after health reform, now 100%, 100% coverage for colorectal screening, with no co-pays and deductibles, i might add. 100% coverage for cholesterol screening. 100% coverage for tobacco cessation. that's prevention. that's wellness, keeping people healthy in the first place. what do the republicans want? they want to go back to this. they want to go back to this. we've made too much progress in prevention and wellness to go back to the, back to the old ways of just treating people after they get sick. again, we've been able to promote a lot of activities around the country to promote health and wellness. for example, in illinois, the state made improvements to its sidewalks and marked crossings to increase student activity levels.

you might say well, big deal. well, it is a big deal. because of these improvements, the number of students who are walking to school has doubled. doubled. and it's expected to save the school system about $67,000 a year just on bus costs. kids are healthier. you save money. in alabama, mobile county is using funds from this prevention fund to support tobacco quit lines, to help residents live tobacco-free. again, under the tobacco ses ation program. -- cessation program. officials enacted a comprehensive smoke-free policy expected to protect 13,000 of their residents. this is in mobile county, alabama. from being exposed to secondhand smoke. so, all across america more and more is being invested in prevention. we know that, for example, a 5% reduction in obesity rate -- just 5% reduction in obesity rate will yield more than $600 billion in savings on health

care costs over 20 years. again, in our prevention fund. out there again getting people the necessary supports and information they need to reduce obesity. so the misguided toefrts repeal the -- efforts to repeal the health reform law, again, most americans know what's at stake. they're going to lose a lot of these prevention activities that enable us to take care of our own health care, to make sure we get our colonoscopies on time, our mammogram screenings. every woman over 40 gets a free mammogram screenings, no co-pays, no deductibles. the republicans want to take that away from the women in this country. colonoscopies without co-pays and deductibles. republicans want to take that away. annual physicals. we know a lot of people didn't get annual physicals because it costs money. now you can get an annual

physical free. no co-pays, no deductibles. republicans want to take that away. so, again, i think we have to ask the question every time i hear the republicans talking about doing away with obamacare or the affordable care act, we have to ask are we going to cut short this transformation into a wellness society in preventing diseases, keeping people healthy in the first place? well, i think the answer is clear. americans are not going to allow all of these hard-earned protections and benefits in the affordable care act to be taken away. we're not going to be dragged backward. we're going to continue our march forward to make ourselves more healthy. we're not going to go back to the old system where a little over half of the people in this country got cholesterol screening. *68% got colorectal cancer screening. we want people tpo get early screening, early support services for preventive care so

they stay healthy. not only is it going to help our family budgets, it's going to help our federal budget if we have people healthier and not going to the hospital in the first place. so this is one of the big aspects of the affordable care act that's not talked about a lot, but to me it's one of the most important aspects of moving us, again, to a society where we're not just relying upon people going to the hospital and paying high hospital bills and things like that in the future. so, mr. president, i'm going to yield the floor. i just wanted to make those comments about one aspect of the affordable care act. of course we do know that there's many other things in the affordable care act that people don't want to lose. right now we ban lifetime limits, helps more than 100 million people. they want to take that away. republicans want to take that away. we cover vital preventive services, which i just went

over. young people remaining on their parents' coverage up to age 26. more than 2.5 million helped so far. republicans want to take that away. they want to end all that. well, i don't think the american people want to end it. i think the american people want to move forward with this health care reform bill because we've made too much progress. too much progress in making sure that health insurance is affordable, available. and, you know, i just have one more thing to say if my friend from rhode island would just let me. everyone here in this senate body belongs to the federal employees health benefit program. you know what? we have coverage for preexisting conditions. we have no lifetime bans on our policies. and yet, that's what we did. remember the debate, twaoeptd say to the american people -- we

wanted to say to the american people whatever we have we want you to have too? we put that in the affordable care act. republicans say we're going to take that away from the american people but keep it for ourselves. i don't think so. i don't think the american people want to say, well, you senators and you congressmen, you can keep all that but you can take it away from us. we're not going to do it. we're not going to go backwards. with that, i'm going to yield the floor to my distinguished friend from rhode island who played such a pivotal role in getting the affordable care act through on our committee and has been one of our more eloquent spokes persons on this health care bill in the last couple of years. so i yield the floor to my friend from rhode island. mr. whitehouse: thank you. mr. president? the presiding officer: the senator from rhode island. mr. whitehouse: may i ask unanimous consent to speak for, say, 15 minutes? the presiding officer: without objection. mr. whitehouse: thank you. let me first congratulate senator harkin for his remarks today, but more than that the work that has preceded today on the health care bill. he was an ardent advocate for

the prevention programs that save lives and money. it was a real pleasure to work with him at that time. today is the second anniversary of the passage of the affordable care act. i want to describe how the law is already making a difference for families in rhode island and across the country. by drastically improving access to higher-quality care, by addressing rising health care costs and by protecting consumers. look at the changes. children with preexisting conditions were denied coverage. no longer. lifetime limits on insurance policies left many american families struggling to pay medical care bills on their own. no longer. and insurers could cancel coverage for individuals who became sick.

no longer. in addition, the law helps kids just out of school who all too often can't get that first job with health insurance. it helps them to stay on their parents' insurance policies until age 26. for seniors, prescription drug costs are down, as the medicare doughnut hole begins to close. this is real change, and it hits home in my home state of rhode island. i hear from rhode islanders, and i listen. i heard from greg, a father in providence who told me about his 16-year-old son, will. will spends two hours every day undergoing treatment to keep his cystic fibrosis in check. in addition to this daily treatment and prescriptions, will sees a specialist four times a year to monitor the

disease. greg said that he often thinks about his son will's future and whether his son will be able to maintain health insurance coverage and receive the treatment that he needs. thanks to the affordable care act, will does not have to worry about insurance companies denying him coverage because he has a preexisting condition or fear that he'll have to go without treatment because his medical bills will have pushed him over some ash -- arbitrary lifetime limit. as many as 374,000 rhode islanders including 84,000 children like will can receive the treatment they need free from lifetime limits on coverage. people who want to repeal obamacare should be ready to look greg in the eye and tell him why they want to take that away from him and his son. olive, a senior from win socket, shared with me that her husband

takes several medications to help treat his alzheimer's disease. a three-month supply for two of his medications costs close to $1,000. as olive said, those months go by quickly. last year olive and her husband fell into the prescription drug doughnut hole in july. without the affordable care act, they would have been responsible for paying the full cost of his medications out of pocket. but because of health care reform, olive and her husband received a discount on their prescription drugs and saved $2,400 last year. olive and her husband are two of the over 14,800 rhode islanders who received a 50% discount on brand name prescription drugs when they hit the doughnut hole. this discount resulted in an average savings of over $550 per

person, for a total savings of more than $8.2 million for seniors in rhode island alone. people who want to repeal obamacare should be ready to look olive in the eye and tell her why that $8.2 million should go back into the drug companies' pockets, why she and her husband should have to cough up an extra $2,400 for the drug companies. briane, a 22-year-old graduate of the university of rhode island currently works part time as a physical therapy aide in providence. her job does not offer health insurance. brianne suffers from the senatos and makes frequent trips to her a letter gist. because of the affordable care act she can stay on her mother's health insurance so she can continue to tkpwept the treatment she needs. -- get the treatment she needs.

without this coverage, brianne said she would be hard pressed to get the treatments needed for her allergies. as of june last year brianne was over one of 7,500 adults in rhode island who gained insurance coverage as a result of the reform law. people who want to repeal obamacare need to explain to brianne why she and those other 7,500 rhode island kids should be kicked off their parents' policy. the affordable care act has also brought needed relief to employers who are still the leading source of health coverage in the united states. jeff is a small business owner in providence. he provides health care insurance for his employees because, as he said, it's the right thing to do. but the rising cost of his employees health insurance has placed increase pressure on his business. jeff's business qualified for

the health care law's small business health care tax credit, which covers up to 35% of premiums paid by a small business owner for its employees' coverage. these credits are a lifeline for small businesses that are struggling in today's difficult economy and for the people those small businesses employ. people who want to repeal obamacare need to look jeff in the eye and tell him why they want to take away that tax credit lifeline that helps him provide coverage for his employees. the affordable care act also provided support for community health centers. in rhode island, like elsewhere in the country, community health centers fill a critical gap in our health care system, delivering comprehensive, preventive and primary care to patients regardless of their ability to pay. dennis roy is the c.e.o. of east bay community action program in rhode island. he tells me that the affordable

care act has provided critical support for his community health center's mission. east bay has received $3 million through this law to construct a new community health center in newport which despite its reputation is one of rhode island's poorer cities. the new community health center will triple the available patient care space for needy newport county residents. to date, rhode island community health centers have received $14.8 million to create new health center sites in medically underserved areas. this is important american infrastructure, and we should not tear it down to make a political point or to assuage a political ideology. these stories are just a few of many that show how the affordable care act is working for rhode island families, seniors and small businesses. and although we've made great progress, the work continues.

over the last two years a tremendous effort has been made by the health care industry, by state and local leaders, and by the obama administration to develop a better model of health care delivery. to shift from a system that is disorganized and fragmented to one that is coordinated, is efficient and delivers the high quality care that americans deserve. private health care providers like guizinger, intermountain and the marsh field clinic are already focusing on quality rather than quantity, efficiency rather than volume, to better serve their patients and their bottom line. because of the affordable care act, the federal government now has the opportunity to support and encourage their focus and to deliver much-needed savings in the most patient-centered way -- by improving the quality of care and health outcomes. there is tremendous potential

for improved care and cost savings in five key areas -- payment reform, primary and preventative care, measuring and reporting quality, administrative simplification and health information technology. savings from a range of responsibility viewpoints run from $700 billion to a trillion dollars a year, all without compromising the quality of care americans have come to expect, indeed likely improving the quality of care. i will shortly release a report to chairman harkin and the "help" committee on the obama administration's implementation of the delivery system reform provisions of the affordable care act, and when i say delivery system reform, i'm meaning those provisions that improve the quality of care, that avoid medical errors, that

coordinate care better, that reward prevention and primary care, that reduce administrative overhead, that reward who gets the best health outcomes, not who orders the most treatment procedures. i worked with senator mikulski on this project. she authored the key delivery provisions of the law and has great expertise in this area. these changes will make a real difference for millions of americans, and i look forward to sharing the report and its findings with my colleagues next week. before i close, i want to acknowledge rhode island's work on a state health insurance exchange provided for by the affordable care act. rhode island is leading the way as the first state to receive a level two grant funding to set up the exchange. the exchanges are commonsense

local competitive marketplaces where individuals and small businesses will be able to purchase health insurance with the prices and benefits out there on display. when insurance companies compete for your business on a transparent level playing field, it will drive down costs. exchanges will let individuals and small businesses use their purchasing power to drive down costs, much like big businesses are able to do. the progress made by state leaders like our lieutenant governor elizabeth roberts who is leading this effort to get to this point, they are remarkable, and i urge them to keep up the good work. so whether it's changing the lives of greg and will or olive or brianne or jeff and his

employees, whether it's building out our community health center infrastructure, whether it's supporting the private sector leaders who are pivoting to a new and better and more efficient delivery system or whether it's something as simple as a marketplace or health insurance that's open, fair and on the level, the affordable care act has made a real difference for hard-working families in rhode island. i will continue to work hard alongside these leading health care providers, alongside the obama administration and alongside my colleagues here in congress to see the full promise of the affordable care act realized for objection. mr. enzi: thank you. we're actually going to be talking about medicare today and the way that the patient protection and affordable care act cuts into medicare, destroys medicare. two years ago, the president wanted a health care bill in the

worst way, and that's exactly what he got. that's exactly what america got. anybody that's out there that's on medicare or about to be on medicare or young enough that someday you will be on medicare should be really concerned about what's happened under this act. all of you, i'm sure, are aware of somebody that is on medicare that's already been denied a doctor, denied a doctor because they are not being paid what they ought to be paid. to call it the patient protection and affordable care act is a major, major mistake. it neither protects medicare patients nor makes it more affordable. in fact, one of the things we'll bring out today is that there has been a theft of $500 billion from medicare to fund other parts of the program. there is some fraud in it because it was spent but it still shows up in the account. that's how they showed that this really doesn't add to the debt.

and to solve the whole thing, they have got a whole new board of unelected bureaucrats to make additional cuts to medicare to make it look like it's okay. and then there is the accounting sleight of hand. i'm one of the two accountants in the united states senate now, and you've got to pay attention to see it, but it goes back to the -- the fraud because if this same sort of thing were being done in the private sector, people would go to jail. there are a number of ways that we will bring out how that is not just budget gimmicks and not just sleight of hand but actually taking advantage of seniors. the chief medicare actuary said that medicare will go broke in 2024. that's five years earlier than last year's report by the chief medicare actuary. that's the guy that works for medicare. he doesn't work for us. and he has to figure out each

year how much in the hole it is and what needs to be done to fix it, and my contention, of course, is that you can't steal $500 billion out of a program that's already going broke and expect it to be fine. and we warned about that as we were going through the passage of this patient protection and affordable care act, which everybody has mentioned was passed two years ago tomorrow. it could have been fixed. there were three plans on the republican side that would have done what is claimed to be done by this act. those ideas were largely rejected. there were few places that they fit in the same as what was placed there, but they were largely regeneral debated. today we'll talk about some thefts, some frauds, some unelected bureaucrats and some sleight of hands. i have some people that want to respond to some of the things said. i think senator coburn listened to some of the previous comments

made on the other side celebrating this great day. the presiding officer: the senator from oklahoma. mr. coburn: i ask that we have unanimous consent to have a colloquy among us. the presiding officer: without objection. mr. coburn: i listened very intently to the first two speakers this morning, and i have -- as somebody who has now been a physician for almost 30 years, practiced full time for over 25 years, i heard the senator from iowa in what his desire would be in the chart that he showed. he showed 100% screening occurring now in three areas. i want to tell you, that isn't true. we're not screening. we hope to screen and we hope to screen 100%, but the facts are on screening that was available is only used 5% by medicare patients on the screening that was already available with no cost to medicare patients. so we have to distinguish between what we desire and what's actually going to happen. but let's just take the example

of colon screening. i'm a colon cancer survivor. i was diagnosed through colonoscopy with colon cancer. but let's take that example and then let's take the example of the other aspect of the affordable care act which is called the independent payment advisory board. now, what's the purpose of the independent payment advisory board? it is to cut the costs of medicare through decreasing of reimbursements, first for the first eight years physicians and outside providers, and then starting in 2019, hospitals. well, what do you think is the first thing that's going to get cut? the first thing that is going to get cut is the reimbursement rate for a colonoscopy. so when the reimbursement rate for a colonoscopy goes bow the costs -- and it's very close right now, by the way. the cost to actually perform a colonoscopy versus what medicare

reimburses -- when that is cut, what do you think is going to happen on screening? the goal of changing health care is an admirable goal. we know that one in three dollars doesn't help anybody get well and doesn't prevent them from getting sick today, but what the american people need to understand is what is coming about is a group of 15 unelected bureaucrats who cannot be challenged in court, who cannot be challenged on the floor of the senate or house, mandating price reductions to control the cost of medicare. what does that ultimately mean? they will do their job. we won't be able to do anything about it, but what it means is they will reimburse at levels less than is the cost to do

services, and so consequently what will happen is the service won't be there. they also are going to do what is called comparative effectiveness research. we know about comparative effectiveness research. if you're a practicing physician today you have to do continuing medical education. part of that medical education is knowing the latest comparative effectiveness research. it's like they're reinventing something that already exists. the point is they're going to use that to deny or change payments for procedures that patients need. what's wrong with all this? what's wrong with all this is we are inserting a government board and government bureaucrat between the patient and the doctor. think about that for a minute. when i go to my doctor, i don't want him concentrating about anything except me. and if he's looking over his

shoulder about whether or not he met the ipab's comparative effectiveness study on what he's doing for me when in fact the art of medicine as well as the science may say they're wrong, and he's going to do what the government says rather than what he thinks is best for me, what am i getting for that? i'll be on medicare next year. much to my regret, because my choices will now be limited in terms of of who i can see. the greatest threat to the quality of care -- it wasn't intended to be that way. it was intended to be helpful. i don't doubt the motives of anybody that set this board up. the greatest threat to the quality of care for seniors in this country is the independent payment advisory board and their noncaring position, because they're going to be looking at numbers and words, and they're never going to lay their hand on a patient.

they're never going to impact a patient directly. they're never going to listen to a patient. but they're going to make the ultimate decisions based on what that patient's going to get. with that, i yield back to my colleague. mr. enzi: decisions that were made in the health care bill, in the health care bill we took $500 billion, half a trillion dollars, that should have stayed with medicare to solve medicare problems. the doc fix is one of the big problems we need to solve. it's up to about, i think, $230 billion we need to do that. that would be a pretty big chunk out of this. unless that's done, people won't be able to see a doctor. i keep saying if you can't see a doctor you really don't have health insurance. that's what we're going to be doing to our seniors. we cut $135 billion from hospitals. we cut $120 billion from the 11 million seniors that are on medicare advantage. we took $15 billion from nursing homes and took $7 billion from

hospices. and we spent it on programs that have nothing to do with medicare or those things. that's fraud. and it shouldn't have happened. the c.b.o. actuary and the chief medicare actuary have acknowledged this reality. incidentally, the chief medicare actuary says the program is going to go broke in 2024. the c.b.o. says it's going to happen in 2016. 2016 is pretty short term. pretty short term to be fixed. i think that 2024 is short term. whichever estimate you want to take, medicare is in trouble. and $500 billion should not have been taken out of it. that $500 billion should have been dedicated to fixing medicare. we still have to fix medicare, and the only solution we've come up with is the one that the senator from oklahoma, senator coburn, mentioned which is to form this new board with surprising powers that are going to be able to cut some more in

medicaid -- medicare, so that it doesn't look like we stole $500 billion from medicare. senator burr is on the committee. he sat through a lot of the hearings and a lot of amendments that were never passed from our side that would have fixed this, and i'm sure he has some comments. mr. burr: i thank the senator from wyoming and my colleague from oklahoma. we have worked on this. we spent tireless hours trying to save not just medicare, but health care as we know it in america today. and i think what you've already understhaod we put -- understood is that we put in place mechanisms and all that will dismantle health care that the american people feel comfortable with, that has served them well and that we agree is way too expensive. but if you just look at the examples that dr. coburn has talked about, ipab, an independent board that will make coverage decisions and reimbursement decisions, when you cut reimbursement, you're going to chase doctors out of the system. as you cut reimbursements,

you're going to defund the hospitals' ability to keep the door open in rural america. but let's look at the things that aren't obvious. what does that effort by ipab do to innovation in health care? what companies are going to go out and put $1 billion on the line for development after new drug or a device given that they don't think they can recover enough through the reimbursement system to could have their research and development, much less the approval process of the products? it would be a vastly different america if in fact all these drugs that are breakthroughs and the devices that are so effective at keeping us living longer are sold in europe and south america and asia, but not in the united states, because we've now developed a health care system that doesn't allow them the ability to recover that money. match that with the lack of

choice. today in this country we have choice. as a matter of fact, as a federal employee, i can pick from probably 30 different health care plans, the same one that every federal employee can choose from. now all of a sudden in a health care bill, we've said to seniors, you know that medicare advantage which allowed you choice, you could choose a provider other than the federal government, we're going to take that away from you. we didn't really take it away. we just said we're not going to reimburse them to the degree that lets them offer the plans. but let's look at what medicare advantage provided for seniors. it provided a wider array of benefits than does traditional medicare. it's good for some. they've chosen it. it won't be good for them in the future if this health care bill is not reversed. because through the actions of ipab and through the explicit language of the bill, medicare advantage will not be an advantage anymore. and everybody will have to default to the government plan

that probably won't be as expansive with preventive care. i know that the senator from wyoming knows in north carolina we sort of lead the country as the model of medical homes. we're on the verge there of trying to put seniors into medical homes. we've already done it with a medicaid population. now, we've saved money. but my state of north carolina this year has a gap of about $500 million in medicaid. the people we're responsible for and the money we've allocated for, even though over the last three years we have saved almost $1 billion by being creative at how we designed our medicaid program. this health care initiative, with no input from any state, will double the population of medicaid beneficiaries in north carolina, and what have we done? we've shifted the responsibility down to the state at the state taxpayer level. we didn't magically change

anything in health care. we're just reallocating where we're collecting the money from. and every state's the same. they underpay for reimbursements under medicaid. doctors limit the number of patients that they see that are medicaid patients. imagine what happens when we double the size of the medicaid population in america. hospitals don't have the ability to limit. they're under federal law that says when you show up, you've got to see them. what we're going to do is probably attempt to bankrupt the infrastructure that we've got for health care in this country, for the simple reason that rather than fix health care, we just came up with creative ways to pay for it. or in the case of ipab, the independent advisory panel, we figured out an external way from congress to cut the reimbursements to doctors and to hospitals and to limit the coverage of all plans where it doesn't have to go through the legislative process in

washington. we're not always the finest example of legislation becoming laws. but, you know, this is the mechanism our founding fathers set up to make sure bad things didn't happen. i've got to say this is one that slipped through. now we've got the responsibility to go back and fix the pieces of it that would be devastating to the future of health care in this country. i thank the senator from wyoming for letting me share some time. mr. enzi: i think you'd be interested too and really involved with some of the accounting sleight of hand that happened with prescription part-d. we put prescription part-d in so people would have a better chance of being able to pay for their prescriptions. a very difficult program. it was very expensive. i know in my state, we were looking at only two people that were selling pharmaceuticals to seniors. and i thought when this program goes in, there probably won't be any. when it was opened up to wide choice, i found out there were 46 companies that wanted the

business in wyoming. it turned out to be a very successful program at helping people out. now, in this affordable care act, of course, they do some things with the doughnut hole which are a little bit of sleight of hand because some of the companies that sell brand name prescription drugs agreed that they would reimburse people for a part or up to all of their medications while they went through that doughnut hole knowing that when they got out of the doughnut hole they would still stay with that brand name and cost the program a lot more. an area where we were saving money and could have fixed it so the seniors have a better chance at it but not giving an advantage to the brand name drug users would have actually saved some money in the program. but that didn't happen. i know since you are involved a lot in the pharmaceutical area and have done a tremendous job at making sure that we're safe from terrorist attacks and pandemic flus and worked at

vaccinations, probably the foremost person at both ends of the building at knowing thousand do that, maybe you'd have comments on this prescription part-d. mr. burr: i thank you for that acknowledgement. that's why the thought that innovation would leave the american health care system terrifies me. innovation is the answer to the threats both natural and intentional that could come to this country and everywhere in the world. and we never know what's around the corner. but our ability to innovate in this country has always kept us one step ahead. and i believe we're on the cusp of a new era of innovation that can only be thwarted if in fact this health care bill is fully implemented. because the incentive will now be gone for entrepreneurs to take risks. there's no longer going to be an incentive that says take a risk, and there's an opportunity at a reward. and i think the senator from wyoming pointed out very well, we've created medicare part-d.

what a novel approach to actually take a health care benefit that didn't exist in the 1960's when we created medicare, and match it up with the coverage of the rest of the delivery system. what was the result of creating a market-based coverage? today medicare part-d is 50% less than the estimate we made years ago when we created it, of what the annual premium cost was going to be. why? it's because we created private-sector competition. we didn't create government plans. it probably would have been much easier just to say, okay, we're going to supply a benefit for every senior in the country. i can assure you had we done that, we would have been well over what we projected the annual cost to be. but we're 50% under because we have private-sector entrepreneur companies that are out there competing for the business, that are smart enough to look at the type of coverage and they're

custom designing it to meet the needs of seniors in this country. i dare say that the current health care plan that's going to be implemented and fully executed by 2014 was not personalized for anybody in this country. it looks at a 17-year-old the same way as it does a 77-year-old. yet, the health challenges, the income are different for both ends of the spectrum. and that's because government can't look at us as individuals. they can't group us and design something that addresses not just the coverage needs, but the cost long term and the solvency. so, we only have one choice, and that's to fix the things that are broken. and it's amazing how there's great agreement on those things that would be damaging long term and those things that are actually positive and move the ball in the right direction.

mr. enzi: that prescription part-d actually drove down the cost of medication and now we're ending up in a situation where part of that will be in trouble because of what's happened to medicare with $500 billion being stolen. i see that we've been joined by the senator from utah, senator lee. utah has had a health care system there that's been a model for other states and now is possibly in jeopardy. i don't know if you'd care to comment on medicare or on that. we appreciate your comments. mr. lee: utah does indeed have a health care system that functions well. it functions well not withstanding the fact that it's not managed. it's not governed by the federal government. this is one of the great wonders of our federal system. you know, when we became a country about 200-plus years ago, we did so against the backdrop that's informative for us still today. we became a country in part because we discovered through

trial and error, through our experience as british colonies that local self-rule works best. people govern themselves much better than a large distant government can govern them. that's exactly why we became a country is because we learned that local self-rule works, and we learned also that there is great change to our individual liberty with any government, because whenever any government acts, whenever it does anything to regulate our lives, it does so at the expense of our individual liberty. we become less free by degrees whenever government does just about anything. but the risk to our liberty is especially great, it's at its highest when the government acting is a large one, when it's a national government. national governments, as we learned in our experience with our national government before we became a country, our

national government that was then based in london, national governments tend to tax us too much, they tend to regulate us too heavily, they tend to be inefficient, they tend to be slow to respond to our needs in part because they are operating so distantly from where many of the people reside. and so when we became a country, we left most of the powers at the state and the local level. we eventually came up with this document, this almost 225-year-old document that has fostered the development of the greatest civilization the world has ever known, and in that document, we came up with a list of powers that a national government must have in order to survive. and we kept that list fairly limited. we said the national government needs to have the power to provide for our national defense, to regulate commerce or trade between the states and with foreign nations and with the indian tribes, to protect trademarks, copyrights and patents to establish a uniformed

system of weights and measures, to come up with a system of bankruptcy laws, laws governing immigration and naturalization, and a few other powers, but, you know, that's basically it. there is no power in this document that gives our national government, that gives us, congress, as a national legislature the power to regulate anything and everything. there is nothing in this document that gives congress what jurists and political scientists refer to as general police powers. that is, just the power to come up with any law that congress might deem just and good and appropriate and advisable at any moment. and that, again, was because of the calculated assessment made by the founding generation that we needed a government possessing only limited, enumerated powers, protecting individual liberty and to ensure that we in america could continue to live as free individuals. over time, we have drifted somewhat in our understanding of

what those powers mean. over the last 75 years, the supreme court has been applying a really deferential standard toward congress in reviewing laws enacted under the commerce clause, clause 3 of article 1, section 8. the supreme court has since about 1937, at least since 1942, said that congress may regulate without interference from the courts under the commerce clause, activities that when measured in the aggregate, when replicated across every state could be said substantially to affect interstate commerce. that's more or less the guideline that the court has given us. they are not necessarily saying that anything and everything that fits within that is necessarily within the letter and the expired of the constitution, but that at least insofar as the courts are concerned, insofar as the courts have been willing to step in and validate or invalidate, that will be what guides the courts

in making that assessment. beyond that, the debate has to be hammered out within the halls of congress. now, the affordable care act, also known as obamacare, contains an individual health insurance mandate that takes congress' powers to a whole new level. for the first time in american history, our national legislature has required every american in every part of this country to purchase a particular product. not just any product, but health insurance. not just any health insurance, but that specific kind of health insurance that congress in its wisdom deemed appropriate and necessary for every american to buy. this is absolutely without precedent. it is also, i believe, not defensible. even under the broad deferential standard that has been applied by the united states supreme

court since the late 1930's and early 1940's. among other things, the limits that have been maintained by the supreme court, notwithstanding its deference to congress dunder the commerce clause, have been limbed by a few principles. first, the supreme court has continued to insist that although some intrastate activities will be regulated by congress under the commerce clause, some activities occurring entirely in one state, activities that historically would have been regarded as the exclusive domain of states, activities like labor, manufacturing, agriculture, mining, although some activities might be covered by congress, those activities at a minimum have to be activities that impose a substantial burden or obstruction on interstate commerce or on congress' regulation of interstate commerce. the supreme court has also continued to insist that the

activity in question that's being regulated needs to be activity, first of all, and not inactivity, but it also needs to involve economic activity in most circumstances, unless, of course, it is the kind of activity that while ostensibly noneconomic, by its very nature undercuts a larger comprehensive regulation of activity that is itself economic. finally, the supreme court has continued to insist time and time and time again that congress cannot in the name of regulating interstate commerce effectively obliterate the distinction between what is national and what is local. now, the afford care act through its individual mandate effectively blows past each and every one of these restrictions,

restrictions that even under the broad deferential approach that the supreme court has taken toward the regulation of commerce by congress over the last 75 years or so, even the supreme court, even under these broad standards isn't willing to go this far. there are very good reasons for that, and those reasons have to do with our individual liberty. they have to do with the fact that americans were always intended to live free, and they understood that they are more likely to be free when decisions of great importance need to be hammered out at the state and at the local level. that is, unless those decisions have been specifically delegated to congress. specifically designated as national responsibilities. this one is not. decisions about where you go to the doctor and how you're going to pay for it are not decisions that are national in nature, according to the text and spirit and letter and history and understanding of the

constitution. they are not and they cannot be. if in this instance we say well, this is just important so we need to allow congress to act, if we do that, we do so at our own peril. we stand to lose a great deal if all of a sudden we allow congress to regulate something that is not economic activity. in fact, it's not activity at all. it's inaction. it's a decision by an individual person whether to purchase anything, whether to purchase health insurance, or if so, what kind of health insurance to purchase. our very liberties are at stake, and that's why i find this concerning. the presiding officer: the senator's time is expired. mr. enzi: i would ask unanimous consent that we get another two minutes. the presiding officer: without objection. mr. enzi: thank you, mr. chairman. i thought i had two more minutes. i appreciate the comments. this is the anniversary, the two

years of passing what is the so-called affordable patient care act. the court, the supreme court has chosen next week to begin the deliberations on it. they are going to take three times as long as they do on any case so that they can divide this up into pieces, and that mandate piece will be the second one. one that they probably won't be going into is this medicare problem. we're going to have seniors that are going to be without care because we have taken $500 billion out of medicare when it needed a doc fix, a whole bunch of other things. particularly in rural areas, rural health clinics. can any reasonable person believe that you can cut a half a trillion dollars from a program and not -- and not affect its impact on patient care? i'd like to have more time. i would ask that all my remarks be -- i have a prepared statement that be a part of the record to show there is this left, there is fraud involved,

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