessee wants to look at ways of reducing interest rates, i'm all for it. you know, one of the biggest users of credit cards are kids in college and look what they're being charged under credit cards. well over 20%. 30% sometimes under credit cards and they need that for immediate needs. if you're a parent with a kid in college, you know what i'm talking about.

well, you know, if you really want to help students, how about capping the interest rates that they can charge on credit cards? i've advocated that 20 years ago, we advocated 12% to 15%, can't charge anymore on this that, i don't hear my friends on the other side to talk about that at all. that would help our students more than just about anything else. so, again, three years ago when we cut the interest rates on student loans, we were criticized by the republicans for not doing enough to increase pell grants. now, we're being criticized for doing too much on pell grants and not enough on interest rates for students. well, i think you see what this is, just another attempt to try to kill -- to try to kill this reconciliation bill. that's all it is. of course i'm for lower interest rates. who wouldn't be? of course we're all for making sure the interest rates are lower. so when this reconciliation bill is through, mr. president, i

intend to come to the floor, some bill probably coming up, maybe a financial bill or something like that, and i will be proposing at that time that we have lower interest rates. and i ask my friend from tennessee to join us in that effort at that time. but now is not the time and this is not the bill on which to do this. we have to get our reconciliation bill through. and every amendment offered by the republicans is no more than an attempt to stop and kill had reconciliation bill and we can't allow that to happen. so, again, mr. president, education -- we're going to have an education bill, we're going to have an elementary and secondary education bill i hope sometime this year, higher education act, reconciliations are in this bill. we're going to make sure that students have the money to go to college and pell grants for the lowest income students. and, yes, we have capped the interest rates. they're capped at 6.8%.

could they be lower? i invite my friend when we have another bill up that addresses this, let's see if we can get lower interest rates. i'd be glad to work on that issue at that time. but right now let's put the savings, the $61 billion that we're saving, let's do what this bill does, put it into better pell grants so the kids can get into college in the first place. and we also put $2.5 billion into something that we have neglected for far too long, and that's our historical black colleges an universities and other -- colleges an universities. so a big chunk of that money goes in there so they can also get an education. this bill was carefully crafted. let's address the issue of the interest rates later on, and i invite my republican friends to join with us in doing that, especially on credit cards when that issue comes up down the

pike. mr. president, again, i urge my colleagues to -- when the vote comes up, to defeat the alexander amendment and keep the money in there for pell grants. i yield the floor. the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, i would just like to say a few words about how much this -- that this underlying legislation helps small business. you hear a lot of claims to the contrary, and i just want to set the record straight. essentially, small business people in america today spend about 18% more than do large businesses for the same health care coverage. why is that? because of high broker fees that small businesses have to buy insurance through, administrative costs are higher for them compared to big business, adverse selection hurts them much more than big business. there are a lot of reasons why small business pays 18% more for health care than big business. this legislation contains contains $37 billion in small business tax credits.

$37 billion in small business tax credits, most of which go into effect this year. not later, but this year. tax credits for a businessperson who wants to offer health insurance for his or her employees. add to that the insurance reforms. they are very much going to help small business. what are they? preventing insurance companies from discriminating against small employees based on pre-existing condition, preventing discrimination on the basis of older or sicker employees. discrimination based on the size of the plan or discrimination against those whose employees work in dangerous industries. all these insurance reforms are going to help small business. i might say the c.b.o., the congressional budget office, also estimates that the senate bill will lower premium costs by nearly 7% for small business. lower premium costs, not increase as has been suggested, but lower premium costs for

small business. it also provides, the bill does, for state-based exchanges. that's going to help small business because that will allow more competition among insurance companies, require more competition among insurance companies. that's going to help give better rates, better quality insurance to small business. and i might say also this legislation exempts small businesses -- that is, businesses with 50 or fewer employees, from the requirement that employees who do not sponsor health care insurance pay a fee for their employees receiving premium tax credits. that is an exemption for small business with fewer than 50 employees from paying any penalty if they do not provide insurance. so i want to make it very clear. this bill very much helps small business, and i repeat with with $37 billion of small business tax credits, along with the other reasons that i gave. mr. president, how much time do we have left? the presiding officer: a minute and a half, senator.

mr. baucus: mr. president, i -- i don't know if senator mccaskill is here? if not, i will just yield back that minute and a half and let the republican side -- i understand senator mccaskill wishes to speak. i will try to find some way to squeeze as much time as i can. senator, you're on. the presiding officer: the senator from missouri, you're recognized, you have one minute. mrs. mccaskill: mr. president, i'm just confused about why the hearing that we had scheduled this afternoon cannot go forward. the subject matter of this hearing is oversight of the contract that is engaged in police training in afghanistan in the contracting oversight subcommittee. this is a hearing that is getting to the heart of the

matter that we have a real problem with the mission part in afghanistan on police training because of problems with these contracts, problems with oversight of the state department. we have now canceled the hearing because we have been told we can't have it. the witness from the state department has been canceled. the witness from the defense department has been canceled. the inspector generals that were coming to testify about a g.a.o. report that just came out last week that was damning in its criticism of the oversight of these contracts. the presiding officer: the senator's time has expired. mrs. mccaskill: i don't get it. the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, is there an order providing for the next half-hour? the presiding officer: there is not. mr. baucus: i ask unanimous consent the republican side control the next half-hour and the majority side control the next half-hour following that. the presiding officer: without objection, so ordered. a senator: mr. president, reserving the right to object,

we should have the half-hour after that. you get the first half-hour. the presiding officer: is there objection? without objection, so ordered. the presiding officer: the senator from new hampshire is recognized. theenator from maine is recognized. ms. snowe: thank you, thank you, mr. president. i also want to thank the senator from new hampshire. thank you very much for your leadership and for the consideration of the time here today. mr. president, as consideration of health care reform draws to a close in the senate with a pending reconciliation bill, i cannot help but arrive at this moment with a sense of profound disappointment in considering what might have been rather than what has actually occurred with respect to one of the most foremost domestic matters of our

time. as i stated as a member of the senate finance committee at the conclusion of our markup of health reform legislation on last october, this is one of the most complex set of issues ever placed before us. at the same time i said that the reality that crafting the right approach is arduous in no way obviates our responsibility to make it happen given the enormous implications of reordering more than $33 trillion in health care expenditures over the next ten years, representing 1/6 of our economy and affecting every american. well, mr. president, if there is one thing i have learned, it's that the only way to allay people's fears is by systematically working through the concerns, the issues, and the policy alternatives from all sides. now, when we hear proponents portraying the passage of health reform as the equivalent of landmark legislation of the past, what they failed to note is that those efforts were all bipartisan. regrettably, part of the history we made this week is that for the first time, a truly

watershed bill became law truly along partisan lines. as i mentioned on the floor last november, it's almost impossible to see how transportation legislation over the last 100 years like social security, medicare and civil rights could have been as strongly woven into the fabric of our nation had they forsaken bipartisanship. well, we could have extended that bipartisan legacy, mr. president. the majority had 60 votes for health care reform, so they had a choice. they could have worked collaboratively to develop a more balanced, effective and credible approach that even if it ultimately failed to attract many republican votes could have ruld in legislation more widely embraced by the american people. because in the final analysis, no one party or person has a monopoly on good ideas. that is precisely the reality that originally brought six of us together in the senate finance committee and the so-called group of six to the credit of chairman baucus who convened a meeting last summer along with ranking member grassley, and that the chairman

and ranking member referenced early in the debate on the floor and i commend them for what has always been a bipartisan effort in any committee of the house and senate. certainly that has been true and indicative of the collaborative, cooperative relationship. as the chairman pointed out, we met 31 times, week after week, for over four months to debate policy and not politics because we were attempting to reach bipartisan consensus on the reform legislation. and while we ultimately did not roach an agreement, given our discussions were ended prematurely by an artificially imposed deadlines, our efforts did in many ways form the foundation for the subsequent finance committee legislation, that while far from perfect, produced bipartisan reforms, including banning the egregious practices that have been discussed here so often and again by the insurance company. we tried to navigate the ideologies on both end of the political spectrum. at the same time as i have stated at the conclusion of the finance committee markup, the

issue of affordability remained one of my paramount concerns. i further express that we cannot create vast new bureaucracies and governmental intrusions. finally i said that my vote to report the bill out of the committee was to continue to work to improve the legislation and therefore would be imperative moving forward, that the majority in the senate give deference to the scope and the complexity of this issue, earn broader support and resist the impulse to retreat into partisanship. regrettably, since the finance committee vote on october 13, the wheels essentially came off. the process went behind closed doors with only one party represented. long gone was the transparency of the finance committee debate, and what came to the senate floor was a 2,400-page bill, 900 pages longer than the finance committee bill that we were forced to complete by christmas day after a mere 21 days on the floor. mr. president, looking at a relative equivalence in terms of

benchmark legislation, the senate debated the civil rights act of 1964 for 57 days and the f.a.a. bill that we just considered, we just voted on on monday, we disposed of 45 amendments. that's 17 more than we address in the amendment process on health care reform legislation in december. what exactly were people afraid of? just think what we could have been celebrating here today. if we would have had the open amendment process that we had been promised or even if we had, as i had urged last october, that bipartisan summit had occurred then instead of last month. if it was a good idea now, it would have been a good idea then. imagine if they had had the opportunity to sit down with the actual legislative language and through working through all of the issues, determining what works and what doesn't work. we could have crafted a better product, but now we'll never know. we could have instead developed

something practical, rolled out in phases, something all the more critical, given that we were already in treacherous economic and fiscal waters. it's not as though we lacked the time, mr. president. after all, the major provisions of this initiative do not take effect until 2014. in fact, c.b.o. has said that with the majority reform issues not scheduled to commence until then, four years from now, by year 2013, there will still be 15 million uninsured americans, exactly the same number as today. now, there are those who argue that the senate-passed legislation was basically the same bill that emerged from the finance committee, but the facts tell a story of a different bill. far from improving upon the finance measures i have indicated would be critical instead went precisely in the opposite direction for what americans wanted, with greater bureaucracies, more taxes, ill-conceived measures that would cost our nation's jobs

rather than help to create them. just look at this chart, mr. president, with respect to the employer mandate to cite some examples. something important to me as ranking member of the business committee. the finance proposal contained no mandate per se forcing firms to offer health insurance. rather, it specified that if a firm chose not to offer insurance and any of its workers received subsidized coverage in the exchange, the firm would pay a penalty equal to the lesser of the -- of an average credit amount that the employee received in the exchange or a flat $400 fee for all of its workers. now, i would have preferred zero penalty. the senate-passed bill actually got worse, as you can see with this chart. first permits nearly doubled from those in the finance package to $750 per employee. then it greatly expanded the instances in which penalties would be applied, requiring employers with more than 50

full-time employees who don't at least offer coverage and have even one full-time employee receiving a subsidy through the exchange to pay $750 for each of its full-time workers. now, under the reconciliation package that's pending before the senate right now, firms with more than 50 workers would have to pay $2,000 per employee with just the first 30 employees exempted. that's 167% increase over the the $750 in the bill that was just signed into law, mr. president. so we have gone from $400 to $750 and now to $2,000. now, if that's not enough, part-time workers and seasonal workers will be now counted in determining whether or not the mandate will apply. that will be devastating. it will be devastating to small

firms, middle-sized firms, restaurant, retail, seasonal industry like my state of maine will be subject to this mandate, which now produces $52 billion in revenue, up from the the $27 billion in the bill that just became law. mr. president, exactly how is this going to help our nation's greatest job generators, that's small businesses? we're depending on small businesses to lead us out of this downturn. now let's look at the medicare taxes. the second chart, mr. president. well, the finance bill did not contain any form of medicare taxes. we did not increase medicare taxes, mr. president. the senate bill that just became law and signed by the president yesterday included $87 billion in medicare taxes. that disproportionately affects small businesses because they apply to the income those businesses would normally

reinvest. plain and simple, this .9% increase in medicare payroll taxes is a job killer. as it essentially takes away one additional percentage point of capital from the very small business owners we're depending on, depending on to create jobs, who are more than likely to employ between 20 and 250 employees, all at a moment when we should be looking for ways to help bring capital into small businesses. now, if that weren't bad enough, here we have reconciliation that's pending before the senate that compounds the mistake with a 3.8% medicare tax that is unprecedented because it's imposing a payroll tax on investment income. and when combined with a capital gains tax increase the majority is planning for the end of this year, this 3.8% tax will raise the capital gains tax rate to an astonishinishing 23.8%, which ia

67% increase in taxes on investment during these precarious times. taken together, mr. president, this is a grand total of $210 billion in medicare taxes, and more taxes. so we went from the finance committee from $0 to the senate-paspassed bill that becae law yesterday to $87 billion, and now the bill pending before the senate, we've got a grand total of $20110 in medicare tax. it's a midden tax, by the -- it's a hidden tax, by the way. it'll be splar to th similar toe alternative minimum tax. it is a major tax increase on individuals, small businesses, on capital at a time when we desperately need that capital to be reinvested to create more jobs. so again, we've gone from zero to $200 billion in new taxes in

medicare. do we seriously believe this is the time to be instituting these breath taking and job-killing increases? not to mention the unprecedented shift because not one dollar goes in reinvested into medicare, not one dollar. not to mention a doesn't fix the -- address the physician proficiency the 21% reduction in provider reimbursement that we have to extend this year for another month because it is a month-to-month problem. we need a ten year fix. we're taxing it for other purposes other than into medicare. so that's unfortunate because of the process that we have at hand, madam president. now look at what two of the largest organizations representing small businesses in america have stated upon passage of the finance bill. first the finance bill. the national federation of independent businesses. they said at the time when the finance bill passed on october 13, "nfib appreciates the many

provisions that reflect small businesses' needs which are rooted in approaches that aim to lower costs, increasing coverage options, and provide real competition in the private marketplace." now fast-forward, madam president, to the senate-passed bill in december that now became law as a result of the president signing it yesterday, and now what does national federation of independent businesses have to say, nfib? "the impact on these new taxes, a rich benefit package that is more costly than what they can afford today, and a hard employer mandate" -- the one i referred to earlier -- "equals disaster for small businesses." and on march 21, they said, "we couldn't have been clearer how damaging this bill will be to america's small businesses and the economic recovery of this country." madam president, particularly in these precarious economic times,

shouldn't that make us all deeply concerned? now consider what the national small business association released this weekend, and i have that ol. "we have continued to work positively for needed changes, but it's now clear that most of these recommendations have not been accepted. we need that it is impossible to create a significant reform such as this one without some objections from nearly every constituency, but our objections to this bill go beyond those reasonable expectations. congress can do better." to which i add, i couldn't agree more. and they say, they oppose the health care reform bill with regret. but they based it on all the significant issues that have been incorporated in this legislation that are going to be damaging to small business, and i couldn't agree more. i'm deeply troubled by the manner in which the medicare tax increases in this bill are to be utilized, the $210b according to c.b.o. -- and this is their

exact word -- "to describe the full amount of the medicare 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." so, one, talking about the fact on the reduction of deficit -- not going to approve it. secondly, whether or not it will be plowed back into medicare. it is not going to affect comairs insolve hava-- affectme. another major difference in the legislation that we passed in the senate finance committee on october 13 and in pending reconciliation bill, and that is

of course it includes the so-called class act to address long-term care. now, while proponents point to estimates that this provision would raise $72 billion over the first ten years, that savings only occurs as a result of a fiscal shell game of using funds promised to pay beneficiaries later, to lower the deficit today. as c.b.o. say, the program would pay out far less in benefits than it would receive in premiums over the ten-year budget window." raising $70 billion in premiums that will fund benefits outside the window. and, as a result, c.b.o. further concluded, "that in the following decade, 2029, the class program would begin to increase the deficit." again, madam president, this is exactly the wrong direction for america. now perhaps most disturbingly, we don't even have answers from c.b.o. to many fundamental questions in the minds of men's shall the minds of small

business. what will be the true impact? those are questions i posed to c.b.o. on december 3, with-to-which i still don't have the answers. what provisions in the legislation would justify and facilitate premium increases, to what extent would other provisions limit their outcome? what would go up, what would go down, madam president? we need to know. what is going to drive up premium costs, what's going to lower premium costs? in my home state, "mainers wait and wonder. how will reform affect us?" that's why i requested specific state-by-state analysis of the reform's effect on premiums. because while we do have from c.b.o. a national average for premiums, what they would be for a minimum credible coverage under the new law, but the reality is that cost would verily widely from state to -- would vary widely from state to state. i asked c.b.o. what the impact would be of opening up the legislation to allow the young

invincible plan to extend it to all americans and extend those subsidies of the bill to that coverage as well so that everyone has at least one affordable option to purchase health insurance. why, because the federal government is requiring for the first time that individuals purchasing health insurance -- that's first, an individual mandate -- secondly, it sets new standards in the plan and the exchanges that could drive up premium costs for certain individuals and small businesses. so shouldn't we have the certainty that affordable choices are available? yet we don't even have substantiation whinl the provisions of this reform -- whether the provisions of this reform will make health care costs higher or lower. in fact, madam president, there's actually a presumption in the legislation that costs may well go up. i find it telling that the excise tax on high-cost insurance in this reconciliation contains a fail-safe provision,

a health cost percentage and that was described in the house democratic summary of reconciliation. they put it this way. "if c.b.o. is wrong in its forecast of the premium inflation rate between now and 2018," well, maine is a higher-cost state because we don't have a competitive market. we have high-cost plans along with 16 other states. but given the bill already provides for thresholds as high as $13,890 for individuals, $36,450 excluding vision and dental benefits before triggering the excise tax, those thresholds are even significantly higher than those that were passed in the senate-passed bill yesterday. now they'll be raised even higher under the pending reconciliation. the question is, why exactly would we still require a medical inflation adjustor for 2018? eight years from now that raised

those thresholds even higher. what does that say about the reformers' confidence in reining in medical costs as a result of this legislation that was signed into law and the pending reconciliation? it says, madam president, they simply don't know. the fail-safe automatic increase in the threshold clearly assumes that this legislation still may not address runaway costs. now, mind you that these are the thresholds -- i ask unanimous consent for one additional minute. the presiding officer: without objection. ms. snowe: thank you. madam president, these are the thresholds. and eight years from now, the legislation is suggesting, because they have add inflation for medical costs, that outpaces inflation two to three times, they're saying eight years from now, we will not have control of medical costs, even with the passage of this legislation and having taken affect as a result of yesterday. it is precisely because of this uncertainty that i'll be

offering amendments to address these very issues. somehow, madam president, the hard work of legislating, of deliberating, of ironing out our differences and being cast aside of either/or propositions when we could have risen to the monumental challenge with the best possible solution to strengthen america's health security today and for generations to come. i profoundly regret this process has provided far too few opportunities to forge legislation that would stand not just the test of our time but for all time. we could have done better, madam president. and we should have done better. i yield the floor. burnmr. coburn: madam president? officer d. mr. burr: madam president? the presiding officer: the senator from north carolina. mr. burr: madam president, i will also offer an amendment tonight. the purpose of this amendment is very clear. it is to protect the health care of our nation's service members, veterans, their wide dorks

orphans, independents. the problem? since the debate on health care debate began, our veterans and their families have asked for just one thing: protect our health care benefits. the president even promised -- he said, one thing that reform won't change is veterans' health care. no one is going to take away your benefit. that's the plain and simple truth. unfortunately, the patients' protection affordability act does not explicitly protect the health care of our nation's service members, veterans, their widows, orphans, or independents. let me explain why. under this health care bill, it requires a minimal essential coverage of any health care plan. the requirements for that health care do not clearly include l tricare, which is the active duty family members of our troops, the v.a. spina bifida program under chapter 11, title

38, and champ v.a., a program run out of the veterans' administration for spouses and dependent children of veteran whose died or who are profoundly disabled as a result of military service and possibly v.a.'s vocational rehabilitation program. as a result, these beneficiaries could be forced to pay additional insurance or to pay punitive fees because the threshold of coverage doesn't meet the threshold defined in this bill. now, apparently, the authors were so preoccupied with the sweetheart deals and backroom negotiations, that they forget about the policy -- they forth h they forgot about the policy part of this health care bill. as soon at issue was identified, the house rushed through on saturday to pass a bill to put a technical correction on the department of defense piece. the bill passed in overwhelming

support -- 403-0678-06789 the pm is, the only piece that the technical piece fixes is tricare. it doesn't fix spina bifida for the children of agent orange survivors, it doesn't fix champ v.a. which is the program for spouses, dependent children of veterans who died or who are profoundly disabled as a result of military service. now, identical legislation was introduced in the senate and some will claim, well, we just need to pass that. you need to pass that if in effect you don't to extend champ v.a. and spina bifida. now, i've got to commend the secretary, kin shaky, and gates, and i certainly appreciate their reassurance. however, the greatest assurance you can provide is to be unambiguous about the issue. and we owe it to our nation's veterans and families to leave

uncertainty outside and to spell it out in the legislation that these items meet the threshold. therefore, those families, those service members aren't obligated in the future for additional penalties and/or fees to participate. it's time we started to listen to the american people, especially when it relates to our nation's veterans and their families. my amendment maintains the integrity of the health care system of v.a. and d.o.d. it assures that the authority of the secretary of the department of defense and the secretary of the veterans administration would not be challenged or obstructed by any provision in the patient protection, affordability care act. my amendment will ensure that nothing in the democrats' health care bill should be construed as affecting benefits provided under tricare or any v.a. health care program. finally, my amendment ensures that the minimum essential coverage -- key word "minimum

essential coverage" -- under the democrats' health care bill includes tricare and all health care provided by the v.a. now, i think it's important to remind my colleagues that over the weekend, the veterans service organizations have expressed their deep concern and more than one v.s.o., veterans of foreign wars, they said this -- and i quote -- "the bill language is important and that's why the v.f.w. remains adamant to expeditiously fixing the new law. all of d.o.d.'s programs should have been in the original bill as well as all title 38, not just one part of one chapter. this isn't playing politics. this is protecting the hard-earned health care coverage our veterans service members and their families deserve." now, some might come to the floor later and say, well, this is not the appropriate place to fix it. madam president, this has been billed as the -- the reconciliation bill has been

billed as the bill to fix everything that's wrong in the original health care bill. that's how it was sold to house members. vote for the senate bill and we'll fix all these things that you find as problems in the reconciliation bill. now we've got before us the reconciliation bill and some will argue that fixing it for our nation's veterans, their spouses, their family members, that this isn't the appropriate place to do it. i agree, we should have gotten it right the first time. we shouldn't have to have a fix-it bill. but when you don't bring sunlight to it, when you exclude people who are focused on poli policy, this is what you get, you get a bill that doesn't fulfill the promises the president made. let me just state again exactly what they were. the president said -- and i quote -- "one thing that reform won't change is veterans health care." he went on to say, "no one is going to take away your benefits. that is plain and simple truth." well, if it's plain and simple truth, then this body has no choice tonight but to take my amendment, to pass my amendment,

to incorporate it in the health care fix bill, the reconciliation bill, and to make sure that when we finish our business, whether that's tomorrow or the next day, that, in fact, it's very clear in the health care bill who's covered. it's not just tricare for life. it is tricare. it is spina bifida for the children of agent orange exposures. it is the champ-va program which covers spouses, children, and the severely stabled of -- of those killed in action. my hope, madam president,is that all of my colleagues will see the -- my hope, madam president, is that all of my colleagues will see the wisdom of supporting this bill that. they won't look for another avenue to do it, they'll nut the fix bill, and they won't leave it up to secretaries to give us the assurance when we have set up so many outside panels to interpret for the american people what their coverage is going to be in the future. i think sometimes we forget the complicated maze that this bill creates where we will actually

have nonproviders determining whether your coverage is sufficient that you constructed or that your employer provided for you or that you went out as an independent and bought, and if it doesn't meet the -- the standard of minimum essential coverage, then you could be open -- the presiding officer: the senator has one minute. mr. burr: i thank the president. then you could be exposed to a fine because a government bureaucrat has determined that the coverage, the health care coverage that you bought, that you were given isn't sufficient enough to meet the minimal essential coverage that this bill crafted. well, very simply, they're veterans around this country that know they've been left out. their spouses, their family members. their kids with disease. tonight we can assure them that they're included by, in the

health care fix bill, actually fixing that one piece and making sure that we extend the coverage that the president promised and that we owed to these veterans and their families. when i introduce that bill, i hope all 100 senators will support it like the house has. i thank the chair. mr. levin: madam president? mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: madam president, i believe the half-hour now turns to our side. the presiding officer: that's correct. mr. baucus: i'd now like to yield to the senator from michigan for a request. the presiding officer: the senator from michigan. mr. levin: madam president, i make this request as chairman of the senate armed services committee. i would note that this man consent request is supported by my ranking member, senator mccain. we've had -- we have three commanders scheduled to testify this afternoon. they've been scheduled for a long time. they've come a long, long distance. one of them has come from korea.

one of them has come from hawa hawaii. and i would, therefore, ask unanimous consent that the previously scheduled and currently scheduled hearing of the committee on armed services be allowed to proceed and that we be authorized to meet during the session of the senate on wednesday, march 24, 2010, at 2:30 in open and closed session to receive testimony from admiral robert willard, united states navy commander of the u.s. pacific command; from general kevin chilton, united states air force, commander of the u.s. strategic command, and; from general walter sharpe, united states army commander, u.s. forces korea in review of the defense authorization request for fiscal year 2011 and the future years' defense program. again, senator mccain supports this request. and i understand it is not likely there will be any votes here on the floor until 5:30 this afternoon.

mr. burr: madam president? the presiding officer: is there objection? the senator from north carolina. mr. burr: as a member of the committee, and i side myself with the chair and the ranking member, that i have no personal objection to continuing. there is objection on our side of the aisle. therefore, i would have to object. the presiding officer: objection is heard. mr. baucus baucus: madam presid? the presiding officer: the senator from montana. mr. baucus: madam president, i yield to the distinguished senior senator from california, senator fine taken to finesenat. the presiding officer: the senator from california. mrs. feinstein: i thank the senator from montana, and his work has been prodigious, long and hopefully not too exhausting. madam president, i want to speak very personally about health care reform, why i support the bill that has been signed by the president and why i support the reconciliation bill and why i will oppose any amendment, no matter how good that amendment may appear to be.

i am a doctor's daughter and i'm a former doctor's wife, so i've lived most of my life in a medical family. i have had very good health care. my father, who was chief of surgery at the university of california medical center, never operated on anyone that he didn't make a house call on. he was well-respected by his students and a great surgeon. my husband, who died, was a neurosurgeon and his practice was spent in sterotaxic surgery with respect to people who had abnormal movements and couldn't control their movements. and so i came to really believe that we had the best medical system in the united states of america. and it was only the last few years that i began to see how much medicine had changed in america. and when you walked into a doctor's office, it wasn't like one secretary in my father's

office, it was a bank of files and a pressure and lines waiting to be seen. and i realized that there were so many people that didn't have good health care, that worried about losing their health care and, in fact, are losing their health care that this kind of reform suddenly was open to me. then i looked at some statistics because i thought america spending all this money, spending nearly 15% of our g.d.p. on health care, we must be getting substantial bang for the buck. and here's what i found instead. according to the world health organization, the top health care systems in the world begin with france, number 1, italy, and it goes on. and the united states is ranked

37th. so let's go on. infant mortality. i think infant mortality is a good criteria of care, because we know with good medical care, you save babies. and i thought, surely, america's going to be number 1 in terms of infant mortality. no, we're number 22. and, in fact, japan is at the top with 3 deaths per 1,000 births. so let's look a little further. avoidable mortality rate. this is death that you can avoid with good medical care. well, we have great medical institutions. you would expect that we would rank very high. again, france is number one and the united states is not 2, 3, 4 or 5 but number 15. and the source of that is the

commonwealth fund. well, i then began to think more deeply about it and to realize that we have all these people in this country growing that are uncovered. and, in fact, in california, my state, a state of nearly 40 million people, in the last two years, each year the uninsured have gained a million people. so over the past two years, california has lost insurance for 2 million people, bringing the total of people up to 8 million, who have no insurance whatsoever. then you see about companies, that when they get really sick with h.i.v., with full-blown aids, will just simply cancel their policy and throw them out. and then you learn that there's such a thing as a preexisting condition, and we all come with

certain preexisting conditions, or probably at one time in our life will have one. and we find there are companies that won't grant insurance if you have a preexisting condition. and in my 17 years in the senate, 18 years in the senate, we've had numerous people write and say, i have been denied this treatment or i have been denied that treatment, would you please try and help me. and we do. and sometimes we win and we get a procedure for them that they had been denied by their insurance company. it's so important to know what this bill will do, that it will essentially cover 32 million or 95% of the people of this country with some form of insurance. and when the exchanges are functioning, they will have real choice if they wish it, that

their insurance will not be taken away from them. right away this year, those of us at the white house -- who were at the white house, heard the president say that immediate gains will take place. for example, $5 billion for a high-risk pool, helping to provide coverage for those who are uninsured because they have been denied coverage by one of the big medical insurance companies. also, children with preexisting conditions can no longer be discriminated against so that the family with a juvenile diabetic who can't get insurance because the child is a juvenile diabetic will be able to get that insurance. and that is really important. we've learned that the notorious doughnut hole, which takes place when you spend a certain amount on your pharmaceuticals, there

is a hole in the middle, at which point there is no help and each person in that situation would receive $250 to help them through that time. and that a child can remain on a parent's policy until the age of 26. these are some of the things that happen right away -- away. now, i know some people don't like these plans. but the question comes do we keep doing what we're doing, spending more and more of our gross domestic product and not really improving our overall performance, not improving our infant mortality, not improving our longevity the way good, practical medicine should? now, i want to talk about one thing that isn't in any bill that i'm very much worried about. a while ago, i introduced

legislation for a medical insurance rate authority. we have about nine very large for-profit medical insurance companies in the united states. as a product of an earlier action, they are the only industry other than major league baseball that has an antitrust exemption. and so what they have been doing is merging and acquiring companies so that they can control markets. in los angeles, for example, today, two of these companies control 51% of all of the premiums in los angeles. and once you have this market share and control, you can raise premiums with abandon. and so earlier this year, a company, a subsidiary of well point, sent out notices to 800,000 californians and said we

are raising your premiums, and these premium raises went up to 39%, for those not in a group policy but who held individual policies. can you imagine getting a notice that your insurance has gone up 40%? and to add insult to injury, they then say we may come back in the middle of the year and ask for another. well, that company came in, and so i asked the c.e.o. what her salary was. $9 million a year. and you realize that these companies also have a substantial percentage that they spend on rent of your premium dollar, on the salaries of their executives in the millions, on your premium dollar, on transportation, on conventions. and generally this can go to 20% to 30% of the premium dollar.

well, we begin to bring it down to 15% of the premium dollar. what is missing and what the president put in the reconciliation bill was my legislation to give the secretary of health the ability to see that medical insurance premiums are reasonable and would establish a rate authority of people who have expertise in the arena that she could con -- consult with in levying this authority. that, madam president, is not in the bill. the presiding officer: the senator has used ten minutes. mrs. feinstein: if i might just conclude? the presiding officer: without objection. mrs. feinstein: these rate increases go into place may 1, so it is vital that we take some action before may 1 or all throughout the united states there are going to be

substantial premium increases. i thank the chair. i yield the floor. the presiding officer: the senator from montana. mr. baucus: i yield ten minutes to the senator from virginia, senator webb. the presiding officer: the senator from virginia. mr. webb: thank you very much. i would like to take some time this afternoon and perhaps being the eternal optimist speak in my hopes that once this process is over here, these votes in the next two days, we can find a way to move forward with our colleagues across the aisle and fix other provisions in this legislation and make it truly the kind of bill that they say they would like to see as well. i'm going to support this reconciliation bill. at the same time as my colleagues on this side of the aisle know well, i worked very hard to narrow and improve this legislation as it was passed last december, including voting, as i recall, eight different times with my republican

colleagues, which didn't make our chairman very happy on a few occasions, to make changes to the bill. in the end, i voted in favor of this legislation despite some serious misgivings with portions of it because it does represent a true step forward in terms of quality, accessibility and affordability of health care for most americans. and the important point for us to remember today and tomorrow as we go through this process is that bill is now law. the question before us now is how best to implement that law so that the benefits can be put into place and the many detriments that i was worried about can be addressed. there are a number of strong points in this bill. many of my colleagues have laid them out. as we know, insurance companies will be prohibited from denying health care coverage to children with pre-existing conditions. young adults will be able to stay on the parents' insurance plans until their 26th birthday. uninsured americans with pre-existing conditions will have access to affordable

insurance options. insurance companies won't be able to drop people from coverage when they get sick. they will be banned from implementing lifetime caps on coverage. seniors who hit the medicare part-d doughnut hole gap in coverage will get a $250 check to help with the cost of their prescriptions, and the doughnut hole will be completely closed by 2020. access to insurance over the next couple of years is going to be expanded, and 95% of americans will implement reforms designed to slow skyrocketing health care costs. working families won't have to worry about losing their health insurance or facing bankruptcy because of a job loss or because of illness. insurance companies will be required to spend a majority of their money on patient care. the law will also provide tax credits to help make health insurance available for individuals, expand access to medicaid, create a regulated marketplace where people can shop for the health insurance

plan that best meets their needs and will prohibit insurance companies from refuse to go sell or renew policies due to an individual's health status. these are just some of the positive points of the law. in fairness, -- and i understand and appreciate some of the frustrations on the other side -- there are serious problems in this bill. i don't like the dramatic cuts in medicare that this law proposes. in fact, i voted against them. i share the concerns by my democratic colleague, congressman rick boucher in southwest virginia regarding the potential impact, the negative impact these cuts could have on rural areas, particularly the population of southwest virginia. this legislation, this bill proposes to cut approximately approximately $450 billion from medicare spending over the next ten years at a time when medicare is already mired in debt and as we a wave of baby boomers are going to start hitting the medicare system immediately. medicare advantage, which

provides better benefits than traditional medicare and is a very valuable tool in rural and underserved areas may decrease. this law does little to address the historic disparity in medicare funding between urban areas and rural areas. i'm also very concerned about the cost and spending projections of this legislation. there is a great deal of debate going on right now about the real cost of this bill. former c.b.o. director douglas holsekan estimated in an article in "the wall street journal" recently that the bill may increase the federal deficit by by $562 billion over ten years because of some of these areas that i just discussed. the official score maintains that the bill would lower the deficit by $143 billion over that same period, but it includes a number of unlikely assumptions. medicare being one of them. the system for reimbursing medicare doctors, called the sustainable growth rate, is agreed to be broken, widely

agreed to be broken, but we have not tried to fix it and that's a a $250 billion ticket. many, including myself, believe that the community living assistance services and supports act, class act is structurally unsound. i voted against that as we were considering the bill. in addition, as my colleague, the congressman from the norfolk-virginia beach area pointed out, there is a great deal of concern among many families and small businesses regarding the impact of this bill. but again, the point is the bill is now law. the question is how to make the law a better law. the process that got us here has been ugly. it has diminished the trust and respect that some citizens hold for our own government. and we need to restore that trust, through a genuine and transparent effort on both sides of the aisle to fix the problems in the law. we also need to start working

together again across the aisle on this and other issues that confront us in a bipartisan sense and a sense of shared responsibility about the many, many problems that face this country. we are now preparing to begin a series of votes through the reconciliation process that ultimately, quite frankly, are going to mean little or nothing in terms of the outcome of this legislation, and they're not really going to seriously address the problems in it. i understand the concerns on the other side, i respect them. these votes in many cases are politically necessary for the other side, but i call on my republican friends to begin work with some of us over here on this side to address the inequities that we're really concerned about, to implement cost controls, to work together for the good of the country once this next couple of days are

done. and with that, i thank the chairman for yielding me the time and i yield the floor. mr. lieberman: madam president? the presiding officer: the senator from connecticut. mr. lieberman: madam president, i gather i have at least seven minutes assigned to me at this moment. the presiding officer: ten minutes remaining. mr. lieberman: i would ask that the chair inform me if i'm not finished when there is one minute remaining on my time. the presiding officer: the chair will inform you. mr. lieberman: i thank the chair. madam president, a good friend once wisely said to me that it's only a very short road that has no turns. the road that health care reform has traveled to get to the senate has been very long and has had many turns. its path to us might well be described as tortious with all that word has come to mean. as i said when i explained in december why i was voting for the senate health care reform bill, any piece of legislation this big, this complicated and this transformational is

unlikely to be perfectly pleasing to anyone. that is true for me. in the end, each of us, i think, has to ask ourselves do the positives in this legislation outweigh the negatives? does what pleases us in it outweigh what worries us? let me begin with the beginning before us now. the reconciliation act that is before us preserves most but not all of the health care reform the senate adopted and i voted for in december. i concluded then and repeat now that together these measures achieve real change in the three big areas in which our health care system needs to be changed -- reforming health care delivery to put a brake on the skyrocketing costs of care for individuals, families, businesses and our government. better regulating health

insurance companies to protect consumers including those with pre-existing conditions, and helping millions of middle-income americans who can't afford health insurance now to buy it. for me, it is particularly noteworthy that the senate bill plus the reconciliation act achieves all that progress without a government takeover of health care or health insurance. that would have been a very costly, deficit-exploding mistake and would have fundamentally and adversely altered the traditional american balance of power between the public and private sectors that has worked so well over our history to create economic growth and opportunity and to build the american middle class. that is why i oppose the so-called public option so strenuously and why i am so

grateful it is not in the reconciliation act the house has sent us. so those are the big and good things i really appreciate in this health care reform package. what worries me about it? well, first, the size of this proposal concerns me. particularly at this time of national fiscal indebtedness and economic stress. i wish we had chosen to achieve health care reform step by step, beginning with delivery reforms that would lower health costs and then moving on to expand middle-class access to affordable health insurance and then more aggressively regulating health insurance companies. but there was never enough bipartisan support for such step-by-step reform. i know because i tried to find it. so now along with each of my colleagues, i must vote on the proposal before us, not on one i wish we had before us. my biggest concerns about this proposal are its prospective

fiscal consequences. i worry that the savings this bill achieves in medicare and the revenue it raises from new medicare taxes to help pay for health care reform will soon be urgently needed to save medicare itself from running out of money that it needs to pay its bills -- to pay the bills for seniors' health care. and most of all, i worry that the bottom line consequences of this health care reform will be to increase our already ominous national debt. i am, of course, greatly encouraged by the conclusion of the independent nonpartisan congressional budget office that this health care reform legislation will not only -- not only not increase the debt but actually decrease it by more than a trillion dollars over the next two decades, and

that its savings in medicare will not only pay for part of health care reform but also extend the solvency of the medicare hospital trust fund. according to the chief actuary at the centers for medicare and medicaid services, the solvency of the trust fund will be extended by ten years as a result of the senate health care reform bill that is now law. however, for those good and significant things to happen, future congresses will have to be very disciplined and keep the promises that are made in this legislation to reform health care delivery to cut costs. most of those reforms will, over time, be opposed by providers and beneficiaries. the record of congress in resisting such pressure to stick with the costly status quo is not encouraging, so in the end,

i weigh the pluses and minuses. and i a decided to vote for this -- and i've decided to vote for this health care reform package, choosing its real change over the broken status quo. raising my hopes above my fears and adding, if i may, a personal prayer that future congresses and presidents do not weaken the reforms in this bill that will stop the constant increases in health care and health insurance costs and help reduce our national debt. that will happen best if we can achieve the bipartisanship in overseeing the implementation of this historic health care reform ungislation that we, achieve in its passage. i thank the chair.

i thank the distinguished chairman of the finance committee for his extraordinary effort that produced this admirable result, and i yield the floor. mr. baucus: madam president? the presiding ofcer: t senator from montana. mr. baucus: madam president, first of all, i thank the senator from connecticut for his very thoughtful addressment of this legislation. he's one of the more thoughtful members of this chamber, and i just want to very much compliment him on his process and his conclusion. madam president, i am -- i have a couple -- i don't think i have much time remaining -- two -- three minutes. thank you very much. the senator from maine raised the issue of medicare solve have en sivment i want to -- solvency. i want to remind my colleagues that health care reform extends the solvency of the trust fund, whether it is nine years or ten years. i'm not sure. but the medicare trust fund is extended for at least that time,

which i'm sure gives great comfort to seniors. health care reform is exactly what the doctor ordered for comairs long-term health. the senate alsthe senator also r from a health care group. let me add many letters of endorsement that health care reform has seevmentd first is with the american medical association. "after careful review and consideration, the board of trustees of the american medical association supports passage of the health system reform legislation under consideration as a step forward to provide health care for all americans." in addition, a letter from the federation of american hospitals. "on behalf of the federation, our more than 1,000 hospitals throughout the united states, i express our strong support for health reform and the reconciliation act of 2010. this legislation is long overdue and we urge all senators to seize this historic opportunity."

it is signed by charles kahn of the federation of american hospitals. i also have a statement from aarp you the association of retired folks. it states, "after thorough analysis of the reform package, we believe this legislation brings us so much closer to helping millions of older americans get quality, affordable care," et cetera. again, that's from the aarp. so there are many, many letters of endorsement, wide a lik whice to put in the record. the presiding officer: without objection. mr. baucus: madam president, i now ask that we -- for one hour on debate evenly divided, a half-hour for the republican side and a half-hour on the majority side. i ask consent that we proceed in that respect. i note the next half-hour will be under the control of the republicans. as i said earlier, the next half-hour in control of the majority. i note that thereafter the republicans will be due an

amount of time greater than half an hour, and i propose that we balance that out in the next consent. the presiding officer: is there objection? without objection, so ordered. ms. collins: madam president? the presiding officer: the senator from maine. ms. collins: madam president, i scurkt to temporaril ask unano temporarily set aside the pending amendments so that i may offer an amendmentties at the desk. the presiding officer: is there objection? without objection, so ordered. the clerk will report. the clerk: the senator from maine, ms. collins, proposes an amendment numbered 3638. ms. collins: madam president, i ask unanimous consent that the reading of the amendment be dispensed with. the presiding officer: without objection. ms. collins: madam president, i rise to speak on behalf of the amendment that i filed, which

would waive the job-killing fines in the reconciliation bill in cases where an employer hires an unemployed worker. madam president, i think that these penalties will come as a surprise to most americans. with unemployment at 9.7% and a real concern that we may be on the brink of a double-dip recession, most americans will be shocked to learn that washington wants to slap fines on small businesses that choose to hire more workers. but the new health care law does exactly that. incredibly, this reconciliation package makes this problem even worse. here's how: in the reconciliation package,

small businesses that cannot afford to provide health insurance to their employees would be fined $2,000 for each worker on their payroll. the way the formula works, the fines kick in at $40,000 when a small business reaches 50 employees. after that, they go up at a rate of $2,000 for each new worker. madam president, imagine what this will do to job growth? our country relies on small businesses to create new jobs. in fact, time and time again, you'll hear on the senate floor that small businesses are the engine of the american economy. and i certainly agree with that. but this reconciliation bill creates a wall $40,000 high

around any small business that wants to grow past 49 workers. just think what these job-killing penalties will mean to the unemployed. madam president, more than 8 million americans have lost their jobs since 2007. more than 6 million have been unemployed longer than 27 weeks. but beyond even these grim statistics, the true picture of unemployment in this country is actually far worse. broader measures of unemployment show that 16% of the american people are without jobs or can't find full-time work. now, i recognize that some in this body will argue that we

shouldn't be bothered with these penalties now because they don't become effective right away, but those who would say such a thing simply do not understand how small businesses really work. we're not talking about big multinational conglomerates here. we're talking about main street businesses that are already struggling. many of them are family-owned enterprises. they do not look at their employees as interchangeable parts, and they don't make hiring decisions to get rich quick. when they bring a new employee on board, they are choosing someone that they know will become part of their team, and the face of their business to the community they serve. having these fines on the books will discourage job growth now,

no matter when they become effective, because small businesses won't hire and train workers today just to fire them tomorrow when these penalties go into effect. ironically, less than a week ago, the president signed into law the so-called hire act. it contains a provision authored by senator schumer and hatch to provide a temporary tax credit to encourage companies to hire unemployed workers. that's a creative idea, and i supported it. but, for the life of me, i do not understand how a week later we could vote for a bill that imposes fines that will hit small businesses when they hire new workers. this makes no sense to me, and it is completely contrary to the

policy that we passed just a week ago. -- when we gave tax credits to encourage businesses to hire workers who are unemployed. with this bill, we're going to fine them if they hire workers who are unemployed, if they can't afford to provide them with health insurance. that is why, madam president, that i'm offering this commonsense amendment. it would waive the fines, the onerous fines that are in the reconciliation bill when small businesses, medium-size businesses hire workers who were previously unemployed. the mechanism to determine which workers qualify is exactly the same one that we adopt thed in e

jobs bill passed by this body just last week. it's the height of irony that we would even consider imposing penalties and fines on businesses that are hiring more workers, particularly during this difficult economic time. i encourage my colleagues to support this commonsense amendment. ank yo madam president.

mr. thune: madam president? the presiding officer: the senator from south dakota. mr. thune: i ask unanimous consent to temporarily set aside the pending motions and amendments so that i may offer an amendment which is at the desk. the presiding officer: without objethctpresiding officer: the clerk will report. the clerk: mr. thune proposes an amendment numbered 3639. mr. thune: madam president, i ask unanimous consent that the reading of the amendment be dispensed with. the presiding officer: without objection. mr. thune: and i would also ask, madam president, i have another amendment and would ask unanimous consent to temporarily set aside my now pending amendment so that i play offer this amendment, which is also at the desk. the presiding officer: without objection, the clerk will report. the clerk: the senator south dakota, mr. thune, for himself and others, proposes an amendment numbered 3640. mr. thune: madamresident, i ask unanimous consent that the reading of the amendment be dispensed with. the presiding officer: without objection. mr. baucus: madam president? the presiding officer: the senator from montana. mr. baucus: might i ask the senator from south dakota, if he might identify his two amendmentfor thesake of -- his s

for the sake of clarity. thune is there a number on those two amendments? the presiding officer: 3639 and 3640. mr. thune: 3639 and 3640. one dealing with student loans shall the other dealing with striking the class act from the underlying bill. mr. baucus: i thank the senator. thank you. the presiding officer: the senator from south dakota. mr. thune: thank you, madam chairwoman. ild i would like to -- in speaking to both of these amendments today, i would like to make a couple of observations about the reconciliation bill that's before the senate and of course it does make amendments, modifications to the senate-passed health care bill that went through the house last week and the house adopted many of these changes. b but i think the thing that perhaps didn't get discussed as much as it should have throughout the course of the debate, madam president, is the impact this is going to have down the road on future generations. obviously, health care, we talked about. the other side, of course,

talked about the coverage, the additional expansions of coverage that are in the bill. folks on our side talked about the impact that it's going to have in the form of higher taxes on small businesses, the medicare cuts that are going to impact seniors across this country, the higher premiums that many americans are going to be faced with. those are all still fundamental features of this bill and in fact many have gotten worse through this reconciliation process because the tax increases are now $50 billion higher than they were before. so now you're raising taxes even even $50 billion more than you were previously which was half a trillion dollars. the medicare cuts have now gone from $465 billion over ten years under the bill that left the senate in december, and the medicare cuts now have been increased by $66 billion. so you are raising taxes more, cutting medicare even deeper, and at the same time adding gimmicks that i think understate the true cost of this bill. we have all talked about this throughout the course of this debate. the other side has said well,

it's a trillion dollar bill or or $900 billion over ten years, but if you look at the way it's scored, you have ten years of revenues, ten years of tax increases, only six years of spending so that understates the costs of it in the first ten years. you have a number of other budget gimmicks, some of which i will refer to in just a moment, that understate the true costs of it. when you look at it when it's fully implemented. i think that's the number that the american people need to focus on, when this is fully implemented, it's $2.5 trillion in expansion of health care in this country, and it's going to be greater intervention than we have ever seen before by the federal government in the delivery of health care in this country. but i want to speak for a moment, madam president, because one of my amendments deals with this issue of how the cost of this is being understated because of these various gimmicks and tricks that are being used. the class act is a program that is created in the bill, and it's a program where there is an assumption that there is is $70 billion available in the class act to pay for this new

health care entitlement, and what it does is it creates a new entitlement. not that the existing entitlement programs that we have that are already on their way to bankruptcy aren't enough, we now have to add another one to it. so the class act is a long-term care program, entitlement program which in and of itself perhaps isn't a bad idea if it were structured correctly and if it were actually the premiums that are going to be paid by people for long-term care insurance, if those premiums were actually going to go into the payment of benefits. but what this does is it assumes assumes $70 billion from this new class act program, the proceeds from which would be used to pay for this new health care entitlement program. so it overstates the amount of revenue that is coming in by by $70 billion, and here's why. at some point, if you're an elderly person or even a younger person perhaps today who wants to buy into this new class act long-term care program, you would pay premiums. those premiums, allegedly, would go into a fund that would be

then available to pay benefits when the time came to pay benefits. that's not going to happen because you have taken that that $70 billion and you're spending it on this new health care entitlement. so at some point in the future when those people who have gone into this program thinking that they are paying these premiums so that they can derive a benefit at some time in the future if they need to, when the time comes to pay out that benefit, there won't be any money. so what happens? it's borrowed. it's added to the debt. so you have another $70 billion that goes on the backs of our children and grandchildren to pay for this new entitlement program and to understate the cost of this bill. so that is the class act bill, and my amendment would strike that from the underlying bill. by the way, i offered that during the debate here on the senate floor during the health care discussion we had the first time around here, and i got 51 votes for it. there were 12 democrats who voted with me in support of taking the class act out of the bill. one of the reasons i think that there is so much bipartisan opposition to it is because everybody recognizes what a sham

this is. the chairman of the budget committee from north dakota, senator conrad, said this is a ponzi scheme of the highest order, something that bernie mad offwould be proud -- bernie made offwould be -- madoff would be proud of. "the washington post" went so far as to say that the class act is a gimmick that says that health care is fully paid for. that's what "the washington post" said about the class act, a gimmick designed to intend that health care is fully paid for. so you take that $70 billion off of the overall revenues that come in under the bill and you're already creating a $70 billion hole. you add to that, there is is $29 billion in social security payroll taxes that are assumed are going to come in as people who get hit with the -- and employers who get with the high-end cadillac tax, currently paying out their employers in the form of health care benefits that are tax free, start shifting to cash compensation which would be taxable.

therefore payroll taxes would apply. that that would generate another another $29 billion in social security payroll taxes. but there again, those are payroll taxes that at some point are going to have to pay benefits, but we don't assume that here. we assume that it's going to go to fund this new health care entitlement program. so it's another $29 billion that at some point in the future when somebody decides i want to draw my social security benefits, they are not going to be there. therefore we put it back on the debt, more borrowing. so i have $70 billion, $29 billion. then you have the implementation costs of this, which c.b.o. has not fully given us because they don't know what it's going to cost in the out years, but based upon what they have given us in terms of what it's going to cost in the near term, we have extrapolated it's going to cost about $143 billion to have this new health care extravaganza from washington, d.c. when you add that cost, you have another $114 billion to cost this thing not paid for.

then you take this -- the medicare double counting, which is really interesting because you have these cuts that are going to occur in medicare, you have got these payroll tax increases that are supposed to occur in medicare that are going to generate collectively collectively $529 billion in additional revenue. but here again, madam president, what's wrong with this picture? the assumption is that these are medicare payroll taxes that are going to go into a medicare fund that at some point in the future will pay medicare benefits, and yet at the same time we're saying these medicare revenues are going to be used to finance this new health care expansion. and so what are you doing? or double counting. you cannot spend that money twice. we are taking $529 billion in medicare cuts and medicare payroll tax increases that supposedly would go into a medicare trust fund to pay benefits at some point in the future to beneficiaries, recipients of those funds, but no, we're going to take that, we're going to spend it on this new health care entitlement. what happens then? someday in the future, that medicare recipient is going to

say okay, it's time to pay out these medicare benefits. i have reached the appropriate age, i'm eligible, and i want to get into the medicare program, and all that money that was supposed to have been in the program to pay for those benefits isn't there. why? because it was spent on this new health care entitlement program. and so what happens? to pay those benefits, the federal government will then have to borrow. more debt that goes on the backs of our children and grandchildren. another $529 billion. okay. so the last point i'll make, because i have another amendment that addresses this issue, but this reconciliation bill will something that obviously was not included in the health care bill that passed the senate the first time, and that is this takeover of the student loan program in this country. now, it's something that has been proposed around here for some time, but as you know, madam president, the way that student loans are distributed across the country today is you have 2,000 lenders out there who make these loans. students ask go and get these loans. this will eliminate that model.

it will draw all the student loans into washington, d.c. you will have four federal call centers where students will go to get their loans. what does that do? first off, it kills a lot of jobs. i have 1,200 jobs in south dakota that are related to student lending business. those are all going to be bureaucrat jobs in washington, d.c. there are 31,000 jobs across the country where you have got people who are working in the student loan business, those jobs are in jeopardy because that's all going to be drawn into washington, d.c. i don't think the american people have effectively yet focused on what's being done in this reconciliation bill above and beyond the really bad stuff that's related to health care. so you've got this now student loan program which is coming back into the federal government, and a lot of the revenues now are being earmarked for other things. they are being earmarked for the health care bill. $9 billion is being used to pay for the health care expansion. $10 billion is going toward, quote -- "deficit reduction" but you have another $19 billion coming out of the student loan program, and who is going to pay for that? well, students are. students are going to pay for it

in the form of higher interest rates on their loan. so essentially, we are now not only taxing small businesses, cutting medicare recipients, but we're also -- we woo are also taxing students to pay for this expansion of health care. so you have got another another $19 billion, which at some point in the future -- of course, this is all going to have to be paid for, again, by our children and grandchildren, but you have got all this double counting that's going on and all these gimmicks that are being used to understate the costs of this thing. when you add it all up, up, $143 billion deficit -- or so-called budget savings ends up in a $618 billion cost. so, in other words, instead of running as the other side has said $143 billion budget surplus because of this health care expansion, if you look at -- if you take out all the gimmicks, the class act revenues, the social security payroll tax revenues which are double counting, the medicare double counting and the student loan program, you've got a real deficit of $618 billion in the first ten years, and if you

extrapolate that out in the second ten years, it's it's $1.8 trillion that will have to be borrowed under this bill to pay for the -- pay for the costs of it. and that's the costs that we know today. that's all going to be passed on, madam president, to future generations to our children and grandchildren. that is the -- the dirty little story that hasn't been told in this whole debate, is how much this is going to cost future generations because of the enormous debt that we're piling up and all the games and the gimmicks and the tricks and the which i canary that are being -- and the chicanery that are being used to understate the true cost of this. when you take out all the double counting, all the gimmicks, end up with a $618 billion deficit in the first ten years. that, madam president, is tragic. that is why i'm offering this amendment to strike this class act. we shouldn't be creating another new entitlement program when we can't pay for the entitlement programs that we have. they're all going bankrupt, and we're going to create yet

another one which is going to lay more debt on the backs of our children and grandchildren. and the other thing i will mention just briefly in closing, madam president, and speaks to the other amendment. the other amendment as i said because of this takeover of the student loan business in this country, there are lots of states that are going to lose significant numbers of jobs. my state of south dakota as i said before has over 1,200 jobs related to student lending. if you look at iowa, 526, nebraska, 891. there are lots of places around this country where student lending creates jobs, private sector jobs. we're going to do away with those and bring all those jobs back in here to washington, d.c. and make students come to washington to get their student loans. and as it turns out, at a higher cost because we're using some of the proceeds of that program to pay for the cost of the new health care program. but what my amendment simply would do is say that the department of education has to certify that there will be no jobs lost across the country associated with this takeover of the student lending business and bringing all that power and consolidating it all here to

washington, d.c. so those are the two amendments that i offer, madam president. i hope that my colleagues will vote for those. this is bad policy in so many ways, but taking over yet another industry in this country that's creating a lot of jobs and therefore killing a lot of jobs is the wrong way to move forward when you're trying to pull an economy out of a recession. madam president, with that, i yield the balance of my time. a senator: madam president? the presiding officer: the senator from texas. mr. cornyn: i would ask unanimous consent to temporarily set aside the pending motions so i may offer a motion to commit which is at the desk. the presiding officer: without objection. is there objection? without objection. the clerk will report. the clerk: the senator from texas, mr. cornyn, moves to commit the bill h.r. 4872 to the committee on finance with instructions to report the same back to the senate within three days -- mr. cornyn: i ask unanimous consent to dispense with further reading of the amendment. the presiding officer: without objection. mr. cornyn: madam president, my

amendment is a motion to commit the reconciliation bill back to the finance committee to report the bill back without a brand-new tax on savings and investment for certain taxpayers. this is an additional 3.8% tax on savings which includes dividends, capital gains, ordinary savings for many consumers, many americans that they have not had to pay before but which this bill imposes. this is a $123 billion tax hike on those categories of income. this is a mistake for a lot of reasons. one, it will discourage the very thing that we need to be doing more of, which is saving. it will reduce productivity and it will depress wages and the standard of living for millions of americans. simply put, increasing taxes particularly during a recession on the very sectors of the

economy that we want to invest and to create jobs is a terrible mistake. according to a forecast by the institute for research on the economics of taxation, a 2.9% tax increase -- not a 3.8%, but a 2.9% previously proposed would depress economic growth by 1.3% and reduce capital formation by 3.4%. the damage on jobs and economic growth during a recession when unemployment is at 9.7% would be even greater under the current proposal because we're talking about a 3.8% tax, not a 2.9% tax which was the subject of a "wall street journal" article and this report from the institute for research on the economics of taxation. not only will this motion protect jobs and the investment security of taxpayers, it will also make sure that the reconciliation bill does not

break yet another one of president obama's promises. this is just another one of the president's promises that has been broken by this bill. when he said, talking about this bill -- he said, "everyone in america -- everyone -- will pay lower taxes than they would under rates bill clinton had in the 1990's." but the truth is, this additional tax on savings and investment will make taxes higher than they were even back in the 1990's when president bill clinton was president of the united states. i would ask my colleagues to support my motion to recommit this bill to the finance committee. madam president, i'd also ask unanimous consent to make two articles part of the record, one, a march 17th "wall street journal" article entitled "obama's worst tax hike" and slicked the report i referred to a moment ago of the institute for research on the economics of

taxation. i'd ask unanimous consent that they be made part of the record at the close of my remarks. the presiding officer: without objection. mr. cornyn: madam president, this is not the only job-killing provision in this bill, this brand-new 3.8% tax increase that will attack savings and investment. other examples of job-killing proposals in this bill include increasing the hospital insurance payroll tax. this tax is increased to 3.8%. it will hit thousands of small businesses that file as subchapter "s" corporations. in addition, this revenue will not be used to pay for medicare but will be used to fund a brand-new entitlement. another job-killing proposal in this bill includes new taxes and fees on health care consumers. that's right, on the very people that we're trying lower the cost and make health care more affordable, they're going to

have to pay -- many will have to pay additional taxes and fees to the tune of $100 billion, which both the congressional budget office and the joint tax committee have confidence will inevitably -- have confirmed will inevitably be passed down to consumers. and then there are the higher premiums for individuals who don't get their health coverage from their employer but have to go into the group market. we're talking about a lot of small businesses, individuals, partnerships, sole proprietors and the like. one consulting firm concluded that premiums in the group market could go up as much as 20% because of the mandated government-approved insurance that has to be sold under this bill. c.b.o. said -- they concluded a somewhat lower level, between 10% and 13%. but, still, if the purpose of health care reform is to make health care more affordable, this bill simply goes in the wrong direction. and then there's the employer

mandate. i met this morning with representatives of the hispanic chamber of commerce, and the hispanic chamber told me something i knew before but reiterated: the important role of small businesses in terms of job creation -- and pointed out to me how many hispanics and minority business owners are engaged in the very kind of job creation we should be encouraging, not discouraging. but this employer mandate will kill jobs because the additional cost of health insurance will be passed along to workers in the form of lower wages. or result in reduced hours or layoffs. in july of 2009, a report entitled "affects of changes to the health care insurance system on labor markets," the congressional budget office noted that it is likely to reduce employment. so at a time when unemployment is at 9.7%, people are losing their jobs, they can't pay their mortgages, so they're being kicked out of their homes, due

to foreclosure, we're making things worse with this bill, not better. all told, this bill will -- that has been signed into law by the president and the bill before the senate, this reconciliation bill includes more than $5 00 billion in tax increases. it makes no sense except under this dome for congress to even consider raising taxes, imposing new mandates on employers and individuals at a time when unemployment is so high. and when that is the most pressing issue confronting the nation today. congress is making this worse, not better, and why congress would pass a new tax on investment that will act like a wet blanket on the economy further exacerbate unemploymentings and make recovery harder is, frankly, beyond me. madam president, i yield the oor.

mr. baucus: madam president? the presiding officer: the senator florida. mr. baucus: madam president, is time on the republican side expired? the presiding officer: there are 25 seconds remaining. mr. baucus: all right. i assume that they do not want to use those 25 seconds. seeing no one objecting ... all right. madam president, we have several speakers. we're waiting on senator shaheen and senator feingold, senator sanders, senator nelson, senator mccaskill. i don't see any of them right now. while we're waiting, i'd just like to make a point about

c.b.o.'s analysis with respect to premiums. c.b.o. says that the health care reform bill will lower premiums for all millions of americans -- all. the congressional budget office said health insurance premiums would fall by 14 fo% to 20% in e individual market. let me repeat that. in the individual market, for the same plan, congressional budget office says that premiums will fall under this legislation. they'll be lower, be less, by 14% to 20%. that's for the same plan in the individual market as for people who buy insurance individually. and premiums in the small group market -- roughly, small business -- would be up to 2% lower than under the current law. why is all that, madam president? it is basically because there are savings. savings come from lower administrative costs, savings

come from increased competition, savings come from better pooling of risk. an analogy i like to refer to is or by the. today you get on, you shop for an airline ticket, look for fares, look for time and so forth and you choosms the same with the type of operation that would occur here with respect to insurance. get on the exchange and shop for insurance. madam president, i see the senator from new hampshire is now on the floor. i yield four minutes to the senator from new hampshire. mrs. shaheen: madam president? the presiding officer: the senator new hampshire. mrs. shaheen: thank you very much, senator baucus. i am pleased to be here to join in this effort to talk about the importance of what we're doing with health care reform. we have waited is he long for health care reform and yesterday it became a reality. today we celebrate a reformed

health care system that president obama has signed into law, and with this historic step, we have eninsured that more -- ensured that more americans have the health care and stability that they netted. families will have choices even if their jobs don't provide t we've end the denials for preexisting conditions and we have guaranteed that no one will have to pay more for health insurance if they get sick and that the insurance coverage can't be takenway. we no longer allow insurance companies to put lifetime limits on amounts of benefits they will cover. but insurance reforms aren't the only thing we've done. we've made health care more affordable for hose to ho need it most -- for those who need it most and made it more affordable for small businesses. we've made important steps to encourage everyone to take advantage of preventive care and we've created incentives for people to enroll in wellness programs and encourage communities to address the public health of their citizens. and finally, we're changing the

way doctors provide care, making it better-coordinated and more patient-centered. now, i'm pleased that we're here building on the success of the health care reform legislation that was just signed into law. and our resolve is strong, make no mistake about that. we must continue our work in making a good bill even better. the legislation we're now considering makes great strides to strengthen the new law. it will provide more tax relief to families to help them afford health care and more help for seniors to pay for prescription drugs. i've talked to seniors throughout new hampshire who struggle with the high cost of prescription drugs. the medicare doughnut hoacialtion as it's known, causes great stress in family budgets when seniors have to pay full price for the drugs that they need. people like sue quinnlyn recently moat new england about

her experience with the doughnut hole. she wrote, "this year because of my illness, my drug costs have doubled. in september i experienced the doughnut hole. this meant that when my total drug costs reached $2,400 for the year, i was on my own." she went on to say, "you know you're in the doughnut hole when a drug you've been paying $90 for is now $364.47." you "you know you're in the doughnut hole when the mail-order prescription company calls to warn that you your order is going to cost $720.82 and wants to confirm that you really do want them to send it. and you have no choice to accept unless you want to stop take the medications. you know you're in the doughnut hole when the pharmacist gives you a sympathetic smile when they hand you your order." well, madam president, under this bill, seniors like sue no

longer need to worry. they'll get a discount on medicine critical to their health and we'll begin to close the doughnut hole. seniors will now have access to affordable drugs they depend on. and we've all heard the stories of seniors breaking their pills in half or skipping their daily doses because of the cost. under this bill, a senior with high cholesterol and heart disease that relies on hip tear and anti-- on lipitor and antihypertension medicine now can take these drugs with peace of mind an less financial stress. this bill will expand affordable coverage to 32 million americans. the bill will provide the same medicaid deals for every state so that the federal government will help share in the burden the states face in providing coverage for new populations. and the bill also builds on the previous bill to attack waste, fraud, and abuse in our health care system. madam president, this is an

historic time. today we build on that historic legislation with improvements to make it stronger and even better for american families and seniors. than you. i yield the floor. the presiding officer: the senator from montana. mr. baucus: madam president, i'm looking for senator feingold. and here he is. i yield to the senator from wisconsin six and a half minutes. mr. feingold: i thank the senator, the chairman, very much. the presiding officer: the senator from wisconsin. mr. feingold: i thank the president. madam president, for far too long, my constituents have been at the mercy of the health insurance industry, which has dictated ed how and whether they get their health care covered. wisconsinites have been denyinged coverage because of preexisting conditions, dropped from coverage because they made

too many claims, or simply forced to pay through the nose for skyrocketing premiums. those days are now coming to an end p. thanks to the patient protection and affordable care afnlgt we have taken an important step with the enactment of that bill, madam president, but as you know, our work is not done. the patient protection affordable care act is not perfect and congress must be committed to strengthening and adjusting this law, as necessary, in the years to come. the first step, of course, is for the senate to pass the health care and education reconciliation act of 2010, which the senate is now debating. this bill will strengthen our health reform law to ensure that hornings is even more affordable for working families and that seniors actually pay less for prescription drug concht taken together with the patient protection and affordable care act it bill will help

wisconsinites purchase good, affordable health insurance and health care. as a result, this year, this year, children will no longer be denied coverage for preexisting conditions, insurance companies will no longer drop americans because they're circumstance young americans can remain on their parents' coverage longer, and the medicare doughnut hole that shortchanges seniors will begin to be filled. and then over the next four years, states will prepare to set up health insurance exchanges for individuals and small businesses to purchase more affordable health insurance. as a result, an estimated 541,000,000 wisconsinites who are uninsured and 320,000 wisconsinites who have individual market insurance will gain access to affordable coverage. as many as 358,000 wisconsinites are expected to qualify for premium tax credits to help them purchase health care coverage.

and experts believe this reform effort will lower premiums in the non-group market for 14% to 27% for the same benefits. premium savings, madam preside madam president, of $1,540 to $2,200 for a family in wisconsin. now, this is real savings, mr. president. and according to the nonpartisan experts at c.b.o., over the next ten years, our national deficit will decrease by $143 billion and up to $1.2 trillion in the following ten years. those savings come from a number of cost containment provisions, including one which i strongly support that will begin to reimburse physicians based on the quality of care they provide rather than on the quantity of care. this movement toward value-based health care purchasing is one that is already seeing great successes in hospitals and medical groups around my state

of wisconsin. i was so pleased to work with our nationally recognized medical centers around wisconsin on these successful efforts. health care reform also means more choice, more affordability and more protections for wisconsin businesses. over 77,400 small businesses throughout the state of wisconsin are eligible now for tax credits starting this year to help purchase health insurance for business owners and their employees. and no longer will small businesses be vulnerable to insurance practices of raising rates on a year-to-year basis due to an employee falling ill. mr. president, i visit all 72 counties in wisconsin every ye year, and i always hear about the burden of health care costs on small businesses. so many wisconsinites are discouraged from striking out on their own to start a small business or expand it because they couldn't afor couldn't --

afford or couldn't get health insurance on their own. this bill will help wisconsinites start businesses and create jobs by providing the affordability and protections of the large insurance group market to small business owners. and, mr. president, reform also means better and more affordable health care for wit wisconsin seniors. the bill we're debating will build upon improvements made by the patient protection and affordable care act by closing the medicare part-d prescription drug doughnut hole by 2020. beginning this year already, seniors who reach the doughnut hole will receive a $250 rebate, with more and more assistance available each year until the doughnut hole is ultimately closed. seniors will also be guaranteed an annual wellness visit and no cost-sharing on preventive care visits to their physician. of course, we know this reconciliation bill is not just about health care. it also ends unjustified subsidies for private banks and lenders to issue federal student

loans. by transferring the authority to make all federal student loans over to the existing federal direct loan program effective july 1 of this year, we will save approximately $61 billion over ten years. the savings will, in part, be used to help ensure that students do not see a reduction in their pell grant awards next year, providing much-needed assistance to wisconsin's low-income and middle-income students when they need it the most. mr. president, historic health care reform is now the law of the land. the presiding officer: the senator from wits business's time has expired. mr. feingold: now to pass this bill is the next step. i yield the floor. the presiding officer: the senator from montana. mr. baucus: i yield seven minutes to the senator from florida. the presiding officer: the senator from florida is recognized. mr. baucus: a very valued member of the finance committee. mr. nelson: thank you, mr. president, and thank you, mr. chairman.

for the first time as a nation, we're recognizing that people have a right to not be destroyed by sickness. and under the senate bill passed by the house and signed into law yesterday by the president, folks are no longer going to have to choose between their health and their pocketbooks. parents will no longer have to worry about whether they can afford to get their kids to the doctor, and seniors won't have to wonder if medicare will still be there -- be there for them several years down the road. health care reform doesn't mean people won't have to continue taking responsibility for themselves. the bill we passed, and even the one that we're now debating, improves health care affordability and access for all

but it still requires folks to do their part. families that can afford to will be asked to contribute to the cost of their coverage, and people are expected to get regular primary care so that they don't end up in the emergency room with something that could have been treated easily and cheaply if it had been addressed sooner. but very importantly, we're also going to hold the insurance companies accountable. we're finally telling them, you can't drop someone just because they get sick, you can't cap someone's benefits just because you're tired of paying for their care, and you can't decide not to offer someone coverage because they have a preexisting condition. we're telling them, no more, no more, no more. we're also saying to our seniors we as a nation remain unwavering

in our commitment to protect and preserve medicare for today, tomorrow, and the next millennium. there's been an awful lot of misinformation going around about medicare and something called medicare advantage. the fact is, the original senate bill proposed an unfair way to fix overpayments to these private medicare h.m.o. insurance plans. the fix would have come at the expense of seniors living in areas with high medical costs, such as my state of florida. i was able to pass an amendment in committee that fixed that problem fairly. under this bill, this reconciliation bill, the president has proposed another way to rein in those medicare

advantage insurance companies, one that upon close inspection also treats seniors fairly. it puts companies on the hook for their performance. if they don't provide quality service, their reimbursements are cut. and their enrollees, the seniors, are going to demand that they provide quality service. i appreciate the president's leadership on this issue and the fact that he heard the concerns expressed by a number of us, including senator schumer and senator wyden. but having said all this, i want to say that we left something undone in this senate bill that is now law and even in this wreck sillian package. i'm not -- reconciliation package. i'm not happy that this legislation let's the drug companies pretty much off the hook.

you all know that over the past few years, i've been voicing the concerns and the fears of residents in my state about what's happening to their drug prices. i also hear from the folks who can't afford their medications when they hit the prescription drug coverage gap known as the doughnut hole. they skimp on food or split their pills or stop taking them altogether. and where this bill offers a discount to seniors in the doughnut hole, there's nothing to keep drug companies from tongue jack up the -- from continuing to jack up the prices until that discount is meaningless. i also hear from folks who are frustrated that in other countries, folks are getting the very same drugs for much less than we pay here. and i had an amendment that would have required the drug industry to pay its fair share of the tab for health care reform. it required the drug

manufacturers to give the government price breaks on drugs for a lot of our low-income seniors and that would have saved us $106 billion of taxpayer money which was more than enough to fill the doughnut hole altogether and then make a dent in offsetting the federal deficit. so i intend to come back and to revisit this, and in the meantime, i want to say that this reconciliation bill deepens and extends the promise of health care reform and the health care reform bill that was signed into law just yesterday. i stood with the president when he put pen to paper yesterday. i think it's great we've begun the process of helping reform -- of health reform. it's been said by many folks in many different ways that we are not put on earth for ourselves

but we are placed here for each other. well, here we are and here we are debating legislation that stands to improve the lives of tens of millions of americans. and so despite its flaws, i will vote to pass this legislation. mr. president, i yield the floor. the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, i thank the senator from florida for his very thoughtful and considered conclusion in deciding to vote for this legislation. i deeply appreciate that very much and thank you very much for being such a wonderful member of the committee. i now yield seven minutes to the senator from vermont. the presiding officer: the senator from vermont is recognized. mr. sanders: mr. president, i thank the senator from montana for yielding. mr. president, my republican colleagues have reached the conclusion that this is not a perfect bill. well, they're right.

while my problems with this bill are very different than theirs, i do hope that in the weeks and months to come, after we pass this reconciliation package, that we will improve it. but i would ask my republican colleagues to tell me something. when they controlled the white house and they controlled the senate and they controlled the house when president bush was our president, during that period, 7 million more americans lost their health insurance and health care costs soared. where were they then in talking about health care? did they have one substantive idea during that period about how we were going to lower the cost of health care for americans and provide health insurance for all of our people?

mr. president, i do hope that after we pass reconciliation, we are going to improve this bill. and in that regard, i want to thank senator reid, majority leader reid, who has promised us, senator merkley, myself and others, that we will have the chance to vote on a public option provision. i think millions of americans understand that public option is a choice that people should ha have, the right to go outside of the private insurance companies for their health insurance, and that public option will provide competitive pressure on the insurance industry to control soaring health care costs. i very much appreciate senator reid telling us that we aring are -- that we are going to have a vote on that issue within a couple of months. mr. president, this bill is a strong step forward. it is no small thing that we are providing health insurance to

32 million more americans. it's no small thing that we are moving to eliminate preexisting conditions as a grounds for rejecting someone for health care. it is no small thing that we're going to begin to fill that doughnut hole so that seniors will be able to get the prescription drugs they need in an affordable way. those are, among other achievements, quite significant. but having said that, after the passage of this legislation, we still -- still -- have got to deal with the reality that we will continue to spend far more per capita on health care than any other major country. just a few days ago, we had an ambassador -- the ambassador from denmark visiting vermont. in that country, they provide quality care to all of their people and they do it spending about 50% of what they -- we do because they have eliminated

private insurance companies and all of the administrative and profiteering costs associated with private insurance companies. and i hope that we will one day allow at least states the option to move forward with a single payer, medicare for all program which i think ultimately is the way we're going to go as a nation if we're going to solve the need for comprehensive, universal and cost-effective health care for all of our people. but, mr. president, i do want to say a word on one aspect, one provision of this bill which i think is enormously important, and i'm very, very excited that it is included in this bill. again, i want to thank senator reid for his help in making sure that it remained in and is amply funded. that is that in this legislation, we are going to take a giant step forward in providing primary health care to the people of this country.

through a major expansion of community health centers and the national health service corps. this legislation provides enough funding so that we are going to create over the next five years 8,000 new health center sites, more than doubling the number that now exists. we are going to increase access for primary health care, dental care, mental health counseling and low-cost prescription drugs to an additional 20 million americans in every state, in every region of this country. that is a huge step forward in providing basic health care to millions of americans who today cannot access that care. and while we do that, we are also going to significantly expand the number of doctors, the number of nurse

practitioners and dentists that we desperately need in order to provide primary health care to our people. this legislation triples over a five-year period, triples the amount of money going into the national health service corps, a program which provides debt forgiveness and scholarships for those doctors and dentists who will be serving in underserved areas throughout this country. we are going to provide an additional 17,000 new primary health care doctors, dentists, nurse practitioners and mental health professionals through this program. and what this means, mr. president, is that if somebody has no health insurance, if somebody has medicaid, if somebody has medicare, if somebody has private health insurance, that individual is going to be able to walk into a community health

center and get the high-quality care they need. and the incredible thing, mr. president, and this is really quite remarkable is that by doing this, we're going to actually save taxpayers money because we're going to keep people out of the emergency room, which is the most expensive form of primary health care. we're going to prevent people from becoming sicker than they should and ending up in the hospital at great expense. mr. president, this -- this legislation is going to be very significant in providing the primary health care that we need as a nation, and i'm very appreciative -- the presiding officer: the senator's time has expired. mr. sanders: thank you very much. the presiding officer: the senator from montana is recognized. mr. baucus: i ask how much time remains on our half-hour?

the presiding officer: two minutes and 40 seconds. mr. baucus: mr. president, i yield 40 seconds to the senator from missouri. the presiding officer: the senator from missouri is recognized. mrs. mccaskill: mr. president, we have had a lot of that childhood story that we all learned of chicken little. we have had a lot of chicken little around this building over the last few months. the sky is falling, the sky is falling. and you know, i woke up this morning, i looked up and the sky was not falling. and every day that goes by in america, people are going to realize the sky is not falling. in fact, as time goes on, that sky is going to get bluer and brighter because people in america are going to realize that this bill is not full of boobytraps. it's full of good things that will reform health care. but i rise this afternoon just to take a couple of minutes to talk about a new low of obstructionism, taking game playing to a whole new level. in ten minutes, i was supposed to convene a hearing on the

contracts for police training in afghanistan. now, this is a very important part of our mission in afghanistan, is the training of local police departments. there was a witness who was going to be there from the state department, a witness there from the defense department. the inspector generals were going to be there. just last week, g.a.o. wiped out a contract that had been let on police training because of problems in the way the contract was competed. so this hearing was timely and it's important. we cannot succeed in afghanistan if we do not have effective police training, and these contracts are problematic. the state department is supposed to be overseeing it. we have hundreds of millions of dollars that's not accounted for. so what do i find out this morning? the republican party is not going to let us have the hearing? what in the world? why in the world are we not being allowed to work this

afternoon? why in the world are we not able to ask questions at a hearing in a few minutes as to why the police training is not going well in afghanistan and how we can do better? our men and women are over there and they are at risk if we don't get this right. i don't get it. i don't get what the purpose of saying no is. i don't get what we accomplish. we're sent here to work. we're paid by the people of this country to work. and the idea that i had to call these witnesses and say go home because the republicans won't let us have a hearing. somebody has got to explain this to me. disagree with us. the presiding officer: the majority's 30 minutes has expired. mrs. mccaskill: vote no, but let us work. i implore you, let us work. thank you, mr. president. the presiding officer: the senator from montana is recognized. mr. baucus: mr. president, i

have one remaining unanimous consent request to continue -- that we continue alternating sides of debate. i will ask unanimous consent that we continue alternating back and forth when the half-hour -- the next half-hour will be on the republican side. i ask unanimous consent that the next half-hour be controlled by the republicans. the half-hour thereafter be controlled by the majority. and the half-hour after that be controlled by republicans. the presiding officer: is there objection? without objection, so ordered. mr. baucus: mr. president, for the information of senators, the final block of time will be reserved under the control of the chairman for concluding remarks. that is, prior to a series of votes. i just make that statement for the information of senators. are -- the presiding officer: without objection. mr. roberts: mr. president? i ask unanimous consent to call up roberts-inhofe-brown. i ask unanimous consent that senator crapo be added as a

cosponsor. the presiding officer: without objection, so ordered. th cle will report. mr. roberts: and i ask -- i ask the reading of the amendment be dispensed with. the presiding officer: without objection. mr. roberts: mr. president, included in the half trillion dollars, yes half trillion dollars of new taxes in this reform bill is a tax hike of of $20 billion on medical devices. a $20 billion excise tax on life-saving medical devices. the nonpartisan congressional budget office and joint committee on taxation have both confirmed that these excise taxes will not be borne by the medical device industry, if, in fact, that's what the other side wanted to do. instead, the tax will be passed on to patients in the form of higher prices and higher insurance premiums. my colleagues are going to speak in greater detail about this tax, but let me just take a moment to talk about some of the people who will bear the burden and what types of devices will

be taxed. people with disabilities, diabetics, amputees, people with cancer, people with alzheimer's are just some of the folks who will see their tax costs go up because of this tax. my amendment prevents this new tax from raising the already high cost for these groups by striking the tax on medical devices. now, this is a tax on innovative devices as well, a device like the cyberknife. the cyberknife is a noninvasive alternative to surgery for the treatment of both cancerous and noncancerous tumors anywhere in the body, yet under this bill, such cutting edge devices would be taxed. those who need the treatment offered by the cyberknife will see the cost of that treatment go up. when innovative and life-saving technologies like the cyberknife, mr. president, are taxed, when the cost of many tests increases because the devices used in the tests are taxed, when the new devices are not developed and when fewer manufacturers are able to

survive in the anticompetitive environment this tax will create, consumers of health care will suffer for it. i urge my colleagues to support this amendment. i yield the balance of my time to the distinguished senator from massachusetts, mr. brown. mr. brown: mr. president? the presiding officer: the senator from massachusetts is recognized. mr. brown: thank you, mr. president. i thank senator roberts for speaking and bringing this very important issue to the forefront. many of you know i live in massachusetts and we have over 225 medical device companies. during my -- before i got here, i visited many of them. the message was very clear that if, in fact, that 3% medical device tax goes into effect, it's virtually all of their profit for many of these young companies and established companies. in placing a tax on medical devices, in my opinion and in their opinion, will dramatically affect jobs, not only in massachusetts but throughout the -- throughout the country.

unemployment in my state is almost -- is hovering near 10%, and we should be doing everything that we can at this point to create jobs and stimulate the economy, and i'm hopeful, mr. president, that in the effort that i made in the beginning for a bipartisan effort to start jobs with the first jobs bill, that we can look at the very -- the areas that we're trying to focus on to make this bill better, and i'm hopeful once again through your leadership and through the leadership of senator roberts and others who have sponsored it that we will look twice at what we're trying to do here in order to pay for the so-called health care bill. at a time we're in the middle of a two-year recession, taxing companies, especially vibrant companies in my state and throughout the country. i'm also fearful that they will leave and they will go to other countries to do their business. so i thank you very much, mr. president, and i yield the remainder of my time.

the presiding officer: the senator from oklahoma is recognized. mr. inhofe: to call up amendment numbered 3558 and make it pending. the presiding officer: is there obction? without objection, so ordered. the clerk will report. the clerk: the senator from oklahoma, mr. inhofe, proposes and amendment numbered 3588. mr. inhofe: i ask unanimous consent to dispense with reading of the amendment. the presiding officer: without objection. mr. inhofe: mr. president, president obama repeatedly promised during the campaign that no one making over $250,000 per year would see their taxes increase. however, the democrats' plan to spend $6.2 trillion in new health care promises at a time when the country can't afford the promises they have already made and we have a record one-year budget deficit of of $1.4 trillion. we hear president obama always talking about what he inherited from george w. bush, but what he inherited was nothing like what he did. he actually raised the deficit deficit $1.4 trillion in one year. that's more than president bush

did in his last five years. now, the health bill which recently passed the house, an unprecedented expansion of government control and increased taxes on americans during a real difficult economic time not only just stopped the one expensive health care bill. now the senate is debating a fix-it bill which increases taxes an additional $50 billion on the american people. now, reading through the legislation, i'm struck by a myriad of ways this raises taxes on american citizens from job-creating small businesses and middle-income families. over half a trillion dollars of new taxes. if you happen to need a medical device, that's what we're talking about now, you get taxed on the bill. section 9009 of the past health care bill improves -- imposes a new tax on assistive devices which includes items like pacemakers and prosthetics,

incubators for premature babies, and the fix-it bill -- and i call this the payoff bill because as you all know the speaker of the house had to pay off all these individuals. we understand how that works, and that's what this bill is all about now. that's why it needs to be amended. that this is what we're currently debating. it actually expands to include more medical devices such as tongue depressors, elastic bandages, most hand held and dental instruments and examination gloves. i'm joining with my republican colleagues to file an amendment striking the tax on medical devices. additionally, i have filed amendment numbered 3588 -- that's what we're talking about now -- that will strike this expansion of taxes on assistive devices for two of the most vulnerable populations -- the children and individuals with disabilities. i have previously spoken on the floor about this new tax, how it hurts americans. let me remind you of a couple of examples. my son-in-law, brad swan,

installs pacemakers and defibrillators. one morning a few months ago -- i know this is true because he lives right across the street from us. at 1:00 in the morning, he was called to an emergency involving an 8-year-old boy with no heartbeat whatsoever, 1:00 in the morning. he was born with a congenital heart disease, was able to have a pacemaker put in that morning right after he was called and now has a full, healthy life ahead of him. my older sister marilyn faced a similar situation nine years ago and is alive and healthy today. a cardiologist in bartonsville, oklahoma, explained to me that the cost of a pacemaker -- you're talking about $5,000, something that lasts ten years. it pales in comparison to the cost of a stroke or multiple fractures. with this tax we are making these medical devices more expensive for families which may prevent others from accessing the device they need in order to enhance or even save their

lives. so, i don't know. i've never been through anything like this in the 20 years that i've been here. we look at the tax increase on this bill, $569 billion. now it's going to be more than that additionally. i was talking this morning in chickoshea, oklahoma. the person interviewing me was talking about his 90-year-old mother and how she depends on medicare. there's $23 billion in medicare cuts in this bill. the white house was celebrating. you could hear the champagne corks all night long. they successfully increased taxes by $569 billion. i encourage people to vote for this amendment to at least relieve part of the problems out there. it's amendment number floor. a senator: mr. president? the presiding officer: the senator from utah is recognized. mr. hatch: isk tt the pending amendment be set aside, and i have an amendment at the desk that i hope we can

consider e presiding cer: without objection, the clerk will report. the clerk: the senator from utah, mr. hatch -- mr. hatch: i ask unanimous consent that further reading of the amendment be dispensed with. the presiding officer: without objection. mr. hatch: i talk about my amendment to exempt our nation's wounded warriors from this knell device tax. let me take a moment to talk about the enormous tax burden imposed under this bill. republicans in congress agree with the majority of americans who believe that simply throwing more hard-earned taxpayer dollars at a $2.5 trillion health care system will not deliver meaningful reform. simply raising more than $650 billion of new taxes at a time when our national employment rate stagnates near double digits is a really, really bad idea. let us take a look at the claims that despite more than $650 billion in new taxes in this bill, this big government bill will not raise taxes for americans making less than $200,000 a year, a pledge that president obama repeatedly mentioned both as a candidate

and then as our president. while the democratic chairman of the finance committee and i commend him for his honesty in his floor remarks on march 23, 2010, stated -- quote -- "one other point that i think is very important to make is that it is true that in certain cases the taxes will go up for some americans who might be making less than $200,000." we have known all along that this pledge is an illusion that will slowly but continuously disappear over time. a recent analysis by former congressional budget office director douglas holtz-eakin based on data provided by the joint committee on taxation revealed startling facts on the distributional impact of the senate-passed bill. let me share some of these findings with you. only 7% of americans would qualify for the new subsidy to help them pay for mandatory health insurance. 93% of all americans will not be eligible for a tax benefit under this bill. 25% of americans earning less

than $200,000 a year would see their taxes rise. 25%. so what does all this mean? for every one family that receives the government subsidy, three middle-class families will pay higher taxes. simply put, we will continue our march towards the europeanization of america as fewer and fewer americans continue to bear the burden of supporting the needs of a growing majority. by the way, the figures i just discussed do not take into account all the tax increases in this bill signed by the president yesterday, including hundreds of billions of dollars in new taxes on employers who do not provide coverage to insurance premiums, prescription drugs, and medical devices. representatives from both the congressional budget office and the joint committee on taxation testified before the finance committee that these taxes will be passed on to the consumers. so even though the bill tries to hide these taxes as fees, average americans who purchase

health plans use prescription drugs and buy medical devices will end up footing the bill. every american knows that there is no such thing as a free lunch in this town. mr. president, included in the $650 billion of new taxes in this health bill is a tax hike of $20 billion on medical devices. of the few exemptions included in the reconciliation bill, there is no mention of the brave men and women in the military and our veterans who have sustained injuries defending this country during the wars. my amendment would prevent this new tax from raising costs or hurting access for american soldiers and veterans by exempting medical devices used by the tricare program and the veterans health care program. we must simply protect our wounded warriors who rely on these lifesaving and life-enhancing medical devices. let me tell you, i hope my colleagues on both sides will stand up for the wounded

warriors. i hope they'll stand up and realize that these folks should not be hammered with higher costs on medical devices. we owe them a debt of gratitude, not more taxes. so i urge my colleagues to stand up for our brave warriors and support this amendment. mr. president, i yield the floor. mr. grassley: mr. president? the presiding officer: the senator from iowa is recognized. mr. grassley: before i speak, i would ask unanimous consent that brittany madoff of my staff be granted floor privileges for the duration of the debate. the presiding officer: without objection, so ordered. mr. grassley: i want to speak in support of senator inhofe's amendment, 3588. that would be to exclude medical devices for children and persons

with disability from a medical device tax. i know when you talk about a medical device tax, and if it's on the manufacturers, you're going to say well, what should i be concerned about that for? because some manufacturer is going to pay it. well, don't fool yourself. you know, corporations don't pay taxes. only people pay taxes. and there's three categories of people that pay taxes: either stockholders or employees or consumers. and i'll bet in most cases consumers end up paying for that. so, this provision in this bill is much broader than the inhofe amendment would apply to. but i think senator inhofe has picked out a very important aspect of adding taxes, the

extent to which surely the vulnerable people that you call children and persons with disability are consumers that shouldn't be paying for a tax to pay for a bill that 59% of the people in this country say they're against. but because the majority party and the president wants to make history -- just make history -- don't worry about the people at the grass roots of america, what they think. so there's all these taxes and all these fees in here. and i compliment senator inhofe for his leadership and at least trying to reduce this burden on people that are very vulnerable, people with disabilities. of the many taxes in this bill, i'm especially worried about the tax on medical devices. what will happen when the democrats impose a new tax hike on $20 billion of these

innovative medical devices? during the markup of the finance committee bill, i asked the question to the nonpartisan congressional budget office, and the nonpartisan joint committee on taxation. and for people who might not understand the efrpl seus of nonpartisan -- emphasis of nonpartisan about the congressional budget office and the joint committee on taxation, i would like to say that it's very important that you understand that because everybody thinks everybody connected with congress is totally political. these are professionals that are around here a lot longer than a lot of senators and representatives, and their job is in a professional way to look at what things cost and how much money certain taxes will raise. so they're kind of like god around here. they're believed.

and if you want to overrule them, it takes a 60 vote. that's a lot of power when you've got to have 60 votes to overrule something on a point of order. so complaining what -- explaining what nonpartisanship is and our constituents understand that so they understand we aren't quoting a republican or democrat -- we're quoting professionals -- i think is very basic to understanding the points we as individuals make so they're accepted as honest. in this case where these two offices, both of them said that these excise taxes will be passed on to consumers in the form of higher prices and higher insurance premiums. when i begin my remarks, i said that that's what's going to happen. well, chuck grassley said that. but i want you to know that that's what these professionals in the joint committee on

taxation and the congressional budget office backed me up in saying. who are the consumers of these devices? well, i forgot that i've got the exact language here of how these things are going to be passed on to consumers so that you know -- you see the document right there. now, who are these consumers of these devices that will bear the burden of the new medical device excise tax? i would like to tell the story of the tillman family, a family that would bear the burden of this new medical device tax. at only tpaoeufl months old -- five months old, keanna tillman had her life saved by a medical device. this story has received a lot of attention because keanna's father is a professional football player for the chicago bears. however, lifesaving stories like

this happen all across the country. when charles tillman reported to training camp in 2008, it wasn't long before his coach told him that his five-month-old daughter keanna had been rushed to the hospital. when charles got to the hospital, keanna's heart rate was over 200 beats per minute. the doctor told charles and his wife jackie that keanna might not make it through the night. keanna survived the night, and after a series of tests she was diagnosed with cardio myopathy. that is an enlarged heart that is unable to function properly. her condition was critical. and without a heart transplant, she would not survive. but finding pediatric donors is very difficult, and many children do not survive that long wait time. keanna was immediately put on a

device that would help to functions of the heart while keanna waited for a transplant. however, ekmol, as an old -- is an old device that has many shortcomings. the tillman waited for one of two outcomes. either keanna would receive the transplant or she would die without the eklmol. -- it is ecmo, acronym. when doctors told them about the medical device called the berlin heart, the berlin heart is an external device that performs the function of hearts and lungs. the tillmans decided to move forward with the berlin heart. after 13 days of being on ecmo without any movement, keanna underwent surgery to connect the berlin heart.

and you can see the, after the operation you can see tianna right there in that photo. it pumped her blood through her body, a job that her heart could not perform on its own. doctors said that the berlin heart helped tianna regain her strength because she was off the parylitic medication and moving. not long after tianna was connected to the berlin heart, a donor was found and she underwent an eight-hour transplant surgery. the risky surgery was a success, thank god. usually it takes a long time for a new heart to start working. but doctors said that due to tianna's strength, her new heart started working immediately. so you see here tianna todayhatl

just like her dad loved the football. she is a happy and healthy two-year-old girl. she enjoys playing on her swing and watching her dad play football. without the berlin heart to keep her alive and help her to gain strength, she might not in fact be alive. and the democrats would increase costs for families like the tillmans with this tax, and particularly it will be relieved somewhat if we can adopt the inhofe amendment. in fact, the democratic bill would tax most pediatric medical devices. i want to make it clear that any vote against the inhofe amendment is an endorsement of the tax on devices like the berlin heart and many others that children across this country rely upon. not only that, but i think it

would also probably have a great deal of an impact upon a -- a great deal of impact upon research that brings about some of these miracle medical devices that make a difference. and taking money away from research at major corporations is going to delay the miracle things that come along, whether they be pharmaceuticals or whether they be medical devices, and we should not be discouraging that. because, you know, in the rest of the world, there hasn't been much research done. you know, maybe go back 50 years ago and you had germany and other european countries very much involved. but their high level of taxation, government taking over everything, and their high rates of taxation drying up resources that are used for research.

and so the united states of america has been the beneficiary of that. and our pharmaceutical industry and medical device industry is taking advantage of it and so much new development around the world in -- in the answerment of these -- in the enhancement of these devices as well as pharmaceuticals has come because of the research that we do. and so this tremendous tax burden that the american consumer is going to feel from massive money coming in for -- to fund this bill, which really isn't going to drive down health care costs is going to just stymie a lot of innovation that we shouldn't want to stymie. could i ask, mr. president, would you please tell me how many minutes my side has left? the presiding officer: the senator has 3 1/2 minutes left.

mr. grassley: okay. i would take that 3 1/2 minutes to comment on another aspect of the bill. so this is not on the inhofe amendment at this point. and it's something unrelated to health care, but, in a sense, it is related to health care. and that is the nationalization of the student loan program. you know, for a long, long time college students in this country have had the benefit of going with a direct student loan from the government or getting it through the banks. they have voted by their feet, by the overwhelming amount of them, by going to the banks to get their student loans. now this bill that the president signed yesterday that this reconciliation is a followup on, in fact, it's in this bill that we are going to nationalize

student loans. have just direct loans. there's 31,000 people around the country that have something to do with student loans. those people are going to be out of work or they're going to be doing something else at a time what we're all talking about jobs. we need to do something for jobs. so nationalized education loans and have that unemployment and then take four call centers around the country to take its place, do you think the college students are going to get the service that they get when you've got to deal with the federal bureaucracy red tape? i don't believe so. but this -- there's -- there's a certain amount of savings in this. i don't know whether it's real savings or not, but the congressional budget office, they scored a certain amount of

savings, even considering the fact that government's going to have to borrow a half a trillion dollars to get this program under way, they -- they -- is going to fund this bill, the whole health care bill. so you're in a situation that's just something that common sense in the mi midwest is not going o understand. but it's something that i suppose would happen here in washington, d.c., which is an island surrounded by reality, that you're going to have college students who are going to pay 6 3/4 of their loans that the government pays 2 3/4 to borrow, that you're going to tax college students to pay for health care. it just doesn't add up at the

very same time that too many of us in this body are complaining about the increased cost of education. so i hope that the college students will speak up in this particular instance about what's being done here that college students shouldn't be taxed to provide health insurance. but this bill -- or this whole health care bill taxes everything. if it just seems like -- just seems like everything. how many minutes are left? the presiding officer:enator's time's expired. mr. grassley: i yield the floor. mr. baucus: mr. president? the presiding officer: the senator from montana's recognized. mr. baucus: mr. president, i yield five minutes to the senator from new jersey, senator lautenberg. the presiding officer: the senator from new jersey is recognized. mr. lautenberg: i thank senator baucus and thank him for his leadership on this -- on the health care reform effort that

is under way. mr. president, this is a most astounding thing for all these weeks our friends on the other side have said no, no, no to health care. not one good word. not one of them stood up and said, yes, we should cover 32 million who don't have coverage. yes, we should cover young people who want to join their parents' health insurance policy, said no to small businesses who need help in affording to give health insurance -- affordable health coverage to their employees. many, i think, know that recently i was stricken with an illness. five weeks ago this time i was in an ambulance on my way to the hospital bleeding profusely, very sick, and i was lucky. i had health care coverage. the doctors were there waiting

for me. they were there to give me transfiewtionz. they were -- transfusions. they were there to give me interveneus fluids, they were there, i had nursing care. as my children stood by -- my five children stood by with their fingers crossed and pleading for my health to return and it was because i had health care coverage that i stand here today on my way to full cure. less hair, but still willing to fight fight for the people that i represent, for the people across this country who are being denied coverage in any way they can do it. and what we see is obstructionism at its worse. i have yet to hear them say, let our conscience come out here and say, we ought to cover these people. that we ought to make sure that health care is affordable.

mr. president, the night that i was brought into the hospital and was so fortunate enough to have the health care coverage that i have, during the days of recovery, i thought, what would happen if i was 40 years younger, had two or three kids, had no health care coverage, and i came in in this kind of critical condition, the chances of my walking out of that hospital would have been very low. and so i say to my friends on the other side, they're not bad people, they're just totally wrong. they don't want to say that a young person can join, as i said, their family on affordable health care insurance. they don't want to encourage people who -- to -- to find insurance that is affordable through the exchanges that are provided. they don't want to permit people who are there without coverage, who would force their way into

an emergency room, perhaps, and say, look, i'm really ill. i have no pep, i have no -- i feel terrible. take care of me. yes, take a number like you do in a supermarket, you're number 32. we'll get to you. don't worry about it. well, i worry about it because i know a different kind of america. i know an america that was there for me when i needed an education. i know an america that's there for people -- i get letters from them all the time -- who say thank you for helping us to be able to afford a better education. thank you for the things that you can do. so i say to my colleagues on the other side, open up. tell the truth. if you don't want to give those people coverage, affordable coverage, then throw in the coverage that you have. throw in your policy. and when you say no to the 32 million people, say i mean it when i say no, and i'm giving up my coverage like those people

out there. tell the truth about how you feel about the people who stand there without coverage worrying every day whether an illness is going to rob them of their jobs, their opportunity to perform their parental duties or any duties. that's what ought to happen. stand up. vote no. vote no against anything that improves or might improve this -- this insurance and say no. i mean it when i say no. i mean it. i'm willing to give up the coverage i and my family have -- i'm talking to the senators on the other side. say no and mean no. the presiding officer: the senator's five minutes has expired. mr. lautenberg: as well as the people outside who are begging for this coverage. i thank you, mr. chairman. mr. president. mr. baucus: mr. president, i want to thank my good friend from new jersey. i'm reminded how he led the fight years ago to stop cigarette smoking in airlines -- in airplanes. i was to pleased when he did

that. i know so many millions and millions of americans who were pleased too. it was you who did it, senator. i would like to yield 10 minutes to the senator from oregon. she's been working health care reform for as long as i can remember. the presiding officer: the senator from oregon is recognized. mr. wyden: thank you, mr. chairman. let me echo your phrase -- excuse he, from new jersey, who has prosecuted the case against cigarettes. what a strong add row cat he -- advocate. mr. chairman, i want to thank you. i want to highlight a few things that you spoke of earlier that we've seen in this morning's newspaper. in particular the provision that you and i partnered on that allows states to innovate and

take their own fresh approaches in terms of addressing health care challenges. we all read today about how something like a dozen states are already challenging the important laws that been signed on the grounds that because of the individual mandate it's unconstitutional. well, you and i worked very closely together to ensure that states could have a waiver to, in effect, go out and set up their own approach. and, in fact, our senate council specifically said in response to our questions that if a state could meet the general framework of our legislation, they didn't have to do it with an individual mandate. so, mr. chairman, i just want to thank you for stepping up and empowering the states. i want country to know that under the legislation that

chairman baucus worked with me on every state doesn't have to litigate. they can innovate. they can go out and look at fresh approaches to address our health care challenges that would include doing it without an individual mandate and certainly having followed this discussion on the floor over the last couple of days about how -- somehow this would europeanize the health care system, what chairman baucus has done with provision 1332, what i thought to do and the legislation that i drafted that had bipartisan support, is to send a message to all the states all across the country that we invite you to come up with the kind of fresh creative ideas that are going to help us hold health care costs down. in fact, the chairman and i spent a lot of time trying to make sure that states could

tailor their own health insurance exchanges. a fresh marketplace so that you would try in montana or oregon an approach that would make sense, but new york could try its own kind of strategy. and not only is 1332 a provision that allows for state innovation, but as the chairman knows, our colleague, senator cantwell, came up with another approach that advances similar state innovation. allowing states to set up a basic sort of health care plan. so my message to these states, talking about litigating right now, is why would you say at this point that you're going to go out and just go to court and sue everybody in sight when, in fact, what the president signed yesterday gives the states the authority to come up with their own approach and legal counsel

is on record as saying that states could pursue their own approach without an individual mandate. so, mr. chairman, i'm going to touch for a moment on the medicare advantage provisions in our legislation, but i just hope that given the amount of attention that is being paid this afternoon to the question of states filing these lawsuits, alleging that the law is unconstitutional because of the individual mandate, i hope that some of those states will take a look at section 1332 that in my view ought to be attractive to elected officials all across the political spectrum who share the view chairman baucus and i share, which is we would like to empower the states. one last point, if i might, mr. chairman, we have a lot of discussion on the floor about medicare advantage and having been involved with this program for a number of years and its predecessors during the days when i was codirector of the

gray panthers, i would just like to offer up to colleagues that not all medicare advantage is created equal. we had testimony in the senate finance committee about some medicare advantage products that as far as i'm concerned are so shoddy and so devoid of consumer protection, the people who sold them ought to be in jail, and we have taken steps to add consumer protection to the medicare advantage program. on the other hand, there are very good medicare advantage programs that are -- in our part of the country that have been able to win recognition from the federal government as high-quality plans, and, in fact, under this legislation, plans that have earned a high quality rating from the federal government on the basis of how they manage a chronic -- how they manage chronic conditions, the kinds of screenings they do of a preventative nature, their

responsiveness to member complaints, when they get a high rating from the federal government on the basis of those criteria and earn those extra stars, the legislation that was advanced by the finance committee -- and again a provision that the chairman worked closely with me on -- they would actually get bonus payments. so we'll probably have a number of further discussions on the floor about medicare advantage, but i only come to the floor today to say that for those who are interested in promoting quality, for those who believe that no matter how much you do to contain costs, you also have to beef up quality because all the cost containment in the world isn't going to get the job done if the quality isn't up to par. take a look at the work that was done with respect to medicare advantage. it acknowledges that not all medicare advantage is created

equal. the president of the senate who has just joined us knows that our home state has the largest percentage of folks in medicare advantage in the united states. over 40%. they happen to be good plans with those high ratings that i just mentioned from the federal government, so clearly our states with high quality are going to be appreciative of this, but so will all the other programs across the land that have similar ratings, and we will have created an incentive for all of those other medicare advantage programs in the years ahead to meet our standards. so i come to the floor just briefly this afternoon, mr. president, to say first i hope that states will use that provision that creates incentives for them to innovate. our message ought to be innovate rather than litigate, and i hope attorneys general will remember that in the days and weeks

ahead. and second, i hope my colleagues will look at the new incentives in this legislation to promote quality because i believe those two provisions in this legislation that encourages state innovation, that promotes quality in the medicare program, they ought to be widely supported by colleagues on both sides of the aisle in the days ahead, and that's, in my view, the kind of approach that can bring the american people together and help us implement this law in a fashion that is in line with what americans want. good quality, affordable care and reform that works for them. mr. chairman, i thank you for this time and particularly your help on those two provisions that i think ought to appeal to both republicans and democrats in the days ahead. mr. baucus: thank you, senator, very much. the presiding officer: the senator from montana. mr. baucus: may i inquire, mr. president, how much time is remaining on this side for this block? the presiding officer: 15

minutes. mr. baucus: thank you. mr. president, i yield ten minutes, five minutes, to the senator from colorado. mr. bennet: thank you, mr. president. thank you to the senator from montana for his generosity. i won't take ten minutes, and i know the senator from pennsylvania is here. mr. president, i stand here today for the millions of coloradans and millions of families who are sick and tired of the name calling, the bickering and the partisanship in washington. i'm here today for over 800,000 uninsured coloradans who will now have a fighting chance to get the health care they need. i'm here for the 1.2 million colorado children who will never again be at risk of being denied coverage just because they have a pre-existing condition. i'm here for the 70,000 small businesses who will get a tax cut to provide health insurance so they don't have to make the terrible choice between providing health care coverage

for their employees and keeping their doors open. i'm here for the hundreds and thousands of seniors who depend on medicare and expect us to protect and preserve it for generations to come. we have passed a bill that makes our country more competitive, ends insurance company abuses, gives people more coverage and starts putting our country on a more sound fiscal footing for the next 20 years. mr. president, i join those on this side of the aisle and the other side of the aisle who have said this is not a perfect piece of legislation. no piece of legislation is a perfect piece of legislation, but it is a great first step for the reasons that i just said. the nonpartisan congressional budget office has confirmed confirmed $143 billion reduction in the federal deficit over ten years as a consequence of our passing this legislation, and a a $1.2 trillion reduction in the first 20 years. now we need to pass this reconciliation bill, a bill that

gets rid of the special deals i spoke out against at the end of the year, a bill to make sure our seniors could afford the prescription drugs they need, a bill that covers more people in my state of colorado. but the insurance companies and the special interests haven't given up. the defenders of the status quo are still at it. put simply, to amend this bill is to kill this bill. the only reason we are going through this process is because opponents of health care reform want to kill the bill. now is not the time to play games with the lives of thousands of coloradans and millions of americans, and i won't do it. mr. president, there are also some who are well intentioned and want to amend this bill to include a public option. i am and have been a strong proponent of the public option and like a lot of people, i have taken a lot of heat for it. i'm not sure why because everywhere i went in colorado,

people said to me, michael, if you're going to require us to have insurance, we would like as many choices as possible for our family. please don't force us into this private insurance if there are other options out there. a lot of us did all we could to quinn the house to include it in this bill, and we were disappointed when they didn't, and we're going to continue to fight for it until we get a vote. we will have our vote on a public option, but i will not risk the well-being of coloradans to do it and i will not play into the hands of those who want to kill the bill. so, mr. president, today i stand with many of my colleagues, with the american diabetes association, the american hospice foundation, the autism society, doctors for america, easter seals, and the national alliance on mental illness, along with over 150 organizations who want us to pass this bill as well. i stand with au pair -- with aarp who knows that changing this bill now will put seniors

at risk. but more important than all of that, i stand with the people of colorado who expect more from their government and who want more for their children and grandchildren than politics and name calling. i urge all of my colleagues to pass reconciliation and send this bill to the president's desk. i yield the floor. thank you, mr. president. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: i yield the balance of the time to the senator from pennsylvania, senator casey. mr. casey: mr. president, i'm grateful for this opportunity to speak about health care -- the presiding officer: the senator from pennsylvania. mr. casey: to speak about health care, and i want to commend our chairman, senator baucus, for his great leadership of the finance committee and on so many other important issues that we have been wrestling with with regard to health care. before i get into my remarks, mr. president, i wanted to ask unanimous consent that a member of our staff, working on our

staff, a fellow in our office, avni shiharani, be granted floor privileges for the remainder of the senate's consideration of h.r. 4872. the presiding officer: without objection, so ordered. mr. casey: thank you, mr. president. mr. president, we have had a chance over many, many months now and even as we speak today to talk about a lot of the policy of the bill that the president signed into law. our health care bill that we passed here in the senate and of course the policy contained in the bill we're considering now, but sometimes it's important for us to step back and talk about some of -- not all of, but a few examples of some of the real people out there that this legislation will have an impact on. i have spoken a number of times about tricia urban from burkes county, pennsylvania, and all of the problems that she and her family had with their health

care. denied coverage because of a pre-existing condition, running into problems with the insurance -- when the insurance company dropped coverage. her husband died in the process, and the same day he died, her daughter was born. i have told that story a number of times, and i will tell it again. i also wanted to highlight what's happened to another family, the ritter family from mannheim, pennsylvania, lancaster county. the family has two young girls who i met, met in 2009. when they were children, the two of these little girls, hannah and madeleine ritter, hit their lifetime cap on their cancer treatment before they completed their course of treatment. when they hit this cap, they were 4 years old. these two ritter twins. and if that isn't proof that comprehensive health reform is needed now, i don't know what more we can say.

so we're very happy that the president signed into law the bill we passed in december, and now that health care reform is the law of the land, the ritter twins, hannah and madeleine ritter, will not have to worry about how to get or keep health insurance coverage throughout their lives, because in 2010, strong consumer protections will go into effect. not only will these protections ensure that these two little girls, hannah and madeleine, not only will it ensure that they can have access to the medical care they need to grow up healthy, but also -- but also they will be able to reap the benefits of other parts of this bill. and this bill will also help hard-working, insured americans from having to declare bankruptcy due to medical bills, as the ritter family of mannheim, pennsylvania, had to do at one point. i don't have the time in this segment to be able to tell their

whole story, but suffice it to say, in addition to the nightmare that their daughters lived through, the family had to declare bankruptcy. but just some highlights of what this bill means to real families. health insurance reform puts american families and small business owners, not their insurance companies, in control of their own health care. secondly, this bill makes health insurance affordable for middle-class families and small businesses. one of the largest tax cuts in history, reducing premiums and out-of-pocket costs. third, it holds insurance companies accountable at long last to keep premiums down and prevent denials of care and coverage, including for pre-existing conditions. number four, this legislation improves medicare benefits with lower prescription drug costs for those in the doughnut hole, better chronic care, free prevention care, and nearly a decade more of solvency for

medicare. and finally, number five -- and this is not a comprehensive summary, but one more point. this legislation reduces the deficit, according to the congressional budget office, by by $143 billion over the next ten years. and if you look at the ten years after that, 20 years in total, it's well over a trillion dollars. so this is a bill and this is legislation whose time has come. at a time in our state in pennsylvania where we have 577,000 people out of work, almost a record number of people out of work in pennsylvania. we have to make sure that one of the things we put in place is a more secure health care system for workers and their families. we all have heard the list of provisions that'll go into effect right away. small businesses will have access to -- have the eligibility, i should say, for tax credits. some companies will get credits

up to 35% of the dollars they spend on premiums. the federal government will be investing in community health centers, even in greater amounts than the federal government does now. older citizens won't be affected by that doughnut hole problem where they have to pay the whole freight for prescription drug costs for several thousands of dollars' worth of care. they're going to get relief from that. and in three months time -- three months from yesterday, people with preexisting conditions will be able to get help from a high-risk pool, a special fund to help them in that crisis. and as we know, in six months, in september, children will have the full legal protection in new insurance plans for denials of coverage -- or, i should say, against denials of coverage for a preexisting condition. so for all of those reasons and more, whether we're thinking about the problem that tricia you are about a and her family had -- that tricia urban and her

family had before her husband's death or the ritter twins, we hope that more families have the benefit of the protections in this bill, and we know one thing. we know that small businesses across the country are starting to get a sense now of what this will mean in terms of helping them with the tax credit, helping their employees with the critically important issue of health care. and, mr. president, i would yield the floor and note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call: mr. gregg: mr. president, make a point of order that the quorum -- i would ask the quorum b set aside. the presiding officer: without objection, so ordered. mr. gregg: i believe the senator from tennessee sheer and ready to go. the presiding officer: the senator from tennessee. mr. corker: thank you, mr. president. i may meditate here for about 60

seconds and suggest the absence of a quorum. unless that's going to give it over to the other side. mr. gregg: no, if the senator is not ready, i'll speak. the presiding officer: the senator new hampshire. mr. gregg: the senator from tennessee will offer an amendment here in a second, and i'll follow him. i want to highlight what my amendment will do as we're waiting. one of the -- one of the extraordinary shell games that's played under this bill in the really alice-in-wonderland bill that this is paid for, is the fact that the doctors will receive a $285 billion cut in their reimbursements, if this bill goes forward in its present form. and we all know that's not going to happen. and so at some point there's going to have to be a doctor

fix, which means that $285 billion, not accounted for in this bill, will have to be spent over the next ten years. and, of course, if they had included this in the bill, this fact that doctors are being underreimbursed and that we're going to correct this -- it's called the doctors' fix and we do it every year on an annual basis -- if they had included it in the bill, as they should have, because this is after all called health care reform, then the bill would have been in deficit even under the gamesmanship played by the democratic party on this bill. remember, the way they got a surplus in this bill in the first ten years was they took ten years of spending cuts, ten years of revenues and matched them against six years -- six years of programmatic expenditures. so they were able to get a surplus, you know, that c.b.o. has to score what it's given.

if you're given phony numbers, you have to score. in any event, what c.b.o. was nolt asked to score as part of this -- was not asked to score as part of this health care, even though there was no attempt to correct it, is how you directly reimburse doctors. after the senator from tennessee proceeds -- i guess he may be ready at this time -- i am going to offer an amendment for a doctors' fix so that this bill will address this issue, which is obviously one of the core issues on the question of health care reform around here. so i'll reserve now on that issue and turn to the senator from tennessee, who i see is ready to proceed. mr. corker: thank you, mr. president. the presiding officer: the senator from tennessee. mr. corker: i want to thank the senator from new hampshire, who i think has offered extraordinary leadership on this issue and on the issues regarding our country's huge amount of indebtedness. and i, like him, find it hard to believe that we're taking over

$500 billion in savings from medicare -- as he just mentioned -- to leverage a new entitlement when we know that medicare itself has a $37 trillion unfunded liability. and he's mentioned, we go further by not even dealing with this doc fix that he just was discussing. i look forward to his amendment. i look forward to supporting it. and i thank him for his leadership. i wanted to talk, mr. president, today about unfunded liabilities. i was the mayor of a city. i know that you served in the general assembly in the state that you came from, mr. president. i was a commissioner of finance for our state where we dwelt all the financial issues for the state of tennessee. i know that senator gregg was a governor. and one of the things that i think bothered all of us who used to serve at the city and state level was unfunded mandates. it's an incredible thing where washington will pass a piece of legislation -- and, by the way, have a major signing ceremony

where everybody is patting each other on the back and celebrating that they just passed something -- and the part that's left out is that the states across this country are left with a huge unfunded mandate. we have a very good governor in our state. his name is phil bretteson. he is a democrat. he spent a lifetime in health care. he's handled our state's finances, i think, very well. he called me on friday talking about the fact that this bill was going to cause the state of tennessee, which is already experiencing huge tuition increases -- we have all kinds of services there that we're having difficulties dealing with -- and this bill, this bill is going to create a $1.1 billion unfunded liability for the state of tennessee p. i just find it hard to believe that, again, knowing the stress that our states around this country are dealing with, that we're passing legislation that

puts in place a $1.1 billion unfunded mandate on the state of tennessee. but let me go a step further. this bill also violates something that we thought around here was sack crow sawngts and that was the un-- that we thought around here was sack crow sangts and that was the unfunded mandates. most of us have served in local governments and we acknowledged that we should not be passing legislation that creates unfunded an mandates. we shouldn't be patting ou pattg ourselves on the back. i think everybody knows that this bill violates that. we said we didn't want to deal inappropriately with states, but we decided we want to pass health care reform and we're going to do t let me come to the one that i find most fascinating. senator gregg -- senator gregg

was just talking about the fact that we have this 21% cut coming for physicians who treat medicare recipients, and instead of taking the medicare savings that we found in this bill and using that to make sure that these physicians were paid, we're not going to do that. and in a short time, without us taking, again, emergency action -- $200 billion or so -- these physicians are going to have a cut. let me tell you what we're doing in this bill. and i think the president may already know this. but what we're doing in this bill, in addition to creating in our state a $1.1 billion unfunded mandate, we're going to pay medicaid physicians -- physicians who treat medicaid patients, the same level if you're a primary physician as medicare reimbursements are today. but we're going to do that for two years. now, this is like the worst joke

ever that we can play on our states. what we're saying is we're going to mandate to the states that the primary care physicians that treat medicaid recipients, their rate has to be jacked up. and we're going to provide the money for that for two years, but then that drops off. and so not only do we have this issue of the unfunded mandate, we're creating that exact cliff issue for states in this bill, which means that after this two-year period ends, after this two-year period ends and we've given them the money, to pay these physicians at medicare rates instead of medicaid, which is much lower, we're going to cut the funding off. and so the state is going to be in the position, obviously, of having to keep that up. it's like the worst joke ever. i don't know how we can come up with legislation like this and call it "reform."

i said this before. half the people that are going to be receiving health care -- health insurance after this bill passes, are going on a medicaid program. mr. president, there was a bill -- there was a bill in the senate that ron wyden and bennett worked on together. it had some flaws t would have been an interesting startinstartingplace, though. that bill caused medicaid recipients to have the same kind of health care that you and i have. what we've done in this bill instead of that, instead of reforming, instead of focusing on cost, we're going to put half of the new recipients in a program that none of us -- none of us -- would want to be in. and we're calling that "health care reform." so, mr. president, i do plan later to offer an amendment to deal with this issue of unfunded mandates. i think it is wrong for us as a

country to have people in federal office that push their desires off on people and then cause them to pick up the tab. i was a mayor, i was a commissioner of finance. you served in the general assembly. senator gregg served as a governor. we know that's wrong. i don't know why we're doing it. and i plan to offer an amendment to correct it. mr. president, i thank you for the time, and i notice the absenceesf qrum. the presiding offeroll. quorum call: mr. gregg: mr. president? the presiding officer: the senator from new hampshire. mr. gregg: i want to thank the senator from tennessee for his very concise and really effective statement on the problems with this bill. and the effect that it will especially have on states and municipalities who end up with these costs that are unfunded.

that's just a simple fact. as a governor you don't have a whole lot of elasticity. you can't print up money -- the presiding officer: the senate? a quorum call. mr. gregg: excus exme. -- excuse me. zi ask that the senate rescind the quorum call. the presiding officer: without objection. mr. gregg: our debt is growing so fast that it's going to be very hard for us five or six years from now to be able to sell our debt at a reasonable price, in my opinion, and we're going to find that ma maybe some people don't want to buy our debt. it was a very significant event this week when it was - determid that the debt issued by warren buffet was going out at a lower cost than the debt issued by the united states of america. that's the first time that anybody could remember something like that. that's a very clear statement by

the markets that they're getting very worried about how much deficit and debt this government is running up. and now we pass this bill, this bill which adds $2.6 trillion to the spending of the united states government, alleges it's paid for, but we know it's not going to be, creates new entitlement programs which we know went be fully funded, and even if it were paid for, it takes resources which should be used to reduce the debt, especially in the area of making medicare more solvent, and uses them to expand new programs. this is -- this -- this event, as i've described it, is an astroyed of debt headed at the -- at our cufnlt and the simple fact is that it's going to have an effect. the effect is that we will have more difficulty selling our debt and that the deficits and debt that we pass on to our children will be extraordinary and that their ability to have a higher standard of living will be being reduced as a result of that. but the point, of course, is that this bill on top of all the other egregious things it does

in the area of fiscal policy and running up debt, creating massive government that we can't afford, being intrusive in everybody's health care delivery system, undermining the ability of small businesses to offer insurance, raising premiums, raising taxes on people not only on those earning $250,000 but earning less than $250,000. replete with special deals. on top of all that, this bill, as senator corker said, puts pressure on the states and local communities t asks them to spend money which they don't want to spend and which isn't reimbursed. that's not fair. it is called an unfunded mandate. we ought to have a law around here that this bill basically runs over that says we won't do that. ace sated -- as i said earlier, another thing this bill does, which i find extraordinary, it doesn't address the elephant in the room, or one of the elephants in the room, relative to the costs

of health care in this country which is the fact that we are not adequately reimbursing our doctors, that our doctors are going to receive a $285 billion cut over the next ten years, a $65 billion cut over the next three years unless we correct that. it's not correct -- this is from basically a freeze level of reimbursement. and every year we adjust that payment so that doctors do get their money that they deserve, or at least some portion of it, in that we don't really keep them up with inflation. but this bill, which is supposed to be a comprehensive resolution of health care, leaves the doctors out in the cold. it means every year they're going to have to come hat-in-hand one more time asking for something that they shouldn't have to ask for, which is a fair reimbursement for their services. and we will every year hopefully address it, but it's not right

that we've got a bill here that doesn't even account for that. and why wasn't it put in? well, it wasn't put in because if it had been put in, this bill could not meet the budgetary -- the budgetary rules that require -- that give it the special protection that allows it to the floor of the senate and it would have been in deficit, at least over the first ten years, by $100 billion, even using the gamesmanship scoring that the other side of the aisle has used relative to the big bill. so this isn't fair to the doctors. the doctors deserve better than this. and we should correct this right now as part of this process. i mean, this trailer bill has the title "fix-it bill" on it. well, one thing we should definitely fix is the fact that the doctors are getting stuck with -- are getting shortchanged here. and so let's fix it. and that's what my amendment does. my amendment says, okay, this

bill alleges that it generates a surplus. let's use part of that surplus to make the doctors whole for the next thee years. and so it's a paid-for amendment. i can't imagine anybody would want to oppose this. i mean, after all, after we complete this bill, immediately after we complete this bill, we're going to do i believe it's a one-month extension to try to correct the doctor problem. well, how inconsistent, how fundamentally hypocritical is it for us to pass a major health care reform bill and then in the next breath, literally in the next breath, within the next 24 hours, this body will take up a bill to give a one-month extension to the doctor fix. i think it's one month. well, that's not right. so let's do it now.

let's do it in this bill. let's do the doctor fix. and i've come up with a proposal here that will take care of the doctors in a fair, forthright manner for three years. and so that's my amendment. and i'm not sure if it's at the desk or whether i should -- have to send it to the desk. does the desk have a copy of this amendment? well, i'll send my amendment to the desk. the presiding officer: without objection. the clerk will report. the clerk: the senator from new hampshire, mr. gregg, proposes an amendment numbered 3651. on page -- supply gregg: i ask unanimous consenmr. gregg: mr. k unanimous consent that further reading of the amendment be dispensed with. the presiding officer: without objection. mr. gregg: i'll just summarize it again. we know that doctors are being shortchanged. they deserve fair treatment. and it's pretty obvious if you're going to do a health care

reform bill, the correct place to correct the issue of doctor reimbursement is in the next bill, not the next day in a short-term extension. so this is a forthright and fully paid-for attempt. and if it's passed, it will occur, to reimburse the doctors at a fair rate for the next three years and correct the problem known as the s.g.r. problem relative to doctor reimbursement. and i can't understand why we wouldn't want to do something like this. and i would ask -- i see the senator from north carolina is here and would be happy to yield the floor to him for any thoughts he may have on this or the senator from oklahoma. mr. burr: i thank the senator from -- the presiding officer: the senator from north carolina. mr. burr: thank you, mr. president. and i just want to reiterate the fact that this should be part of health care reform. it's not. it's shocking that we would have

something of this magnitude that's not fixed in the reform bill. but we've got an opportunity in a bill that's now come before us which is to fix the things they missed in the health care bill and to provide a three-year comfort on the part of physicians around the country that their reimbursements aren't going to be cut. they're targeted for 21%. it expires march 31. there's not a more appropriate time than right now. but i think what a lot of us have said is, let's pay for it. let's just simply pay for it. enough's enough. it's spending money that we don't have. here's an excellent opportunity where we've got savings from the health care reform bill that we can now pump back in to paying for the -- the fix to the sustainable growth rate that doctors have been under the gun

about. now, we've gone every 30 days for some time without paying for it. here's a real opportunity in a bill that's designed specifically to fix things that were missed in the health care bill, and i would -- i want to thank the -- my colleague, senator gregg, for understanding the importance of this, of working up an amendment, but, more importantly, saying to every physician in america, we can finally fix this, we can do it with money that's paid for and, more importantly, we can take you out of the box of this horror story of wondering what your reimbursement for services is going to be at any given point in time in the future. let's seize this opportunity in this bill and fix the sustainable growth rate. mr. coburn: mr. president? the presiding officer: the senator from oklahoma. mr. coburn: what needs to be fixed in this bill is a whole lot more than this but this is a great attempt to try to solve the problem. let me -- let me describe a scenario, what's getting ready to happen. every state is cutting medicaid reimbursement.

we're going to add 16 billion people to medicaid. we can't even get them all seen now. and then we have a doctor cut that's coming to 21% for people who are under medicare. what's going to happen? what do you think the average physician in this country's going to do? i can tell what you they're going to do. they're going to do three things. fewer will see medicaid patients, so there will be fewer doctors taking medicaid at the time when we increase the enrollment by 50%. that's number one. number two, fewer doctors are going to take medicare, as we have this ballooning increase of baby boomers going into medicare. and, number three, and this is probably more important than anything, you're going to see a large percentage of doctors with this bill passed with no continuity to see how they're ever going to get refunded under medicare just quit. they're just going to quit.

they can take their training, their earth effort, their educa, and their knowledge, apply it in some other field of endeavor, and not have to live with the hassle of a 21% cut hanging over their head. and even if we fix it from three years, three years from now, the same problem's going to come up except it's going to be worse. so there is no fix in it. there's an unrecognized $300 billion to get doctors even, let alone take away the cut, no increase, with this amendment. my hope would be that we would fix this for three years. mr. gregg: mr. president, i'd ask to be able to participate in a colloquy on our side of the aisle. the presiding officer: without objection. mr. gregg: i want to ask the senator from oklahoma, who is obviously a physician and -- and has really an in-depth knowledge of this. you know, i heard the other side of the aisle say, there are no cuts to the benefits of people on medicare. well, if you reduce doctor payments under medicare 21%,

don't you think that's going to affect what they receive? maybe i mean technically there will be no cut because they'll still have the right to see a doctor, but isn't it going to be pretty hard for them to see a doctor because doctors are going to stop seeing them? mr. coburn: they're not going to find a doctor, and that's the whole problem. whatever you see now in the urban areas, multiply it tenfold in the rural areas. so the people -- we're going to increase the he had jibility for medicaid to -- eligibility for medicaid to 133% of the poverty level, we're going to add 16 million people to a system that isn't handling the people that are in it today and so we're going to promise them, here's your medicaid; now, where's the care? it isn't going to be there. there's not the available physicians in this country to care for 16 million new medicaid patients. so if you, in fact, don't fix on a long term the s.g.r., in the long term, physicians are going to do one of two things: they're either going to completely quit seeing medicaid and medicare or they're going to retire.

and, quite frankly, physicians my age who are still practicing aren't doing it for the money, they're doing it because they love patients. but they're going to be forced because they won't even be able to pay their overhead to be able to care for those patients. mr. burr: let me, if i could, add to dr. coburn's payments and say when you double the size of the medicaid population, you're already forcing more doctors to say, i'm not going to see medicaid patients, but you're changing the payer mix of every provider, every practice, every hospital is going to see more patients that's reimbursement is less. that's automatically going to affect medicare right there because doctors are going to have to try to bring in more private pay, private insurance. mr. coburn: would you yield for a second? mr. burr: absolutely. mr. coburn: what it's going to do is exacerbate the cost-shifting that's going on with medicare and medicaid right now, which means insurance rates for everybody else in the country are going to go up.

mr. gregg: well, i thought we were told that insurance rates weren't going to go up? mr. coburn: well, you know, all i would tell you is the best guess of sib circumstances wonderful people -- c.b.o., wonderful people, they only can make decisions within the parameters that they're given, and that there's no question that private insurance, individual insurance, family insurance, is going to go up, but everybody else's is because we're going to increase this trend towards cost-shifting from government programs to private sector. so you're going to end up with three taxes. you're going to pay income tax taxes. you're going to pay a medicare tax. and then you're going to pay a tax on your insurance -- actually, you're going to pay four. and then you're going to pay higher health insurance premiums because the government doesn't cover the cost. mr. gregg: and i presume that's not just going to be people with incomes over $200,000? mr. coburn: no, that's everybody in this country that has private insurance, either through their employer or individual market. mr. gregg: and isn't it equally likely that a large number of small employers will simply get so frustrated with the rate increases that they're getting in order to support people on medicaid that they'll simply

drop that and push their -- push their membership, their employees over into this new exchange? mr. coburn: yeah, they'll pay the fee, they'll pay the tax and say it's easier. so consequently, the young people in our country, because we don't have a big enough payment under the -- quote -- "individual mandate," they're going to say it's smarter for me to save my money, pay fient and not get insurance -- pay the fine, and not get insurance because when i get sick, committee get it, so you're going to get what's called adverse selection, which is going to drive the rates up even further. anybody 40 and other, watch out, your health insurance rates are getting ready to bloom. mr. gregg: is you have basically a multiplier effect in the area of costs being driven as a result of this new policy of adding a huge number of people to an uninsured system that can't support it right now, medicaid? mr. coburn: absolutely. mr. gregg: the costs are going to multiply on people who are in the private sector, and the effect will be higher premiums, less opportunity for your

employer to give you insurance, and in the end the higher tax rate for you, americans who are just working americans, not people with high incomes? mr. coburn: and people who aren't necessarily getting a subsidy. mr. gregg: and then they don't even take care of the doctors. they cut the doctors 21% on top of all this. in coburn know know: -- mr. coburn coburn: so what happo all of this? the effect is the -- is getting rid of the insurance market. mr. gregg: well, that's the goal, isn't it? mr. coburn: that's the goal. mr. burr: even though some would choose to have the coverage and pay the fine, we've got an emergency room system that is obligated to see those individuals when they have traumatic care. so for those that claim that we've now sorted out the system to where the high cost delivery of care doesn't exist? no, again, we've exacerbated the problem. and i think senator coburn hit on the key. as you try to handle the health

care of individuals by limiting the reimbursement, whether that's the way we're limited in the amendment you're trying to fix, whether we do it by shoving into medicaid, you have now cost-shifted more money to the side causing greater inflation for the health care of many in this country. mr. gregg: well, isn't it true -- you're absolutely right, senator. but isn't it true that one of the ultimate cost shifts is to claim that the health care bill is fiscally responsible when it ignores the fact that doctors are being cut by 21% and doesn't even attempt to address that huge problem which represents $65 billion over three years? mr. burr: i've learned throughout this whole process to never try to figure out what promises have been made. i know the promises we made to physicians to reimburse them fairly for the services they

provide. anything less than that jeopardize the pool of health care professionals that we have and eventually will affect the quality of care just simply because if the pool's not big enough to handle the patients, the quality will suffer. mr. gregg: i guess i will get on to the next question, because it's pretty obvious we've got to correct this problem with the physicians. in fact, as i understand it, the next bill immediately we'll consider will correct it for 30 days. why wouldn't we correct it right now for three years, get that three-year consistency into the system so physicians can have some confidence in their rekpwrurt rates full -- reimbursement rates fully paid for? what conceivable reason would there be to vote against this type of amendment? mr. burr: this body did pass a bill that partially paid for an extension of this through september of this year. the problem was when they passed the health care bill, they used the pay-fors out of that

extension bill to be included in this health care bill. so now they've gone to a point that they just seek the 30-day renewals and claim that it's an emergency. one, i don't think it passes the threshold of emergency. i think it should be paid for. and this is a legitimate way to pay for it and extend it for three years where this congress can fully understand the implications of the current health care bill as it's implemented and put the comfort for physicians around the country back -- and their trust back in the system. mr. gregg: i think the senator is absolutely right. but i would also suggest that maybe there's another reason they haven't paid for it in this bill, which is -- or put the correction in this bill, which is that if they did that, the bill would fall because it would be out of compliance with the budget, because it's a $285

billion cost over ten years. and, therefore -- aren't they sort of trying to pull the wool over somebody's eyes here? i mean, we're trying to act as if this bill that we know exists for our doctors, we're never going to pay or we're not going to pay. we're going to act as if it doesn't exist when we know as soon as this bill is over, we're going to have to do something about it, at least for the next 30 days. mr. burr: you're absolutely right. that will be the first order of business when this bill is finished, if we miss the opportunity to fix it for three years. mr. gregg: the senator from arizona. mr. mccain: i'd like to discuss for a minute -- mr. president, i ask unanimous consent to be included in the colloquy. the presiding officer: without objection. mr. mccain: i would ask the senator from new hampshire, there is some recent information that i found hard to believe, but apparently may be the case as we go through this 2,733-page

piece of legislation that the i.r.s. may need up to $10 billion to administer the new health care program this decade. and it may need to hire as many as 16,500 additional auditors, agents, and other employees to investigate and collect billions in new taxes from americans. is that possible in this legislation? i would ask the senator from new hampshire. mr. gregg: the senator is absolutely correct. that does call into question the representation that this bill isn't a tax increase, that we need 16,000 new i.r.s. agents to enforce it. mr. mccain: at $10 billion to administer. that's probably believable given what's in 2,733 pages. mr. gregg: you're going to need one i.r.s. person for everybody in america who doesn't

have insurance, i guess, or however the ratio works out. everybody's got to buy insurance under this bill. your local i.r.s. agent is going to show up at your door to tell you you better do it or else you're going to have to answer to the i.r.s. we know there are no new taxes in this bill because that's been represented to us a number of times. mr. burr: if i could add, it also gives some insight as to how many people will choose not to have insurance and make themselves susceptible to the fine. the anticipation is that the i.r.s. is going to chase a lot of people to recover the fine. mr. mccain: i finally add that perhaps we could get some indication -- we should, i think, before we voted on passage of this bill, as to how many new bureaucrats and bureaucracies there's going to be with 193 new boards and commissions and other layers of the bureaucracy. i think the american people are owed at least a round figure as

to how many new bureaucrats there are going to be to administer this program. i see the senator from montana, and i don't want to impede what has been agreed upon rule here, but i did want to continue. i would say to my friends very quickly, i think there are several myths here that have to be refuted by the facts. one is that this legislation will result in a tax cut for the american people. i say to my friend from new hampshire, we have to rebut that in the next hour. the next is that millions of americans with incomes below $250,000, the myth is that the health care bill won't increase taxes on individuals with incomes under $250,000. the fact is millions of americans with incomes below $250,000 will pay higher taxes. the myth that the legislation will reduce the growth of health

costs, president obama's stated goal for health reform and premiums would go down. fact: national health expenditures and premiums will increase. myth: the legislation is deficit-neutral. fact: the commitment to health care spending under existing obligations increases the deficit. myth: if you like the plan you have, you can keep it. fact: millions of americans with coverage will lose their current coverage, including 330,000 citizens of my state that have the medicare advantage program. finally, the myth will immediately provide coverage for children with preexisting condition. fact: children are not necessarily protected against discrimination for preexisting conditions. so, i hope we have a chance, i'd say to my friend from new hampshire, these are the allegations about this legislation. and perhaps the first one is that legislation will result in a tax cut for the american people when the fact is taxes

will increase for millions of americans. i would ask my colleague from new hampshire. mr. gregg: i think the senator from arizona, who has been one of the most cogent and thoughtful speakers on this issue of what this bill really does has hit the nail on the head time and time again with his points. they are all absolutely accurate. if the senator has completed his statement or does he have further statements? mr. mccain: i wanted to throw in here perhaps one of the most egregious -- and it's worth repeating again. the most egregious is this so-called doc fix that they are using the assumption that we will cut physicians' fees by 21% sometime this fall in order to make up -- please correct me if i'm wrong -- some $281 billion over ten years, which we know is not going to happen. the reason it's not going to happen is doctors would refuse

to take medicare patients if they cut their reimbursement by some 21%. this, one of the fundamental assumptions they're selling this on is that it's deficit-neutral when it is not. mr. coburn: if you think about it, we're talking about the cuts that are set to go. but since there's no tort reform in this bill, we spend $250 billion on defensive medicine and liability costs continue to rise, you can bring -- they're still going to keep seeing medicare patients. one other point is with the student loan being taking -- taken over by this government, we're going to lose 31,800 jobs in the private sector but add 15,000 jobs in the i.r.s. i don't think anybody in america

would like that to happen. a letter written saying the prices for caterpillar would go up by $100 million next year. what does that do to caterpillar? it obviously makes them either not hire or lay off individuals as they pay an additional $100 million. and i might point out, as we all know, caterpillar's headquarters is in peoria, illinois. again, i would ask again the senator from new hampshire, is this legislation deficit-neutral? mr. gregg: no, it's not deficit-neutral if you actually score it, if you score the number of years of income against the number of years against expenditures or you include the doctors' fix. either one would throw this into a deficit negative situation. mr. mccain: isn't that another scam? for four years the benefits are cut, taxes are increased and for most benefits of this bill, none

actually kick in until after four years? you then score it, that's the way you make it -- quote -- "deficit-neutral over ten years"? mr. gregg: that is correct. it is at bit of a scam. i'm going to have to reserve the balance of my time for a moment, but i understand the senator from north carolina -- mr. burr: i ask unanimous consent to temporarily set aside the pending motions and amendments so that i may offer an amendment that's at the desk at this point. the presiding officer: without objection, so ordered. the clerk will report. the clerk: the senator from north carolina, mr. burr, proposes an amendment numbered 3652. mr. burr: asknanimous consent the amendment be considered as read. the presiding officer: without objection. mr. burr: i would yield the floor and protect the balance of the time. the presiding officer: who yields time? a senator: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, the debate on this bill is winding to a close, so let me return to

the nonpartisan congressional budget office. c.b.o., the congressional budget office, is the referee that we all turn to as an impartial judge of whether we are accomplishing what we set out to do. so let me just take a moment and quote from the congressional budget office. it's very appropriate to the prior conversation on the other side. let me read excerpts from the most recent congressional budget office statement on deficits, debt and coverage, and whether this is deficit-neutral or not. this was released saturday. this is saturday's statement by the congressional budget office and the joint committee on taxation. they are our scorekeepers. they determine how much we're spending and how much revenue we're taking in in legislation and what the net result is. here are the highlights of the

letter: "enacting both pieces of legislation, h.r. 3590" -- basically the senate bill that passed the house and the president signed. "h.r. 3590 and the reconciliation proposal will produce a net reduction of federal deficits of $143 billion over the 2010-2019 period." a direct quote from the c.b.o. further quoting -- "enacting h.r. 3590 by itself would yield a net reduction in federal deficits of $118 billion over that same period, 2010-2019." further quoting -- "the incremental effect of enactingel would be an estimated net reduction of federal deficits of $25 billion during that same period over and above savings from enacting h.r. 3590 by

itself." further quoting c.b.o., "the combined effect of enacting h.r. 3590 and the reconciliation proposal would be to reduce the number of nonelderly people who are uninsured by about 32 million people. the share of legally nonelderly residents with insured coverage would rise from about 83% currently to about 94%." c.b.o. said of the new health care law, "enacting 3590 would reduce federal budget deficits over the ensuing decade." that is the next decade, second decade. "with a total effect during that decade, a broad range between .25% and .50% of gross domestic product." what's more, c.b.o. further said

"the combined effect of enacting h.r. 3590, the bill signed by the president, and the reconciliation proposal would also be to reduce the federal budget deficits over the ensaourg decade -- ensaoubg decade with a total effect during that decade with a broad range around 1% of gross domestic product. that is about $1.3 trillion. c.b.o. continues, "the incremental effect of enacting the reconciliation bill over and above the effect of enacting h.r. 3590 by itself would thus be to further reduce federal budget deficits in that decade. with an effect of a broad range of zero and 1% of the g.d.p." in other words, the new health care reform law would accomplish major deficit reduction. this is the c.b.o. talking. not senators. don't take my word for it.

don't take anyone else's word for it. this is the congressional budget office. and this reconciliation bill itself would accomplish major deficit reduction. probably the greatest deficit reduction we're going to take, mr. president, over a long period of time, preceding perhaps eight, nine, 10 years in the subsequent period of time. don't know that, but it's certainly a major deficit reduction. together these two bills would accomplish deficit reduction of historic proportions. let me continue to quote the letter from the congressional budget office. quote -- "the reconciliation proposal would continue to reduce budget deficit relative to those under current law in subsequent decades." not just this period, not just the next decade, but subsequent decades. this is my edit now: this means this bill continues to reduce the deficit in year after year after the second decade

according to the congressional budget office. finally c.b.o. says, and i quote -- "in subsequent years the effects of the provisions of the two bills combined that would 10 to decrease the federal budgetary commitment to health care would grow faster than the effects of the provisions that would increase it. let me repeat that statement. it gets to the federal involvement in health care as a consequence of this bill. again, -- quote -- "in subsequent years the effects of the provision of the two bills combined that would tend to decrease the federal budgetary commitment to health care would grow faster than the effects of the provisions that would increase it." further -- quote -- "as an effect c.b.o. expects that enacting both proposal would generate a reduction in the budgetary commitment to health care during the decade following the budgetary window."

relative to current law. in other words, mr. president, c.b.o. says after the first decade, health care reform will reduce -- yes, reduce the budgetary role of government in the health care sector. who else are we going to trust? who else are we going to listen to? we all have opinions. those folks at c.b.o. have sharp pencils. they're good at what they do. they're nonpartisan. nobody's questioned their professionalism. they're very good and this is what c.b.o. says. so that's it, mr. president. c.b.o. says that health care reform cuts the deficit -- let me pause and let that sink in. c.b.o. says that health care reform cuts the deficit. c.b.o. further says it expands coverage. more people get health insurance from 83% to 94%. and also this legislation reduces the government's

budgetary role in health care. reduces. that's quite a feat, mr. president. more coverage, deficit reduction and less involved in health care. i think the bill is -- i think this bill is pretty well designed to accomplish all of those purposes, cuts costs, increases coverage and reforms the health insurance market most significantly in the individual market and also in the small group market. mr. president, i ask that that letter from the congressional budget office be placed in the record. the presiding officer: without objection. mr. baucus: mr. president, on other matter, i think it's relevant and important. this is a letter from aarp dated march 24th this year. and it says, dear senator, we have made enormous progress advancing historic, urgently needed health care reform

legislation, but we are not done yet. this is from the aarp. continuing -- "we now urge to you promptly pass health care, the reconciliation affordability act of 2010 without amendments." let me repeat that aarp in a letter dated march 24th strongly suggested that the congress pass this legislation without amendments. their their words, without amendments, in order to make affordable, high-quality health care available to more americans. the letter is longer, mr. president, i wanted to quote one of the more sal yent provisio provision -- salient provisions where aarp wants to pass the bill which the president already signed and get health care to americans who desperately need it, and reform the health care industry which is desperately needed and reduce health care

costs, which is desperately needed. the presiding officer: we have 2751 on the minority side, i see, and 3542 on the minority side. mr. gregg: let me make two quick in here. the only way that c.b.o. could get to the conclusions they ache a they had to get to those conclusions because of the facts that were put before them. one of those facts they have to presume that medicare's going to be cut $500 million in the first 10 years before full implementation, a second -- and $3 trillion during the first 20 years of full implementation. $3 trillion. and all of that money is going to be taken out of medicare and moved over to start new programs, new entitlements to benefit people who are not senior citizens and who, for the most part, have never paid into

medicare. that is a serious problem. and you can score that positively if you wish, but first off i don't think it will happen, and i think what will end up really happening here is we'll all get put on our children's back as debt. secondly, if it does happen, it's wrong because medicare's going to be fixed and you're taking the money to fix it, if you believe in these types of cuts in medicare and you're spending them on a new entitlement. mr. baucus: might i ask my colleague, my friend, a question. mr. gregg: on your time. including my answer, which may take 24 minutes. mr. baucus: i trust the good faith of the senator from new hampshire to not abuse the situation. i understand, basically, senator, does not question the professionalism of c.b.o. clearly c.b.o. had all of the facts that all of the senators had before it. c.b.o. has all the facts. so you're questioning c.b.o.'s professionalism, but you do question their conclusion.

mr. gregg: i -- i certainly don't question their professionalism. they're an extraordinarily good organization with a wonderful leader who is fair and unbias. i don't question their -- they have to score a fact pattern given to them and the fact pattern given to them by this bill is on its face not believable relative to what's going to happen in the out years even though they have to score it as believable. mr. mccain: i would ask the senator from new hampshire while the senator from montana is here, maybe it's a legitimate we: does the senator from montana believe that the assumption that was given to the congressional budget office that the so-called doc-fix, that the reimbursement for physicians that treat medicare patients will be cut by 21%? the senator from montana knows full well that the a.m.a. has been told in no uncertain terms that it will be fixed between now and when it's supposed to

take effect because the fact is that as the senator from montana knows, if you cut medicare physician reimbursement, then doctors will not treat medicare patients. so maybe the senator from montana would tell us if that was a valid assumption given to the c.b.o., that there would be some $281 billion that would be accrued because physicians payment would be reduced by some 21%. mr. gregg: i ask that the time for the senator from arizona's time come off of ours and the senator from montana's time come off of theirs. mr. baucus: let me say to the senator from arizona, first of all, clearly, this body, the senate and congress is going to not let the s.g.r. problem expire, that is, doctors are not going to be cut 20%, whatever the rate is, the first year or

more. that's not going to happen. first, from the seniors's point of view, second from the doctors' point of view, that's not going to happen. the long and short of it simply is that we're going to have to find a way in this congress to address this problem. it's not part of health care reform and we will find a way -- a question of how much is going to pay for, that's a judgment that this body's going to have to make in the pretty near future. mr. mccain: i appreciate very much the acknowledgement on part of the manager of the bill of the assumption that provides us with deficit neutrality is not valid. that's the.we've been trying to make here. it is based on false assumption. and the -- and the assumption that doctors -- i'm very happy to hear the senator from montana state unequivocally, what was given and assumed by the c.b.o. when they gave us our numbers is

not true. so we will be voting in a short period of time on a -- on a piece of legislation which is based on false assumption. i -- i think that that's an unfortunate circumstance. mr. gregg: i would simply note that the senator from montana made the case for my amendment rather eloquently. it does address the doctor fix and addressed it rather eloquently. at this time i would yield five minutes to the senator from georgia. a senator: i thank the senator from new hampshire. let me reiterate what came out of the colloquy between the senator from montana and the senator from arizona, and that is this, c.b.o. said this is going to be a deficit reducer and the president's going around the country talking about the fact that this bill is going to reduce the deficit. but what the president's not going to say, but what the senator from montana just agreed to, is the fact that our

physicians who are due a 21% decrease in medicare reimbursement payments are not, in fact, going to have that 21% reduction. and when you factor that in, this not only does not reduce the deficit, but it adds to the deficit an additiona additional $281 billion difference in what the number the c.b.o. says that we're going to reduce the deficit by. so, you know, very clearly we're going to add to the deficit when we pass this bill because the senator from montana's right, we're not going to see that 21% reduction. and i suspect that th the $523 billion in medicare cuts that are provided for in this bill that are scheduled to take effect in the future years may not ever happen. and if that is the case, then not only are we looking at an additional cost of tha

that $523 billion, th the $281 billion for the s.g.r. fix, or the doctor fix, but we're looking at increasing the deficit to fund a domestic program in a huge way. one thing that the c.b.o. does say is that this bill provides an additional $569.2 billion in new taxes. new taxes on the american people. particularly the small business community that's hit the hardest by this. and, mr. president, i want to ask unanimous consent, first of all, that my entire statement be inserted in the record. the presiding officer: without objection. mr. chambliss: and also, mr. president, i want to talk about a specific provision that is going to have an immediate direct impact on my taxpayers in georgia. and that is with the increase in the threshold to qualify for medicaid going from 100% to 133%

in my state, according to our governor, and he has run the numbers, that's going to cost the taxpayers of georgia, in addition to their share of thi this $569.2 billion in additional taxes, an additional $1 billion per year that georgia taxpayers are going to have to pay. we're in difficult times in my state, as all 50 states are right now. that's a new provision, a new tax, and, again, mr. president, i'd like to ask unanimous consent that a statement from the governor of georgia be inserted in the record. the presiding officer: without objection. mr. chambliss: lastly, let me say, mr. president, that in the last 48 hours, the agency that will administer the new health care reform bill that the president signed into law is none other than the internal revenue service. the internal revenue service has said that in order to review the

tax returns of every tax paying american to ensure that they have complied with the law and bought insurance or had insurance taken out through their employer, that they're going to have to have an additional 16,500 internal revenue service agents at a cost of an additional $10 billion to the taxpayer. that $10 billion is not factored in here anyway. so, mr. president, we are dealing with a piece of legislation that the american public has shown over and over and over again and every poll taken whether by a democratic pollster or republican pollster or independent pollster that they do not want. and we're going to force that bill down on the american people, and that is wrong. that is not the way that this body and the body across the capitol should be working with respect to the best interests of the american people.

and i urge my colleagues at the appropriate time during the vote on the amendments this afternoon and tonight to repeal this bill and let's replace it with a meaningful health care reform bill that we can all agree on. and there are a lot of provisions in those 2,700 pages plus the length of this so-called fix-it bill that we can agree on that we can replace this bill with that will provide the american people with true, meaningful health care reform that they need and deserve. we won't see all of these huge increases in taxes, we won't see all of these huge reductions in medicare benefits, and we can do the will of the people in the right and appropriate way. with that, i would -- mr. gregg: i would yield two and louisiana. mr. wicker: -- mr. vitter: i ask unanimous

consent to call up amendment unfunded mandate 3553. the presiding officer: without objection, so ordered. the clerk: the senator from louisiana, mr. vitter, proposes amdmt number 3553. mr. vitter: i ask unanimous consent to waive reading of the whole. the presiding officer: without objection. mr. vitter: thank you, mr. president. this amendment is very simple and it goes to the heart of all of these arguments. this amendment would repeal this new obama care plan. all of us on this side urge this action and urge us to focus sneddon a focused, step-by-step approach to solve specific real problems with specific solutions. this gargantuan plan which this amendment would repeal doesn't do that and this gargantuan plan has fundamental problems at its core that my colleagues have been talking about. truly offensive, fundamental problems like over a half a

trillion dollars cut to medicare. mr. president, the american people do not want to pay for anything through that. over half a trillion dollars of increased taxes and costs. mr. president, the american people don't want an approach that does that. increasing health care costs when the american people know that our big challenge is to do the opposite and nonpartisan sources like the congressional budget office confirmed that the obama care plan doesn't decrease health care costs, it increases health care costs from their rising rate already. it pushes that cost curve up. and growing a bureaucracies, -- growing a bureaucracy including thousands of i.r.s. workers and putting them and the federal government between you and your doctor. these are not minor parts of the obama care plan, mr. president. this is the core of that plan, and that's why we absolutely

need to repeal it and take a fundamentally different approach, an approach that's focused like a laser beam on real problems and that deals with those real problems with real and targeted and step-by-step solutions. the presiding officer: the senator's time has expired. mr. vitter: thank you, mr. president. i urge support of amendment numbered 3553. mr. baucus: mr. president? the presiding officer: the senator from montana. mr. baucus: mr. president, we're coming to a close, or a beginning, i'm not sure which, when we start to vote on amendments. if my calculation is correct on the time for debate on this reconciliation bill will expire

around 5:10, about that time, approximately. and at that time, approximately, we'll start voting on amendments. by my count, we have 21 amendments pending. if we vote on amendments with the time it usually takes to vote on amendments in a series, it's my experience that it roughly takes around an hour for three amendments. now, maybe we could speed that up. with 21, that's seven hours. 5:00. that means right now -- and that's the good news. there will probably be some intervening disruptions. but the good news is that that means that the earliest we might be finished is around midnight. but, of course, that's not the case because there will be other amendments offered. and so i just -- for the information of my colleagues, just to repeat, we will probably start voting on amendments at approximately around 5:10 or thereabouts. and we have 21 amendments

pending at the present time. it takes about one hour to vote on three amendments. maybe we can squeeze that time down. it's my hope that we can. that's my experience around here, it takes about that long. and because there are a lot more amendments most likely to be offered, i just warn my colleagues that we'll be in very late tonight. we will certainly be in past midnight, way past midnight because of the number of amendments that are currently pending. mr. gregg: mr. president, what's the tim situation? the presiding officer: you have -- the minority has 23 minutes and 47 seconds left. mr. gregg: and the majority? the presiding officer: 24, 52. mr. gregg: i would yield ten minutes to the senator from tennessee. mr. alexander: mr. president? the presiding officer: the senator from tennessee. mr. alexander: thank you, mr. president. could you let me know when eight

minutes have been consumed? the presiding officer: sure. mr. alexander: thank you very much. mr. president, this has been a debate filled with passion and good intentions and a lot of hard work, and our political parties have come to vastly different conclusions. the president and the majority have said this is an historic occasion. i agree. but i believe, as do most of us, that it is an historic mistake. it is important to say why we think that. this is the fundamental mistake that what we have done is to -- with the law that was passed majority and the majority is proposing to do in this second bill is to expand a health care delivery system that we all know is more expensive than we can afford instead of stepping back and instead seeking to reduce the cost of that health care

delivery system so that more americans with afford to buy health insurance. that's the mistake. so i'd like to try to say in three or four minutes what this bill means to tennesseans. i was listening to the senator from montana and the republican senators talk about debt. we believe, i believe that this bill, these two bills will increase each tense indiana's share of the national debt. the senator from montana says but well, the congressional budget office says it doesn't. well, that would be like going to the congressional budget office and saying i've got a horse farm here. tell me how much it costs to operate over the next ten years. and the c.b.o. would say would you like me to tell you how to do it with the horses or without the horses? if you tell me how to do it without the horses, it's not going to cost as much. or if i have a gas station, would you like to have me tell you how to operate that with the gas or without the gas in it. that's what they are saying

here. they have gone to the congressional budget office and said tell us how much this health care bill costs, and they have said to them with the doctors or without the doctors? they say oh, no, keep the doctors out, because according to the president's own budget, that's $371 billion more over ten years. and if you put that in, then the whole bill adds to the deficit. and so they leave it out. so that's why we say and i would say that the first thing this bill does is add to the debt each tennessean's share of the debt. the second thing is it has has $8,470 in new spending for each person in tennessee. the next thing it does is the tennesseans enrolled in medicare advantage -- about one out of four persons enrolled in medicare -- will have their benefits reduced by half, according to the congressional budget office in testimony before congress, whose veracity we have been hearing extolled on all sides. the next thing it does is about

1.4 million tennesseans making less than $200,000 will pay higher taxes, according to estimates by the joint committee on taxation. 300,000 tennesseans in the individual health insurance market will see freedom rate increases of 30% to 45% according to a blue cross/blue shield study of tennessee and other analyses. next, tennessee small businesses employing 50 or more people will see premium rate increases -- well, small businesses employing 50 or more people and construction companies employing five or more people, that's 5,000 construction companies in tennessee will pay higher health care costs because of new government mandates. then here is the other one. this is the one that was just added over the weekend. 200,000 tennessee students, including, i checked, 11,000 at the university of tennessee-novel where i was this

week will be overcharged by by $1,700 to $1,800 over the next ten years on their student loans in order to help pay for the health care bill and other programs. let me say that again. over the weekend, without any debate in the senate, they have stuck in this bill. they're going to overcharge 19 million students in america, 200,000 in tennessee, $1,700 or or $1,800 more than it costs the government to borrow the money because the government has taken over the student loan program. they borrow the money at 2.8%. they loan it out at 6.8%. they take the difference, they spend it. $8.7 billion of it to help pay for the health care program, so that's 200,000 tennessee students. these aren't wall street financiers. these are a mom with a child and a job going to school to get a better job. that's 200,000 tennessee students. $1.1 billion in costs will be forced on the tennessee government. that's according to our state

democratic governor who said that's the cost of the medicaid expansion and what happens to the state after the physicians' reimbursement expires in two years for medicaid. this will force, this will force states, tennessee for sure and many other states, to raise taxes, cut services or increase college tuition. according to an oliver wyman study, 30% of young people will pay up to 35% more in premiums as premiums go up in the individual market. and then -- and then -- and then finally, of course, the bill does add in tennessee about 200,000 people to our tenncare or medicare rolls. but, mr. president, that's not health care reform because nationally only about half of doctors will see new medicaid patients. so we're saying to people we're giving you health care, but it's

like saying we're giving you a bus ticket to a bus line where the bus only runs half the time. and when you put these low-income americans into this program in such large numbers, what that additionally does is create more opportunities for physicians, for hospitals and for drugstores to say we can't serve medicaid patients anymore. so, mr. president, that is why we feel this is the wrong course and a historic mistake. what we would do instead is replace this bill with a different bill that focused on costs. we have said it over and over again. we said it at the health care summit. we would start with -- with allowing people to buy health care across state lines, with small business -- with aligning small businesses to combine resources to offer more services to people at lower costs,

reducing the malpractice lawsuits, we would expand health savings accounts. all of these were proposals made before the senate, basically ignored. but the fundamental mistake and the reason we have such a difference of opinion between that side of the aisle and this side of the aisle is that that side of the aisle which has the majority is expanding a health care delivery system that we all know is too expensive, and we think instead what we should be doing is focusing on reducing health care costs so that more americans can afford to purchase health care insurance. i thank the president and i yield back my time to the senator from new hampshire. mr. gregg: mr. president, i would yield for 30 seconds to the senator from kansas to put in order a couple of amendments. the presiding officer: the senator from kansas. mr. roberts: mr. president, i ask unanimous consent to temporarily set aside the pending motions and amendments so that i may offer an amendment

numbered 3577 which is at the desk. the presiding officer: without objection, the clerk will report the amendment. mr. roberts: i ask consent that the reading of the amendment be dispensed with. mr. president, i ask unanimous consent -- the presiding officer: the clerk will report the amendment by number. the clerk: the senator from kansas, mr. roberts, proposes amendment numbered 3577. mr. roberts: i thank you, mr. president. i ask unanimous consent now, mr. president, to temporarily set aside the pending motions so that i may offer a motion to commit which is at the desk. the presiding officer: without objection. the clerk will looter the choation motion. the clerk: the senator moves to commit the bill h.r. 4972 -- mr. roberts: i ask that the reading of the amendment be dispensed with. the presiding officer: without obction. the senator from montana. mr. baucus: madabut

mr. baucus: mr. president, i think we have -- i yield half of our time to the chairman of the banking committee and active chairman of the "help" committee and the most valuable and productive -- and one of the most valuable and productive senators in this body. 12 minutes to the. the senator -- tothe senator of. mr. dodd: i thank the senator and thank him for his wonderful leadership on this issue along with our distinguished majority leader and many others, including wonderful staff. we don't often mention the remarkable work being done by the staff and committee staff members. i see my good friend tom harkin here who now chairs that committee w. along with max baucus and so many others on the leadership staff that have brought us to this moment. i thank all of them. i rise this afternoon, mr. president, to discuss the health care and education affo affordability reconciliation act and although none of us are

ignorant of the historic nature of the health care portion of our work this past week, i'd like to take a few moments, if i could, to talk about the significance of the education portion of the bill. i listened intently to my friend and colleague from tennessee, lamar alexander, talk about this part of the bill as well. i have great admiration for him, having served as our secretary of healt education. we disagree with this particular portion. i want to express a different point of view, mr. president, about why i believe what we have included in this bill has great value. obviously the major ateption has been focused on the health aspects of what we're doing. and that in itself would be a major achievement. in the reconciliation portion of this bill before us now, strengthens this bill maingsdz it eve -- strengthens this billd makes it even better. last night i discussed the valiant efforts.

the education portion of this bill also has great significance. since the pell grant was established in the 1970's, as all of us in this chamber know, it has made college a possibility for millions and millions of young americans. i have the great, great pleasure of serving with claiborne pell. he was a member of this body. he served in the late 1960's up to a few years ago. we lost him a few months ago. when i you this of what a difference that one senator made in the millions of our fellow citizens, many may not know who claiborne pell is in the years to come, but i would like the record to reflect he was a wonderful senator. he wrote the legislation that banned the testing of nuclear weapons on the ocean's floor. he was the author along with jacob javitz of the national endowment of the arts and humanities and he was the author of the pell grants, a unique and remarkable contribution, each

and every one of them, but he should long be remembered for making education an opportunity that would not be denied because you lacked the resources to afford it. those millions of students are now leaders, innovators. not unlike the g.i. bill at the end of the world war ii, how many of us have met men, particularly men who came back from the theaters of the pacific and the european theatres, who got an education under the g.i. bill who would tell you what a remarkable investment it was and has been repaid millions of times over by those who today made contributions to our country because they got an education, because there was a creative congress, because there was an administration that understood the value of an education in the midpart of the 20th century. here we're into the second part of the 21st century. should there be anyone's doubt in anyone's minds about the value of not only making us a healthier country by the adoption of the health care provisions of this country but a

better-educated country, not only to advance our own needs but to make sure individuals have the opportunity to maximize all of their potential, today that wouldn't have been the case without pell grants. what they have done to our society has been remarkable. without the opportunity to attend college, they wouldn't have had the opportunity, of course, without pell grants. since then, the importance of a college education has only grown, mr. president. not only to individual students, obviously, who want to achieve their full potential but our nation as well. america's ability to compete in the global economy depends, as it should be just so obvious, on having a well-educated workforce. -- in the 21st century. that means a college-educated workforce. while the door for attending college has grown and the support for our college aid program has slipped. it has gone off the cliff in many ways.

in 1975 the maximum pell grant covered 80% of the average student tuition -- fees, room and board, and a four-year public university. 80% in 1975. today it covers less than a third at a public university. our fail tour keep pace with the exploding -- our failure to keep piece with the exploding cost of attending college slams the door for many and leaves those who need to find a way to attend with an overwhelming burden of debt. allowing the pell grant program to wither, as would be the case without adoption, would be a slap in the face to the working families and is a serious threat to america's competitiveness. the legislation in front of us presencpresents an opportunity o revitalize the pell grant program and unlock the

opportunity for millions of americans. the bill investors $2.5 billion to fill the shortfall in the program and ensures that such a shortfall doesn't occur again and the cost of college continues to increase in the years ahead. for instance, mr. president, if we fail to act, the maximum pell grant award could be a paltry $2,1 00 for the year 2010. never before has the effectiveness of this program been at such risk. the bill increases the award to almost $6,000 by 2017, seven years from now. we all know in seven year, the cost of education will continue to skyrocket. while we're putting a lot of resources into this program, imagine in 2017, seven greers now, whe what college education would be like and the pell grant

assistance, as important as it is, is not going to come close to meeting the needs. so we tried to peg these increases to education so that it can keep up with the cost of higher education. in my home state of connecticut, this would enable 4,300 additional students to go to college. this legislation makes important investments in historically black colleges, community colleges, and college access challenge grant program which fosters partnerships between government and nonprofit sector that help low-income kids get a chance to go on to a higher education. it invests in programs that help students figure out what college is best for them as well and prepare not only to get into the schools but to graduate from them as well. and when those students do graduate, they will no longer be faced with that mountain of debt that we've heard about oaferredz and over again -- that we've heard about over and over again that put so many of them on their own careers and contribution to society on hold while they have to pay off these debts seeking jobs and students that may not be what they need

for their future growth. our legislation caps repayment of federal loans at 10% of discretionary income and forgives payments after 20 years. now, mr. president, this represents an important investment not only in our children's future but the future of our children, as i've said, and it will pay enormous dividends. but this investment isn't just smart. it's fully paid for. in fact, the congressional budget office estimates that this legislation in front of us today will reduce the national debt and deficit by $10 billion over the next ten years. we accomplish that, mr. president, by eliminating what amounts to billions of dollars in wasteful spending within the federal student loan program. will the me explain. currently some federal student loans are made through the direct loan program while roars made through the federal -- while others are made through the federal student loan program called the so-called ffel

program. that money intended to help students go ton to a higher education ends up helping to pad profits of those lenders. that's a waste of money. what's more, banks in the s so-called ffel program get their payments regardless of how they treat the borrowers. taxpayers end up shouldering the risk of defaults. so our legislation in fronts ever us today converts all future federal student loans to direct loans. this doesn't cut the private sector out, i would quickly add. what it does is as american as apple pievment it makes them compete and when institutions have to compete, consumers benefit. what it does do is end these unnecessary payments and force banks to compete for the job of servicing student loans. students and parents -- for students and parents, it means better customer service, the same good rates that have always

been the hallmark of federal student loans. as for taxpayers it means a savings we're teeld o told of $1 billion over ten years, money that now flows into the coffers of banks. this will help more kids go on to college. in short, what we have here is a win-win, a fully paid for and much-needed investment in equal opportunity and american competitiveness. but i'd be remiss if i did not note that we could and should be doing more. it comes as a serious disappointment to me and to education veect advocates acrosr country that funding for a new early childhood initiative was not included in this package. i desperately wanted it to be here, did my friend from iowa. as important as it is to enable a high school student to graduate and attend college, it is just as critical, mr. president, that we prepare

every child to be a viable candidate for their next step? the education process and the achievement gap that robs too many children of that opportunity begins very, very early, before the age of three, according to everything we know about child development. you know the statistics. most of us do heemplet investments in recallly childhood education pay off tenfold, mr. president, when we consider the decreases in crime, the reduced need for special education, and welfare services and improved health of these kids who have access to early education. and just as the increasingly competitive global economy calls us to unlock the door to higher education, we must dlos everything we can to bring -- we must also do everything we can to bring that child to the maximizing of his or her potential. that requires a serious requirement in early education in our nation. this legislation would have been a perfect opportunity to follow through on that commitment.

so the fight will continue. unfortunately, without the strength this bill would have provided. but for now we have the chance to do some real good for young people and for our nation. so i had a urge my fellow -- so i'd urge my fellow senators here, both democrats and republicans, to support this commonsense measure, save the pell grant program, make a real difference in the lives of countless young americans for years to come, and i remind my colleagues, this is just part of what is at stake in this debate. the amendments being offered on too many occasions by our friends on the other side are doing nothing more than trying to stop this legislation from going forward. i would hope that would stop. let us pass this bill. we have a chance to not only change the quality of health but also to change the quality of a higher education tiewfnlts for those reasons, i urge the adoption of this peafnlgt i yield the floor, mr. president.

mr. president, i don't know -- i see senator gregg on the floor and senator mccain. the presiding officer: the senator from arizona. mr. mccain: mr. president, i've read a lot about what's been going on in the health care debate. all of us have. americans are very aware of it. and i keep hearing the word "historic," "this historic, "that historic," and i agree. it's an historic vote. and i think we're pretty aware of what the outcome will be sometime tonight, tomorrow, or the next day. it's the first time in history, in the history of this country, that a major reform has been enacted on a pure partisan basis. the first time. every major reform throughout history has had significant -- and you can go down the list of bipartisanship votes in the

1970's. this one, purely partisan, rammingerammed through from bego whatever this end is. it's historic. and it's the first thyme that a process called -- and it's the first time that a process called reconciliation has ever been used to affect one-sixth of the gross domestic product, and i know the response will be, well, republicans did it, et cetera, et cetera. it'll be the first time that 51 votes has been the measure of decision on so-called reconciliation. now, that's historic. that's historic because we have basically broken down the 60-vote tradition of the united states senate when we address it in this fashion and an issue of this magnitude. let me tell you when the president was still a senator -- when the president of the united states was still a senator, the

last time we were doing -- another time we were doing reconciliation, and he said, "you know the founders designed this system as frustrating as it is to make sure that there's a broad consensus before the country moves forward. and what we have now is a president"-- --he was referring to former president bush designee "hasn't gotten his way. that is now prompting, you know, a change in the senate rules and really i think would change the character of the senate forever." and what i worry about would be you essentially have two chambers, the house and the senate, but you have simply majoritarian absolute power on either side, and that's just not what the founders intended," barack obama, senator from illinois, said. so here we are. yes, it's historic. it's historic. and it's historic what we have seen take place from the beginning. we have seen the special interests. we have seen the votes -- the

provisions in these bills that carve out special deals for special interest and special states, such as the louisiana purchase, the $100 million inserted in this 2,733-page document that gives -- builds a hospital in connecticut. why connecticut? why a hundred million dollars? why is it that there are these special provisions for certain locations in the country? what about -- i'll tell you, it's historic in the special deals that have been cut for pharma, for the american medical association, for the hospital association, for the unions in the taxation of cadillac plans, and everybody's got a deal but the american citizen. the average american. how many americans, how many ordinary americans that are,

say, enrollees in medicare advantage in my state who are going to see the medicare advantage program cut drastically, how many of them were allowed in the majority leader's office? how many were allowed in the speaker's office? how many of them were allowed in the white house as the special interest representatives went in and out? so there's winners and losers, that's what is being judged he here. winners -- the winners will be those who live in favored stat states, will have special deals. there will be those who are winners, the pharma, hospital association, the unions. again, my congratulations to the pharma. they're running $100 million-and-some worth of ads favoring this deal because they got a deal that's worth billio billions. worth billions. as i've quoted on the floor several times, their head lobbyists are $2 million-a-year lobbyists, said, a deal is a deal, we expect the white house to keep it.

so -- so who are the losers? who are the losers? well, the first loser i think is the united states senate. because, as i said before, this reconciliation requiring only 51 votes is a radical departure from anything we've done in the past, and i do not accept the statement that it's been done in the past. not when it -- not when it affects one-sixth of the gross national product and is a direct result of the vote of the state of massachusetts that gave this side 41 votes. if you still had 60 votes, we wouldn't be doing this on reconciliation, we would be doing it in the regular way we address legislation. legislation through the house, legislation through the senate, a conference committee, and th then, obviously, a final vote. but they can't afford a final vote because there's 41 votes now, not 60. so the senate is a measure

casualty of this process. but the biggest losers probably are average citizens. average citizens who were told that the congressional budget office judged this to be deficit neutral and that it would not cost the taxpayers additional money. i just had a conversation with the senator from montana who said clearly we're not going to cut physician payments by 21%, so, therefore, the assumption that they gave the congressional budget office is false. is false. so it really, before you go any further, it's already $150 billion deficit. because everybody knows we're not going to cut physicians' payments by 21%. so the american people are the ones who never had access to get a special deal. 330,000 citizens of my state who are -- who have enjoyed and

chosen medicare advantage program are now going to see those benefits slashed. but the average citizen who thinks today that there is a huge disconnect between their lives and that of the life that's led here and the way we do business here. last saturday i was in my own home state of arizona, i did two town hall meetings, one in prescott and one in east valley, phoenix. and people are hurting. people are hurting, and they're angry and frustrated, and they feel there's a huge disconnect between themselves and washington. and i come back the next day and they're drinking champagne in celebration of historic victory. americans don't get it. americans don't get it. they're angry. they're frustrated. and i want to assure them, i want to assure them that this fight is not over, that we will take it, as i mentioned before,

to the towns and cities of america. we'll have town hall meetings all over the country. we will register voters, and we will urge them to turn out, and we will urge them to take part of in one of the most seismic elections in the history of this country. now, i know the liberal media is saying, well, the american people are going to move on. well, they're not going to move on. they're not going to move on because they're sick and tired of the spending and the generational theft that we have committed on future generations of americans. and this is only one part of their frustration. it's a big part. but it's only one part. so i know i speak for my colleagues when i say that this fight is far from over. this struggle to regain control of this body and this institution in washington, d.c., and give it back to the people of this country will go on. i have a great faith in this country and its future and

that's why i'm confident that over time, sooner or later we will go back and we will repeal and we will replace, we will replace this huge government takeover with medical malpractice reform, with going across state lines to get insurance of your choice, to reward wellness and fitness, to establish risk pools that insurance companies will bid on in order to treat people with preexisting condition conditions. we have a long list that we will replace this mortgaging of america's future with that will be what all americans want and that is to maintain the quality of health care in america and at the same time bring costs under control. i want to thank the senator from new hampshire for his leadership. i want to thank the senator from montana for his courtesy during this debate over these days and weeks and even months, on days and nights and weekends. and i want to assure my

colleagues, this debate is far from over. i yield the floor. mr. gregg: well, mr. president, i just want to thank the senator from arizona for his excellent summation of where this issue lies and american people. i hope that that statement will be read across this country because it was a reflection of the concerns which are legitimate and which are being expressed by vast amounts of americans. and it's not unusual it should be expressed by the senator from arizona because he is so much a personality of this nation and a force within our political process. and i would reserve the balance of myime. mr. baucus:r. psident? the presiding officer: the senator from montana. mr. baucus: mr. president, i'll yield to the distinguished chairman of the "help" committee, who's involved in health legislation, education legislation. and i yield to him -- might i

ask, how much time do we have left? the presiding officer: 11 minutes, 48 seconds. mr. baucus: mr. president, i yield as much time to the senator as he wishes to take, including 11 minutes and 48 seconds. mr. harkin: i thank you. mr. president? mr. president? the presiding officer: the senator from iowa. mr. harkin: mr. president, i want to thank my friend from montana, chairman of the finance committee. i thank him for all of his great leadership. and also senator dodd, who just spoke. i might just -- if i might just add a little historical footnote. senator baucus, chairman of the finance committee; senator dodd, who led the effort through the "help" committee; myself, as now chairman of the "help" committ committee; chairman miller on the house side, chairman of the education and labor committee, and; chairman waxman, the chairman of the commerce committee, all of whom had big parts of the whole health care bill to develop. historical footnote. we were all sworn in on the same day in january of 1975.

it was a great class and our classmates, as history would have it, survived to be able to put together this great health care bill. and i again want to thank my -- my longtime friend and colleague from montana, senator baucus, for his extreme patience and his endurance in getting to us this point. mr. president, we're in the midst of an historic week in the nation's capital. health reform is no longer a bill -- it is the law of the land. it's been signed. and just as the history books remember 1935 as the year f.d.r. signed social security into law, 1965 when lyndon johnson signed medicare into law, they'll now remember the year 2010 as the year president barack obama signed comprehensive health reform into law. each of these three bills marked a giant step forward for the american people. each was stridently opposed by the special interests and defenders of the status quo. but in the end, in 1935, in

1965, and now in 2010, a critical mass of senators and representatives rose to the historic occasion. they voted their hopes, not their fears. they created a better, fairer, more compassionate america for all of our citizens. as a nobel prize-winning economist recently put it, "thee new health reform law is -- and i quote -- "a victory for america's soul." "a victory for america's soul." at long last we are realizing senator ted kennedy's great 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. think about it. over the decades, we have outlawed discrimination based on race, color, national origin. we have outlawed discrimination

based on gender and religion. we've outlawed discrimination based on age and disability. but until now, it has been perfectly legal to discriminate against our fellow americans because of illness. because of illness. and to exclude tens of millions of our citizens from decent health care simply because they could not afford insurance or afford health care. blatant discrimination. when president obama signed health reform into law on tuesday, he set in motion a series of changes that will tear down these last barriers of discrimination and exclusion. that truly is a great moral victory. it is, indeed, a victory for america's soul. mr. president, our work is not done. the reconciliation bill now before us includes a number of

modifications to strengthen the new health reform law. it also includes reforms in the student lending program that in their own way are also profound and historic. i regret that these landmark education reforms have not gotten the attention they deserve. senator dodd, i just listened to his speech, outlined in great detail what these reforms are and what they'll mean for our families and for our students. this bill in front of us now eliminates $61 billion in wasteful subsidies to banks, redirects most of that money to low-income college students in the form of increased pell grants. the status quo in student lending is a bizarre rube goldberg process that makes no sense. the federal government pays private banks to make entirely risk-free loans. the banks then sell the loans back to the federal government and pocket hundreds of millions of dollars in