minority party has stopped us from putting that budget into conference now for more than six months. there is a significant group of people in this body who would love to talk about reform and improvement but who reject shutdown and default. and this gets to the nub of the issue. last night i asked the senator from texas about reforms he was interested in, and he laid a number out on the floor. and -- and he had some that i liked, some that i thought were good. and i asked the senator, "have you prepared any legislation to make these reforms?" and he answered: "i don't currently have a reform proposal but i'm going to work with my staff to come up with some reform ideas." and, mr. president, this gets to the nub of the issue. there is a right way to approach health reform. and though i disagree with it, there's also a right way to approach a repeal of the

affordable care act or defunding the affordable care act. and here is what you do. if you have a better idea, introduce a health reform bill with your own ideas and try to convince your legislative colleagues that you have a better answer. or participate in debates about the budget or the appropriations bill and make your argument about the appropriate a funding for the affordable care act. the senator from texas and every legislator has the ability to raise whatever reforms or whatever funding or defunding ideas they want in these ways, make your case, argue your position, try to convince your colleagues, and then accept the outcome. but, mr. president, do not threaten to shut down the government of the united states if you don't get your way, if you're not able to convince your colleagues that you have a better answer. do not threaten to default on

america's fiscal obligations if you don't get your way, if you can't convince your colleagues that you have a better answer. there is absolutely no reason to jam your plan to overturn a law passed by congress, signed by the president, and afirmt affiry the supreme court into the very gears of the american government. do not let your opinion on one issue threaten not only government operations but the economy of the united states. in other words, mr. president, let's talk about reform. let's talk about improvements. let's do it the right way, not the wrong way. let's separate those discussions out from all the threats of shutdown or default. and if we're willing to do that, i think we'll be able to get somewhere. mr. president, to conclude, i want to go back to where i started. i ask my senate colleagues, avoid all the brinksmanship and

promptly approve a continuing resolution to fund the continuation of the american government. strip away the separate issues that should be debated and considered separately and let the house vote on the simple question of whether they believe that american government, after 237 years, shall continue. we have come far, we have achieved so much, and we have much work still to do. government by, of, and for the people is not perfect, and it will never be perfect. but i'm resolved, and i hope all my colleagues are resolve, that government by, for, and of the people shall not perish, not for one year, not for one month, not for one week, not for one day, not for one hour, not for one minute. government shall not perish on

this earth. thank you, mr. president. i yield thai m my time back. mr. coburn: mr. president? the presiding officer: the senator from oklahoma. mr. coburn: thank you. i've spent a lot of time the last few weeks listening. last night the senator from texas made a big point that members of congress, in his opinion, were not listening to the american people. i have a lot of experience at listening as a physician. that's what i got paid to do. i think what senator cruz and some of his allies in the senate, their motives are pure, their tactics are tremendously erroneous, in my opinion, but i want to draw a picture for new a minute about this idea of listening and what it means.

even though i disagree with their tactics, i admire their spirit and their vigor. i've spent a lot of nights having delivered 4,000 babies, i've had a lot of sleepless nights. i've gone two and three days with two or three hours of sleep over that period of time to care for people. but i would make this point. as a physician, the first thing you're taught in medical school is listen to your patient and they'll tell you what's wrong with them. and so do you have to spend time listening to our constituencies. but a doctor doesn't just listen to the patient. they observe the patient. they exam the patient. they do tests on the patient. then you can combine all that

listening with all the other data they've collected. then they make a decision about giving advice to that patient. they give what's called informed consent. and that's a big story that hasn't been told to the thousands and thousands of people from oklahoma that have called my office. they haven't been given informed consent. they've been sold a bill of goods. and when i have young interns and young staff in my office taking significant calls from people who've been misled, there's no way you're going to talk them out of a position that outside interest groups and a very few small number of people inside the senate have planted. so i want to spend a few minutes addressing it, and i want to go back to the patient for a minute because, in my broad experience of treating everything from newborn babies to grandma to broken bones to gallbladders to you name it, i've gained a

little bit of experience on how you judge inputs of information. what we have outlined -- and i want -- i want those people that called my office to listen. what we've had outlined is a group of people that said somebody has a terribly swollen knee. if you don't fix it, they're not going to be able to walk. and then we got to fix it rate now. nothing else matters. we have to fitch it righ fix it. except they have a staff staph infection in that knee. because we don't listen to all the facts, they don't realize it's already infected the heart value of. no-- the heart valve. the good physician will do the tests, listen, the exam, find out what the real problem is and the staph infection in the knee came from a staph infection in the heart.

and if in fact you don't go after treating the heart of the problem, doesn't matter if you ar--doesn't matter about curinge knee. that's what we've been put pounce by some of my colleagues. they've been misdirected in terms of what the real problems are. you know, nobody fought harder, i would say, against the affordable care act as a practicing physician than i did. i was still practicing and being a u.s. senator at that time. i was still visiting babies on the weekends in oklahoma. it wasn't -- senator mccain said it was a fair process. it wasn't a fair process. the one bill that actually would have solved our health care problems never got a vote on the floor of the senate. it is called the patients' choice act. the majority leader wouldn't allow a vote on that amendment. it was a complete substitute. it actually fixed the real

problems and did so without putting the government between you and your doctors. but let me -- let me go back. what senator reid, the majority leader, has said is right. what is the affordable care act about? it's about ultimately getting to a single-payer system where the government controls all of health care. so senator cruz san and senatore aren't wrong about worrying about it, aren't wrong about wanting to change it. we have a whole lot bigger problems than the affordable care act. it's just one of them. and so i want to spend a little bit of time talking about what this debate has taken our attention away from. the real problem in our country right now is that we're bankru bankrupt. our total unfunded obligations of the federal government are

$124 trillion. the entire net worth of the entire country is only $94 trillion. we're $30 trillion in the hole and growing that hole, and what that means is we're leaving a legacy of pauperism and debto ds prison to our children and grandchildren. so while we've had this big debate, nobody is focusedn fact that washington is still lying about the numbers up here. including the bill that came across from the house. and i'm going to spend a little bit of time going through that so we can refocus on the infected heart instead of looking at the infected knee. so i'm very glad that they've

raised the issue. the problem is we're double-minded and doublespeaking when we talk about the numbers. and let me show you that. just for a minute. congress, the president, the house and the senate voted for the budget control act. we made a promise. we said, we recognize we have some problems. the first thing we can do is we can start addressing some of those problems through discretionary spending. and you had all these claims that we made all these savings, over $2 trillion. well, here's the real number. the real numbers are in 2011 the base discretionary spending was $1.062 trillion.

by the time you aped the emergency spending, the troop spending for the war, we spend $1.221 trillion. in 2012, as we worked this budget control act through, the base fenspend base spending was3 trillion. you add in everything else, we sperchts $1.198 trillion. this is the discretionary spending. 2013 throughout budget control act, the base according to that was $988 billion. through all the othe extra thine allowed, emergency spending, war spending, et cetera, we spent $1.145 trillion. now, the estimate according to the c.b.o., read ing what the law is and the promise to the american people, is that this next year it's supposed to be

$96 billion. -- $967 billion. if you add what is expected in war and discretionary spending through emergencies, it's to be $1.1114 trillion. so what have we done? by forcing a discussion about the wasteful spending, we have set us on a path to slowly actually cut actual discretionary spending. something we're going to have to do if we're not going to have our kids in debtors' prison. so what is the bill that we have coming over here? the bill that we have coming over here is $985 billion. so it's $18 billion bigger than what we promised you just last year, and besides that it's even $18 billion higher because we've got fake pay-fors in there, so it's actually $18 billion higher

than that in something that we call chimps, where we assume something that we assumed the year before. it didn't count the year before and it didn't count and we'll use it again this year. it is the type of accounting that anybody in this country would go to jail for. they'd be convicted and go to jail. but what we agreed to in the budget control act is 2014 would be the last year of discretionary cuts, then every year after that it rise by 2.4%, the estimated rate of inflation, and that we could change the mix and get there. but we're not doing that. and just to show what the -- here's -- the spending is still going to rise. the discretionary spend something still going to rise. here it is in terms of baseline and actual, and you can see, we're not cutting spending anymore after this year. it's going up.

which begs the question, what is are we doing with this continuing resolution? we're breaking our word that we gave you last year. and the year before. we're already funding -- we're can't help ourselves. we're addicted. and you could say, well, as nancy pelosi has said, the minority leader in the other party, there's not anything else left to cut in discretionary spending. of course, that belies the fact that the government accountability -- accounting office, accountability office has listed $ 165 different setsf dumb cayive spending, wasteful duplicative spending that's $250 billion a year that, if the congress would do its job, you

could save half of that. so you could be -- instead of doing this, we could be doing this. what does that mean? that means your children have a brighter future. that means we don't waste money. we clean up the fraud and corruption in the federal government. that's what it means. there are points of order that can be raised against this bill, and i'm hopeful that we'll do it. because we violate the budget control afnlgt so if 60 senators say we don't care what we promised you before, we've got to spend more money, then they'll vote -- they have to have 60-plus votes to wave that budget point of order -- and i predict they probably will because we can't help ourselves. i won't, but we're going to spend more money than what we just last year promised the american people we would do.

and of course that doesn't address anything. any of the real problems that are facing our country, which are the mandatory programs. anand i want to give you just a short flavor of some of the programs -- and i'll just take green buildings, for example. here is -- and i'd ask unanimous consent to use an oversized chart on the floor. the presiding officer: without objection. mr. coburn: if you just look at this, nobody in their right mind would create this. but of course congress isn't in its right mind. we wouldn't have a $5750 billion deficit if we were in our right mind. here it is for all the green building programs in the country.

we have in this nine different departments that are running multitude of programs that all do the same thing? now, a cogent person would say, if it's good to have green building programs, why don't we have one? and why don't we create a czar of green building programs, put them in charge of it and let's have one set of grants, one set of incentives and one set of bureaucracy that runs it? but we haven't done that. so let me just go through for a moment this series of duplications that the government accountability office has outlined and just see if you think we're doing our job, see if you think we're doing the oversight that we should be doing. here's the first group.

we have 15 unmanned aerial aircraft programs of which we're going to spend $37 billion over the next five years. why do we have 15? maybe we need one for each branch of the service and they can subcontract out what they deliver to homeland security if we need those for homeland security or for the intelligence agencies. why do we have 15? we have 18 different food programs oning througprograms r8 different agencies. we have 21 homeless programs, seven different agencies. we're spending $27.9 billion. we have transportation service for the transportation disadvantaged person. we have 80 different programs in eight different agencies spending $2 billion a year. job training and employment, we have 47 job-training programs for the not disabled. we have six veteran job-training programs. and we have over 50 job-training programs for -- for the disabl

disabled, spending $18 billion for the nondisabled and a total of $21 billion combined. and what we did is the oversight in the state of oklahoma to look at that, and what g.a.o. says just on this one particular one is all of these programs overlap one another except for three. so they all do the same thing, except there's no metrics on any of them. to see if they're actually giving somebody a family, stabilizing long-term job or the skills for a long-term job. we have 82 different teacher quality programs run by ten different agencies. not at the department of education. we're spending $4 billion a year on it. food safety, military veterans and health service. economic development, 80 different programs, $6.5 billion a year. i could go on. i won't. i won't bore you. there's two other pages full of

it. 165 different sets of duplication, over $250 billion. and here's what congress has done with it. we've addressed 8% of it. 8%. there's been hearings. that doesn't mean we've had an answer for it. we've addressed 8%. so when you look at congress' activity of doing real oversight to really find the -- solve the problems, to really eliminate duplication, to really eliminate fraud, to really eliminate waste, most members of congress aren't interested in doing that. they don't get the glory. but it's our oath, it's our responsibility to do that, yet we fail to do it. i heard the senator from virginia mention the debt limit.

i'm going to say again something i said in 2009. we don't have an income problem in this government. we have a spending problem. do you realize the average american spends one-quarter of their life working to fund the federal government. now, think about that for a minute? you're going to spend a quarter of your life working to fund -- if you count the unfunded liabilities that we have and you count the 25% of g.d.p. where we are on spending today, you're going to spend a quarter of your life funding. now, if i remember correctly and i read the constitution correctly, this little book, what our founders talked about was a limited government, not a government that consumes 25% of your labor to run it. not a government that ignores the 10th amendment or ignores

the enumerated powers. it's interesting. i introduced the enumerated powers ack. it's powers act. it's a very simple act. it has 37 cosponsors. and what it says is before you introduce a bill on the floor of the senate, you have to reference the area of the constitution that gives you authority to legislate in that area. and sad to say i couldn't get any of my colleagues on the other side of the aisle to join on that one very simple bill that would help us bring us back to what our founders thought about a limited government and the responsibility. our government's limited only to the extent at which it can borrow right now. we have tons of structural deficits in our economy today. we have a job deficit in terms of creating jobs. we have a skills deficit in terms of matching those skills to the jobs that are available. we have a demand deficit because

of the overbearing and overreach of the federal government and the regulation that is imposed upon the citizenry. we have a deficit of watching out for those that can't watch out for themselves. we have a program -- we have programs that are supposed to do it. but when you go back and read our founders' vision and you read "the federalist papers" and you read what this most wonderful government that's ever been created was designed to do, first and foremost it was designed to be limited because our founders knew that when it became 25% of your labor, your liberty was diminished, your freedom was diminished. and, of course, that ultimately is what the fight is over the affordable care act. it's what will it ultimately cost and how much freedom will you have as we give you something that some need, what will you give up to receive that? so i'll end with just the

following. i think there's four questions that the american people ought to be asking the members of congress right now, four critical questions. and i would tell ya, i think too often we fail in answering these questions. here they are. are you leading in a -- such a way as to restore confidence inesinourselves, our governmentd our institutions? are you trying to unite us or are you trying to divide us? i already described we're bankrupt. how do we get out of it? the only way we get out of it is working, coming together, real leadership that draws us together that says, hey, folks, there's no finger pointing here. there's lots of mistakes been made. how do we solve these problems,

and how do we do it together without making somebody else look bad? how doesre the confidence that we know we're going to. i want to tell you a i did town hall meetings during august and i went to a town, miama, oklahoma. and there's a wonderful plant there that grows mushrooms and vegetables. it's a big operation. and came to my town hall meeting was the owner of that plant. his name is virgil verginsmyer. he's probably my age or maybe a little older. and he said, "tom, i'm spending $60,000 to $70,000 a month buying from my competitors right now to fill my orders. i could create a couple hundred jobs of my own. it's not a big city. but i don't want -- i don't have the confidence in the future of our country right now to invest

$5 million and go to the bank and borrow that to create these jobs because i don't think we've got it together as a country anymore." now, he's not partisan. i don't know what his political leanings are. but what i do know is he's lost confidence. and that's happening all across our country right now, because we don't have leadership that does anything except point out what's wrong with the other side th -- what'swrong with the othe. what we need is leadership that brings us together, that compromises, that works together to identify and solve the problem. the second question that i think ought to be asked is: are you more interested in the short-term political gain as a legislator than you are the long-term problems o of this country? i'm a term nimentd senator. i set my term limit when i first

ran. i have a little over three years to go. i'll never run for another office the rest of my life. and i'd like to think that most of my thought has been about long term since i've been in the senate, not short term. actually solving problems. the long-term problems, not the short-term problems. i talked about our structural deficit. we have to get after it. we have to get after it now. and if you look at the political dynamic, right now's the only time between now and the next presidential election that it will be positive for republicans and democrats to join hands together to solve the problems with medicare, social security, and medicaid and our structural deficit. we have less than 3 1/2 months to do -- to come to an agreement to do that. because the political dynamics will never allow that to happen again until after the next presidential election.

because everybody will be pointing fingers. wouldn't it be nice if we had the leadership that said republican and democrats, come together, compromise, fix these problems? even if you lose your election, fix the problem for the country. fix the problem for the childrenmenchildren. fix the problem for our grandchildren. but the selfishness of careerism drives us to do what is politically expedient and what is popular rather than what is right. the third question: are you willing to look at this institution of government and he ensure that we're not wasting, duplicating or being defrauded in the programs that we authorize through a congressional continuing resolution? the answer to that question is we're being defrauded everyday, we have waste everyday that

we're not working on, and we have duplication like crazy from the g.a.o. that we're not even attempting. i have to give my hat off to the president. if you look at his budget, he took more of the g.a.o. recommendations that they made and put them into his budget than we've ever considered in both the house and the senate. at least he's listening to some. they actually acted on it in his budget for the fiscal year 2014. the question really on this third question is do you have the political courage to fix what's wrong and compromise on the solutions to fix what's wrong? the g.a.o. has told us what's wrong. and yet we fail to address it. and then finally, and maybe this is more of an oklahoma thing, i hope not -- but do you actually believe what the

constitution says about a limited role for the federal government? and will you vote to ensure that the tenth amendment that our founders added is brought to date, is revered, and, unfortunately, that's hardly ever a concern in the u.s. senate. i've been here over nine years. we don't worry about the enumerated powers. we want to fix things. and in our good desire to fix things, we trample the continuing resolution. and so now we're $17 trillion in debt, we have $124 trillion in unfunded liabilities, and that is growing every day. so the one thing that this debate that we've had the last

few days in the senate has caused us to not focus on is the very thing that is the real problem facing this country. and it's ineffective leadership, it's fixing the wrong problem, it's the heart, it's not the knee. it's the heart that's infected. and we have to address fixing the heart before we can ever hope to cure the knee. mr. president, i thank you for your patience, and i thank the senator from missouri for his patience. we don't have one problem in front of thing this nation we can't fix. if we restored confidence, we'd be growing at 4% a year right now. if people had the hope that we were going to do what was right, not what was expedient, what was right, what was in the best long-term interest of us all, not me, not republicans, not democrats, but us all, and we had that kind of leadership,

we'd get out of our funk. we'd get out of our debt, and we'd be the america that we had when i was growing up. i yield the floor. the presiding officer: the senator from iowa. mr. harkin: i ask unanimous consent that daniel goldberg, samantha aster and whitney wait of my staff be granted floor privileges for the duration of today's session. the presiding officer: without objection. mr. harkin: mr. president, we find ourselves in yet another alice in wonderland moment here in the senate. again we're on the brink of a government shutdown for no reason other than the house republicans' absolute obsession, absolute obsession with repealing the affordable care act. now, their strategy isn't anything new. they're running the same old

plays out of the same old playbook that they've used for three years. mind you, none of these attempts have worked, but failure is no deterrent if all you care about is scoring political points with your political base. 42 times, mr. president, 42 times the house has voted to repeal or defund the affordable care act. you'd any after the first 41 they might get that it's the sense of it that it's just a waste of time, but no, the house is at it again risking the widespread economic damage a government shutdown would cause just so they can indulge their political obsession yet one more time. i sort of half facetiously said this last weekend that the good news is that obsessive compulsive disorder is covered under obamacare in case these house republicans might care to use it.

defunding the affordable care act would deprive americans of all of the law's benefits, historic consumer protections, affordable coverage and cheaper prescription drugs just to mention a few. work on the insurance be marketplace which open for business as we know next tuesday would stop. as a result individuals and small businesses would no longer be able to enrole in affordable, comprehensive health insurance through the marketplaces. nor would they receive possible tax credits to help them with their premium payments. in addition the plan expansion of medicaid would be canceled. seven million americans who are projected to enroll in the marketplaces next year and nine million through expanded medicaid would lose their coverage. over the next decade the number of uninsured would rise by at least 25 million americans. now,% it is a if 25 million more than uninsured weren't bad enough, this bill from the

house would cancel all of the hard earned, long-awaited consumer protections that's in the law to protect every american with insurance. like coverage of preexisting conditions. coverage of young people on their parents' policies to age 26. so we'd kind of go back to the bad old days when insurance companies were in the driver's seat telling you what kind of health care you're entitled to and when, and charging you outrageous prices for it. instead of protecting all americans against arbitrary limits on coverage, repeal of the affordable care act would take us back to the days when insurance companies could terminate your illness just when you're the sickest. this would hurt families like danny and lisa grassmove from texas who were unable to find coverage that would pay for their son's hemophilia treatment until the affordable care act banned lifetime limits.

more than 105 million americans are currently protected by this provision. 105 million americans. protected. that's under the affordable care act. instead of allowing young people starting a new job or new business or going off to school to stay on their parents' policies until they're age 26, which they can do now under the affordable care act, repeal would make them fend for themselves in a chaotic insurance place that offers too little coverage for too much money. more than three million young americans are currently covered and are taking advantage of this protection, three million. they would lose it under the house bill, lose it. all 105 million americans protected from a ban on lifetime limits would lose it under the house bill. now, instead of protecting 130

million nonelderly americans who have a preexisting condition like high blood pressure, diabetes, heart disease, from denial of coverage repeal would put insurance companies back in the driver's seat picking and choosing who they want to cover. 130 million americans right now covered under that ban on preexisting conditions. instead of helping all americans prevent illness or disease by providing free preventative services like mammograms and coal on he owe scoppies, repeal would allow expensive co-pays, sometimes as much as $300 for these essential services. right now i just talked to a friend of mine who went in for his annual checkup, got an annual checkup, got advice on how he should handle his health care, no co-pays, no deductibles under the affordable care act.

repeal under the house bill would deprive states and localities funding to combat chronic diseases like heart disease. thanks to health reform the prevention and public health health suspend furpd is saving lives and cutting costs by supporting such programs. and utt asking off funding would immediately stop states' work building the health insurance marketplaces i just mentioned which start up next tuesday. these will be transparent, easy to understand, one-stop shops for individuals and small businesses can purchase affordable coverage. starts next tuesday. now, these marketplaces had been endorsed by experts all across the political spectrum because they will create for the first time a real marketplace for health insurance. for individuals -- where individuals and small businesses have the same purchasing power

and choice only big companies enjoyed before. and, again, this will have a direct pocketbook impact. premium rates are coming in from marketplaces across the country and they're much, much lower than projected. in fact, my home state of iowa released rates last week that independent experts say are some of the lowest in the country. in the marketplace. well, the house bill would take that away, would stop that. why would we want to do something like that when we're providing a really good deal for consumers? most importantly, these exchanges are a centerpiece of a system that will bring coverage as i said earlier, to more than 25 million americans who otherwise would be uninsured. living with the oppressive fear of being one illness away from bankruptcy or not knowing if they can afford a doctor visit

for their child. so why would anyone want to stop this? why would minimum tell states stop what you're doing to serve your citizens? that's exactly what the house bill does. if we pass that house bill, congress will turn its back on america's seniors, tossing out hard-won improvements in medicare benefits, it would take us back to the days when medicare prescription drug coverage had a giant gap. we all know that as a doughnut hole. in the middle, exposing millions of seniors to the full cost of drugs just when they need the most assistance. now, health reform closes that doughnut hole step by step until 2020 when it all disappears. i just received this from iowa, mr. president,. already the affordable care act in iowa seniors on medicare

saved -- listen to this -- seniors on medicare saved $76 million on prescription drugs because of the affordable care act in iowa. just in iowa. $76 million. you adopt the house bill, takes that away. reopens that doughnut hole. 6.6 million seniors all across the country have already saved more than $7 billion in discounts on drugs purchased in the doughnut hole. now, repealing this would increase seniors' drug prices by $5,000 a person over the next ten years. why would we want to do that? the house bill will roll back the unprecedented investments we make in medicare fraud prevention. this is another little-known aspect of what we put into the affordable care act.

we increased criminal penalties, we launched innovative new technologies to detect and pursue fraudulent activities, we put more cops on the beat to preserve medicare funds for beneficiaries, not the quacks, and the fraud manipulators. taxpayers of this country save $8 for each dollar we've put into that program. put in $1, we're saving $8. why would we want to repeal that? but the house bill would repeal it. it would hurt seniors' access to health care in rural areas. i come from a rural state. the occupant of the chair comes from a very rural state and we put in the affordable care act incentive payments paid to rural primary care providers in the affordable care act. the house bill would take that away.

and the -- in the affordable care act we put provisions in there as i mentioned earlier for seniors to get preventive care and wellness visits, no co-pays, no deductibles. in 2012, more than 34 million mrn seniors got free preventative services in medicare. the improvements we put in the affordable care act to medicare payment policy coordination and efficiency -- that c.b.o. tells us will extend the life of the trustee by another decade, republicans are always going on, well, medicare is broke, it's going to go broke, okay in the affordable care act we did things that the experts say will extend the life of the medicare trust fund by yet another decade, they want to repeal that. kind of doesn't make sense, does it? it just doesn't make sense.

finally, mr. president, we come to the most inexplicable part of this debate. republicans have played the washington stage politically for all it's worth, we saw an example of that last night when one of our colleagues on the other side kept the senate in all night long. i think the distinguished senator from texas started off yesterday afternoon around 2:00 or something like that, you'll excuse me if i didn't pay a lot of attention to it but anyway, he started around 2:00 in the afternoon, went on all night, kept the senate here, went on this morning until about noontime, i guess. i respect every senator's right to come to the floor, to speak unhindered just as i'm doing now, just as pretty soon another senator will speak unhindered. that's one of the beauties of the senate. but i think we also have a

responsibility to be at least a little cognizant, just a little bit of how we're burdening others. so, yes, a senator spent all night here. i wonder if that senator ever stopped to consider how much it cost the taxpayers to keep this place lit, to keep the clerks and the people here, all the police, all the safety people here and around outside, just to keep this place running just so one person could speak all night. i wonder if you ever considered that. like i said, everybody has a right to speak, but you have to wonder about responsibility, being responsible, being responsible to the body and to the public at large. imagine my surprise when that same senator who kept everybody, kept people here all night, kept the lights lit, cost the taxpayers i don't know how many

hundreds of thousands of dollars at least, imagine my surprise when he voted for the very bill he was talking against, the provision, 100-0 vote today. some things are really hard to grasp around this place, you know. i'm sure the public out there watching this would say, wait a minute, he spoke all night about -- against this bill and against the affordable care act, against obamacare, threw in a few other things too, but then turned around and voted for cloture on the motion to proceed. so i said, some things are pretty hard to understand around this place. i guess you just have to -- i guess you have to define it in terms of pure politics. sometimes just pure politics. well, again, here's why i talk about the most inexplicable part. my friends on the other side

have been making great and solemn speeches about the debt and deficit, warning us, bringing us within hours of a government shutdown all in the name, they say, of fiscal discipline. but as a condition for agreeing to fund the government, what do they want? repeal, one of the best deficit-cutting measures we've passed. the nonpartisan congressional budget office confirmed that the affordable care act reduces the deficit by more than $100 billion in the next ten years and over $1 trillion in the next ten years. so again, let me see if i can get this straight. the republicans proposed to reduce the deficit by increasing the deficits. well, again, as i say, some things are just kind of hard to understand around this place. so i think it's time to stop the silly games. we had our debate. we worked hard on the affordable care act. so this debate's not about deficit reduction.

it's not about the nation's fiscal health. it's stkwruft about tearing -- it's just about tearing down health reform at any cost. tear it down. get rid of it. go back to the way it was when powerful health insurance companies had control to raise your rates whenever they wanted to, to not give you health coverage if you had a preexisting condition, to deny you coverage when you got sickest, cut you off right at that point, deny you benefits, and making insanely big profits doing so. those are the old days. it seems to me my friends in the republican party, they want to go back to those days, but we don't. the vast majority of the american people say no, no, no. we want to move forward with a health care system that covers everyone and doesn't leave anyone out.

again, as i said it's not based on my friend's obsession -- this health care reform law is not based on budget considerations. sometimes i wonder what it is based on. now, if someone were to ask me, senator harkin, do you think this affordable care act is the end all and be all and is absolutely perfect? i'd have to say what i said when we first passed the bill that it came under the help committee. i said at the time i likened it to a starter home. you might have to add some rooms later. we might have have to move a door away here or there. we might have to change some of the designs about this. but it was like a starter home to be filled in over the months and years ahead. changing conditions and circumstances. and as we learned more, as we learned, as we went ahead that maybe things would have to be changed in the affordable care act.

but the foundation was solid. solid foundation. and a solid structure of making sure that we had a health care marketplace open to all, that it wasn't controlled by a few, that everyone, no matter how poor, everyone would get health insurance and those who are the poorest would get a government subsidy to buy into that insurance. we wanted to make sure that we had good preventive programs, wellness programs to keep people healthy and out of the hospital in the first place to change from what i've already said we had in america. we did not have a health care system. we had a sick care system. if you get sick, you get care. but in america, we've never had much of anything to keep you healthy in the first place. as i've said many times, in america, it's hard to be healthy

and easy to be unhealthy. we need to change that around. make it easier to be healthy and harder to be unhealthy. affordable care act takes steps in that direction, providing these free mammograms and cervical cancer screenings and colonoscopy colonoscopy, providing wellness checkups every year, putting in place community transformation grants so communities can begin to think how they can instruct their communities to promote wellness, good activities, better diets. so, yes, like a starter home. do i think some things will have to change in the affordable care act in the future? i'm sure that's true. but that doesn't mean tearing down the structure and digging up the foundation and throwing it all away and going back to where we were before from square one. the answer is, is to move ahead.

let's open up these marketplaces. let's get people signed up. if things need to be fixed and changed in the future, that's our job here. that's our job, to fix these things and make sure that our laws are correctly interpreted and benefit people. it's like some people have the idea all we have to do is pass the law and sit back and everything else will take care of itself. that's not true. no law is not like that. we need to implement them but we need to do it with goodwill and in a spirit of compromise and in a spirit of not everyone knows all the answers. but in a spirit that what we are attempting to do with the affordable care act, or obamacare, if you will, is to move us in a direction where

people will be healthier, where people will have affordable quality coverage that can't be take be away because they get sick or be denied because they have a preexisting condition, where kids can stay on their parents' policies for a decent length of time after they get through school. all the things i just spoke about. these are good, solid foundations for a good health care system in america. so i think, you know, my friends on the other side who want to repeal this are simply on the wrong side of history. i'm always reminded of what -- of what william buckley once said. william buckley was soefrt -- sort of the father of the modern american movement in america. he once said that the role -- the role of a conservative is to

-- quote -- "stand athwart history yelling 'stop'." knowing the late mr. buckley, i'm sure he probably had a smile on his face when he said it. but it seems like that's what some people are saying, we just want to stop all this. i've said many times since we first started the affordable care act debate several years ago and working on this, if people have a better idea, come forward with it and let's take a look at it and see what we come up with. but i haven't seen that yet. so i just want to close by referring to a couple of letters that i just got from iowans. they make it clear what this is really all about. angela from edgewood, iowa

writes she has a family history of cancer and now i am able to get the screenings i need. she asks me how she can spread the word to others. i just did. john from des moines said because of the a.c.a., affordable care act, i've been able to start my own business, been able to purchase coverage and am looking forward to the exchanges. end quote. so the choice is to go forward, to work together, to make whatever needed improvements need to be made, to come together as a united american people and to create a reform health care system that works not just for the healthy and the wealthy, but for all americans. that's what this battle is about, mr. president. that is what this is all about. and that's why we don't need to shut the government down. let's act responsibly. let's pass a short-term continuing resolution without defunding the affordable care act or all this other nonsense dealing with the debt ceiling

increase, and then let's get down to the hard work of working together to make sure that we fund the government next year as ri congress, this session of the congress to a close later in november or december. so hopefully the next couple days the senate will act and we'll let the house know that we're not going to defund the affordable care act. with that, mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from missouri. mr. blunt: mr. president, i'm pleased to have had the chance to listen to really the better part of an hour to my two neighbors, senator harkin and senator coburn, one from oklahoma, one from iowa, both of whom, as many of us do apparently have totally different views of why we're here and what's going to happen based on what we do in the next few days and the days that follow after that. first of all, why are we here,

mr. president? this is the new spending year starts a week from yesterday. it starts next tuesday. has the senate passed a single appropriations bill? no. why are we doing this again? why are we so committed in the last five or six years to management by crisis? i think in the last six -- and it may be seven years now -- the appropriations process has not worked one time. it wasn't too many years before that when we passed all the appropriations bills for the year that ended september 30 and began october 1 in july. all of them individually. and that's how the government worked and was supposed to work. here we are a week away. why are we here? why does everything have to ride from crisis to crisis? you know, that's why people are frustrated, people are upset. senator harkin, my good friend, we're both frustrated and upset.

we'd like to see this process work. the appropriations committee would like to see the process work. why do we go from hanging from one edge of the cliff -- standing on one edge of the cliff to the next time people pay any attention, we're on another edge of another cliff again. we need to work to make this process work. there's been, as senator coburn pointed out, been some significant disagreement on where the current debate could take us. one side believes that at some point -- one side of that debate believes at some point the president of the united states would sign a bill that eliminated the health care plan, that he calls now obamacare. so i'm going to call it that too, as he has. and senator harkin has alternated using that term. i don't believe the president would sign that bill, but i do believe he's president. i do believe he has to sign a

bill for the bill to happen. and so we have to at some point decide what can we do to make this process understood in a better way by the american people? it was referred to that with health care, this is a starter home. i don't know exactly where this goes, but i do know that the stkwrorl in the last few -- the majority leader in the last few days said where this heads is a single-payer system. i'm not for that. as far as i know, nobody on my side of the aisle, and many people on the other side of the aisle, aren't for that. but that's where the senate majority leader said this goes. and i don't want to go there. so what can we do to make the health care system work better? and i want to talk about that a little later too because there have been plenty of ideas of what can make this work better. apparently when it comes to not moving forward with the affordable health care act, the administration believes it can

decide whatnot to move forward but the congress can't. it can decide what to repeal. part this act was called the class act, the long-term health care provisions that about a year and a half, two years ago the secretary of h.h.s. just said what i said in the committee when this bill came up when i was in the house committee, the commerce committee this dealt with th-fplt long-term -- this long term plan won't work. it will work and provide lots of money. secretary sebelius said about a year and a half ago that it won't work so we're not going to try to do it. the president said recently or the guess the secretary as i said said recently that the small business plans are supposed to be available january 1, 2014, won't be available. the president said, we're not going to have any penalties for the business requirement in 2014, but we're still going to have the individual requirement.

now, interestingly, the president also said, in the normal -- in normal circumstances, i had gay to the -- i'd go to the congress and say, change the law. but these aren't normal circumstancesment i don't believe there is a presidential prerogative to decide whether a normal circumstance or not. if the law needs to be changed, let's change the law enforcement if the law -- if parts of it need to be repealed, let's repeal it. if parts of it need to be postponed, let's postpone it. here we are only six days from the beginning of a new spending year. we're also six days from what will be a critically important moment for a lot of families, a lot of individuals, employers, people who are going to be looking at this exchange, and they don't seem to be ready. it hispani had been hoped that e will be available information

out there so for week there could be a dry run. that's just not there. and weigh know i.t. not -- and we know it's not there. in missouri where i live, people have been concerned from the very first about what they saw as a flawed law. in fact, our state was the first state in the country to actually vote on whether we wanted to be part of this or not and overwhelmingly missouri voters said "no" when it was more popular in any polling than it is right now. people have looked at this, and they don't want to go there. moians imissourians in 2010 hade on the ballot and 51% said that we shouldn't participate. 71%, and that was again when the law was more popular than it is nowvment this is the first timn. this is the first time that

people had a chance to vote on this. in 2012, missouri voters voted again and this time the direction to the legislature was and to all state agencies and the goafn governor, don't estaba state exchange unless the legislature agrees. there was some disagreement as to whether the governor could do that on his own. and so for in our state, as in a majority of the states, it hasn't happened. the implementation is not there because people don't believe this plan will work. the elements of this that improve what happens in a competitive marketplace could still be there in other changes we could maifnlgt this is incredibly unpopular around the country. people are frustrated by it. people are looking for ways to end moving into the affordable care act. it just simply won't work.

senator coburn explained earlier why it wouldn't work. charles krauthammer, one of the leading conservative commentators in the country today said about one of the plans this week, it won't work. the president's health care plan is falling under its own weight. when something like that is happening in politics, you don't rush in to stop it from happening, if you don't think that the lawyer should be implemented anyway. let people see that this won't work and we're seeing that. i'm for defunding the plan. i'm for starting over again. i believe most americans would like to see us start over again and take the best health care system in the world and make it work better. anybody who is defending our system as perfect got into a trap they shouldn't have gotten into because it wasn't perfect. largely an accident of a couple decisions made in the 1940's and

health insurance became way too much dependent on where people worked, where people didn't have the ownership they needed in health care and where we didn't have the competition that we needed to buy across state lines, to shop for a better product to do all those things. but this is a plan where, again, the law is the law, unless it applies to the administration apparently. the congressional research service, no partisan organization, the congressional research service recently found that the administration has missed 41 of 82 deadlines. now, if you're a batter in professional baseball, that's a pretty good average, .500. it's not very good if you're trying to figure out how to implement the law. missed 41 of 82 deadlines. the employer mandate requirement the white house has said is unworkable now and announced its

delay, how in the world we could defending saying that employers don't have to meet their requirement but individuals have to pay a penalty if they don't have insurance ... how could any of my friends defending that? we ought to at the very least pospostpone the individual mande for as long as we postpone the employer mandate. if individuals are paying a penalty and employers who the law says are supposed to offer insurance are paying a pe penaly aren't offering insurance and around paying a penalty, there is something wrong with a government that decides that's the appropriate way to do this. despite the employer mandate announcement, we still see businesses beginning to react because they know this is eventually -- or they believe this is eventually likely to start. businesses big and small trying to look at, well, if somebody doesn't have to have insurance

if they don't work more than 30 hours, maybe we should have more employees that work less than 30 hours because our competitor might decide that. or companies that have always provided insurance and assistance senator families and spouses decide, you know, the law now doesn't say we have do that, so we're just not going to do that any longer. the law initially anticipated 3 million people that currently had insurance would lose that insurance. i.t. going to be ait's going tot higher than that. the same people who were saying 3 million are today somewhere between 8 million and 15 million, and, mr. president, that number is going to go up. all you have to do is calculate what's just been announced in the last few days to know that's going to go up. the cleveland clinic hosted president obama in july 2009 during the height of trying to convince americans this was going to work. he talked about how the cleveland clinic was an example

of cutting-edge technology. but what they recently cut in cutting health dlirvetio delivey recently cut was 44,000 employees. they said it was because of the president's health care plan. the same president that went there to talk about how that organization runs and why we should have his health care plan announced they're terminating 44,000 employees because of the health care plan. this is a plan where people who were for it -- and i was not for it, i have not been for it; i just simply don't believe it will work, mr. president. people who were for it overpromised and now they're underdelivering. that famous statement made history of and over again, if you like your he health care plan, you can keep it -- well, nobody believes that anymore. ask the employees at general electric or i.b.m. or ups or

walgreens or home depot or thousands of smaller businesses than those, what about keeping the health care plan you like the day that commitment was made? those plans aren't there anymore. those plans aren't there anymore. it was one of the main selling points of this planning. if you like your health care, you can keep it. it just turned out not to be true at all. not only has this not made health care more affordable, but family premiums have gone up by more than $2,500 since this became the law, even though it was the law and we're moving toward it not implemented it. nearly three in four small businesses say they planning to cut hours or let employees go because of the president's health care plan. people who have less than fewer employees are doing everything they cannot to have more than -- more than 50 employees, rather,

are doing everything they cannot to have more than 50 employees because that's one of the criteria where you're really penalized under this law. meanwhile, in april of 2013, the administration said that it would delay a provision that allowed employees to pick their own plans in states that have the federal exchange, states like ours, just not going to happen. another delay. in july of 20 13-rbg the administration delayed enforcement of the employer mandate for a year. in july the administration announced it would significantly scale back the requirements for new state-based insurance marketplaces to verify income. and if -- quhu scale bac when yk the requirements to verify income, you're also scaling back the burden that people have to provide information in order to get assistance. i assume that means more people

will get taxpayer assistance, but it also means that the cost of that assistance is going to be higher, just for many reasons that's one of them. another one is that people are going to be on the exchange that everybody anticipated would still be getting workplace-based health care. in august of 2013, the department of h.h.s., the health and human services, delayed the signing agreements with insurance companies that were supposed to have specific amounts available in august. i wrote a letter at the time that said, it's really important that you meet this deadline because people need to begin to think about the decision you want them to make beginning october 1. the department of labor delayed a limit on out-of-pocket spending for beneficiaries from 2014 to 2015. again, apparently, if you want to delay the law, if you want to decide that you're not going to enforce the law, that's okay. but for those of us who say,

let's have a permanent delay, let's not fund this and now go back and start with a process where the house passes a bill, the senate passes a bill, the two bodies come together and talk about the differences -- that never happened with this law. and my trend from eye would said, well, it is a starter home. but there's no remodeling process to start up for the starter home, and we're seeing what happens there. unfortunately, too many examples of this. americans deserve commonsense health care solutions where doctors and patients are in charge, not government bureaucrats, not people at the i.r.s. when you've got a health care bill that adds thousands of i.r.s. new workers and doesn't add a single new doctor or nurse, you probably missed the boat in what you're trying to do with health care. and for better ideas, there are lots of better ideas out there.

more individual ownership, better tax treatment. the tax treatment that we've had for decades now, where you don't pay income tax on a benefit you get at work. but if you get snuns on your --t if you get insurance on your orientation do you that with dollars you have paid tax on. either said nobody gets a tax benefit for the money that's used to buy insurance or everybody gets the tax benefit. let people shop across state lines. let people find what they need that meets the needs of their feavment we'rfamily. we're going to have more single young adults without insurance on this. the and why are you going to have more? not because of the provision that allows people to stay on their family. that actually add people to the insurance rolls. but because of the provision that says that the most expensive people you insure can't be charged more than three times the least expensive people

you insure. young, healthy people are going to look at insurance rates higher than rate rates they havn on the individual market, again before. and it'll make a dins. difference. there's plenthat i can be done here. my colleagues on the other side face an important decision this week. they can stand with what is now the overwhelming majority of americans who have rejected the direction we're headed in and say, let's defund this; let's start over again. the one thing we've got in front of us that would allow us to start over is the house bill we just voted to move forward on that would defund obamacare, and let us start over again or my friends oner the other side can decide that the president and senator reid are right, that senator reid's idea of this leads us to a single-payer system is where we want toarks that the president's idea that he can change in law however he wants to and the congress is not

involved is right. i would strongly urge all of my colleagues to join me in voting against any attempts by the majority leader to restore funding for this this flawed, flawed law and to work with all of us working together as we work to replace it and with that i'll note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

the presiding officer: the republican leader. mr. mcconnell: are we in a quorum call? the presiding officer: we are. mr. mcconnell: i ask that the quorum call be dispensed with. the presiding officer: without objection. mr. mcconnell: i ask that the senator from kentucky and myself be allowed to participate in a colloquy. the presiding officer: without objection. mr. mcconnell: i'll just say to my friend from kentucky, i've had over 50 hospital town hall meetings in our state over the last year and a half, you and i have done a couple of these together, and as a health care professional yourself, looking at it from a hospital and health care provider point of view, which you and i both had -- either you in your profession or me by being in these hospitals a lot the last couple of years learned a good bit, what do you think is the most devastating impact of obamacare on the provider world?

mr. paul: i talked to a lot of doctors, and i have been in town hall meetings with you at the different hospitals. the hospitals are concerned that if everybody goes on medicaid they'll go out of business. many hospitals bottom line is driven by they can take care of the poor through medicaid but rely on private insurance to make a profit. and hospitals in most communities have to make a profit to stay in business. so the rural hospitals particularly in small areas, some of them have already gone bankrupt in kentucky. but they're very concerned about people being shifted from private insurance to public assistance. the president says it will be free but it has a cost. we all pay for it through higher taxes and the other way we pay for it we have to ration care or ration what we pay for care. we have to limit what we pay hospitals, hospitals are already being forced -- they have been for a while but even more so now. same the same with doctors. how do doctors respond? doctors, some respond by saying i'm either going to see a couple

of medicaid patients or no medicaid patients and then when everybody is on medicaid or the vast majority are on medicaid, they'll be waiting in line to get to see a doctor. mr. mcconnell: speaking of medicaid, i remember reading our governor got tiered up when -- teared up when he he nowndz he had decided to accept the additional medicaid mandate which the supreme court had said was optional. i revenue having a teared up feeling, too, but for a different reason. i gather what will happen in our state they'll there will be between 2,200,000 and 300,000 rushing to emergency rooms, and what i heard no my town hall meetings they can't handle the medicaid load they have now, coupled with the $750 billion in health care provider cuts over the next ten years to help

provide subsidies for people who are not old. i mean this can is coming out of medicaid to provide subsidies for people who are not old. what's your take on where this heads? mr. paul: when we say we want to provide health insurance for everybody which is a noble cause, you look at what we have, the government provides for medicare for everybody over 65. medicare's $35 trillion to $40 trillion short. why? it's nobody's fault, we have a big baby boomer generation but medicare is $35 trillion short. so we're instituting a brand-new entitlement, very big, the biggest we've had in 50 years, we're going to pay for it by shifting money from medicare that's already $35 trillion short. that alone should give people paws. the other -- pause. the other thing that should give people pause, we can't get people to sign up for this free program. the president is going to spend tens of millions of dollars on tv promoting it, hiring people

to beg you to sign up for something free. something is disorganized if people won't take something that is free. mr. mcconnell: this bill was sold as doing something about health care costs and i was just noticing here that h.h.s.'s own actuaries revised their projections just last week to say that obamacare will actually increase health costs by $621 billion out across the economy. is there any way, i would say to my colleague, dr. rand paul, how this could possibly hold down costs? mr. paul: no, and i think there were problems in health care but as a physician for 20 years what i heard most was the cost of health care. people came to me and said it's so expensive, if they were a small business owner they'd say our insurance costs too much. that was their main complaint. this does nothing to control costs. in fact, obamacare does the opposite. obamacare is a collection of

mandates, so i was talking earlier, it's the difference between freedom and coercion. it will coerce insurance companies and customers to buy only certain kinds of insurance. and people say, well, it's good, my kids will be covered when they're in college. that's good but it's not free. it's going to cost you more money. so if you're the working class or the working poor, you're struggling to buy insurance, it's going to cost you more. and so he always says he's for the middle class, the middle class is are going to pay more for their insurance. they already had insurance and will pay more across the board. there are a a lot of problems and this bill does nothing to control costs. mr. mcconnell: one of our constituents, you probably got it from the same constituent i did, to underscore how the rising cost is impacting people outside the health care provider world, regular people in business. this is from a fellow constituent of ours who rice wrist my father began his kentucky fried chicken business

with the colonel himself and with the colonel's family, says we proudly served original recipe for 40 years and it saddens me however well intentioned this ballet law will undermine ability to provide employment and deplete resources that could otherwise be used to grow my business. you and i both heard from a lot of kentucky business people indicating as this k.f.c. franchisee underscores the impact on the private sector. mr. paul: i have here 68,000 americans, senior citizens, who soind a petition from conservative 50-plus alliance. they want to delay it, do anything to slow down this monstrosity. we've heard, both you and i from folks who work for u.p.s. one one of our biggest employers

in louisville, 5,015,000 spouses losing insurance coverage from u.p.s. that they had chosen. u.p.s. is a great company with great benefits but they're forced to cut back because of obamacare. we hear from individuals throughout the state. we've gotten thousands and thousands of letters, one couple i met recently was actually prefiled on -- profiled on fox news, the mangione. he said we're paying $300 a month, we're going to $900 a month. one of the real things we had that was working in our health care and that should be expanded if we were in charge and talking about this, is health savings accounts. people could save for things that weren't covered by their insurance, straightening your kids teeth, cosmetic, elective surgery, deductible, meeting things through a tax-free account. we made it bigger and bigger over time, boirk makes it smaller. if you have a kid with autism or

spina bifida or special needs you need to save money that money so you can help your child with extra stuff you need to do for your child. the president has narrowed that. also health savings accounts bid prices down. when you have a higher deductible, you ask the farm assist -- pharmacist how much companies does that cost. that simple question is concern on the part of consumer drives prices down but we've gotten rid of that. mr. mcconnell: the other thing that's clearly happening here is that all indications are we have a record number of part-time employees in our country now. employers are downsizing in order to try to get below the 50-employee threshold and, of course, even as they do that they're not necessarily unaffected by the rising cost of health insurance premiums but looking around at some way to try to prevent the worst-case

scenario here, all of this disruption in our istually the o many part-time workers, is it not? mr. paul: yeah, and the thing is there was a french philosopher who talked about the seen and the unseen. i'm sure the president will show us the person who gets the insurance. that's the seen, the good effect. the unseen will be the person who doesn't get the job. you don't know their name because they never got the job. the person who would be the 51st or 52nd employee or the part-time worker going to 29 hours. i don't question the motives of the president, but they didn't think this thing through. authors of the bill are calling it a train wreck, the teamsters saying we didn't know we would have to pay all these taxes. warren buffett, former

president clinton, all of these people questioning, boy this is going to hurt the people you tried to help. that's one of my concerns. there has been talk about procedure around here, we ought to have ability to amend this, to make it less bad is the way i like to describe it, less bad for the american people. the other side, spent a lot of dialogue on our side but not much on theirs. are they willing to talk about fixing obamacare, making it less bad for the american people. mr. mcconnell: you were not here yet but you're fully aware how this bill passed in the first place. not a single member of our party in either the house or senate voted for it. they brought us intlo session the day after thanksgiving in 2009 and we were not allowed to leave for a movement we're here seven days a week nor a months, managed to eke it out, had 60 republicans, 40 republicans, eke it out without a loat-vote to spare on christmas eve as a result of things like the cornhusker kickback, a special

deal for nebraska, the louisiana purchase, a special deal for louisiana, the gatorade, a special deal for florida, all while the president, the vice president, former president clinton were up here telling us believe me, they're going to love it by the fall. here we are four years later and it's more unpopular today, i would say to my friend from kentucky than it was the day it was passed and isn't it reasonable to conclude that's because of what it does? mr. paul: absolutely. it's the content but it's also because there has been no input. obamacare is 100% the president's bill, 100% the work of the democrats. with no input from our side. and i think people actually do, when you go home, they do want us to have dialogue, work together a little bit, there's been no working together on obamacare. it's theirs. the president i think got it exactly wrong the other day and it's bad i think to misinform the people this way. he said republicans want 100% of

what they want or they're going to shut down government. i think it's the opposite. he wants 100% of what he wants. he doesn't want any compromise, we have a bill before us. there is a discussion about obamacare. why not -- nearly 80% of us voted and said the medical devices tax is going to be a disaster for innovation in the medical industry, it's a bad piece of this bill. we should repeal it. why not have a vote on that? but to my understanding, there will be no vote on any amendments to make obamacare any better. mr. mcconnell: well, you know, the president himself seems to be kind of conceding that some things aren't working out well. he decided to delay the employer mandate per year. apparently, he has been meeting with some of these union allies to figure out what he can try to do for them. i believe the -- the 100% view of republicans is that if we're going to have a delay for business, why not have a delay for everybody.

everybody. obviously, we'd like to defund the law entirely. there is a math problem on that in the senate. there are 54 democrats and 46 republicans. but couldn't we all agree on just delaying this train wreck? the train wreck, by the way, was what the democratic chairman in the finance committee here in the senate, one of the authors of the bill called it. mr. paul: i think there is also something important about how we change obamacare. if a law has problems and we incorrectly pass the law that has, to say the least, blemishes, it should come back and we should redebate and fix it or try to make it less bad i think is the best way to put it, but the thing is that it is illegal and it is unconstitutional and it is unprecedented for a president just to do this on his own. and to my mind, win or lose this week, this is an important philosophical battle, bigger than obamacare. it's as big and as broad as the country is, and that's whether or not congress writes the law and the president executes the

law. if the president gets to both write and execute, that's a type of tyranny. they talked about the separation of powers. when the legislative power becomes the executive power, that's a type of executive tyranny. we have to do something that says to the president, and that's why i think this needs to be pursued all the way to the supreme court and rebukes the president and says you are not a king. you're the president and the legislation comes from congress, not from you. mr. mcconnell: well, you know, we have another example of that that affects our state. the president, even when he had a 40-seat majority in the house and 60 votes in the senate, couldn't get cap-and-trade through the congress. couldn't get it through the congress. yet last friday, he's announced he is going to do it anyway. all indications are there won't be another coal-fired generation plant built ever. a perfect example of what you are talking about. kind of executive arrogance, that if i can't get what i want through congress, i will just do it on my own and see you in

court or whatever limited options we have left. if he really believes he has the power to delay obamacare, why not delay it for everyone, not just businessmen? mr. paul: i think that's what people see as unseemly. gosh, if there are problems, is it right for him to just give exemptions to his friends. you see a line of people going to the white house that were big contributors of his, and it's like can you really buy access to good law, can the president change the law only for people who gave him money, can he give out grants and loans to people who are contributors. that's what sort of belies this tale when he says along for the -- i'm for the middle class. i don't see the middle class, i don't see any of my neighbors or my friends getting special deals at the white house. i see them bearing the brunt of people who do get special deals. i don't like the if you have really good health insurance placing a tax on you, a special tax. many of the unions will get that. i would stand here and fight

tooth and nail not to have a special tax on the unions. some might be surprised by that, but it's not for me a union, nonunion thing. it's about is it good for america, is it good for americans? some executives have good insurance, too. should we have a special tax on something good? it doesn't seem like the right thing to do. mr. mcconnell: here at some point, regardless of the differences of opinion that we have had on our side over procedure, what's likely to happen here at some point is we're going to have a 51-vote vote on defunding obamacare, something we have not been able to achieve here in the last four years, and, you know, four democrats who had second thoughts, who had a -- an opportunity to take a look at the carnage over the last four years could actually pass a bill that defunds obamacare. i remember i say to my friend and colleague standing at this very chair four years ago hoog

at the other side and saying if just one of you, just one would come with us, this bill wouldn't pass. and i also said, however, if none of you do, every single one of you is responsible for its passage. that any democrat on the other side, -- had any democrat on the other side, any one of them said this is a bridge too far, it wouldn't have passed. consequently, every single one of them is responsible for its passage, but they have a second chance now, an opportunity for a do-over at some point here this week. they will have a chance to cast a real vote on an up-or-down basis to say look, i have watched this for four years, and i really don't think we ought to go forward. it will be interesting to see if party loyalty will be so great that not -- none of these folks will be able to bring themselves

to admit that they made a mistake four years ago. mr. paul: i think one of the dispinting things about the debate both then and now is we're talking about something that all americans want. they want affordable health care. they want most people to have insurance. we want everyone to have insurance if they can do it. we have made it a partisan battle -- not we, but congress and the deliberative process has become very partisan when in reality there are probably things that we could agree. even the problems with obamacare i think half on the other side agrees that there are problems and they ought to be fixed. but because of sort of some kind of stubbornness that we're getting 100% of what we want or we're willing to risk shutting down the government, that's what we get from the other side. it's their way or the highway. they want all of obamacare or they want the government to shut down. i think really in reality there is a lot of good things that we could actually come together and work on, because really obamacare never addressed price. there is 85% of the public had insurance and their price is

going up. so really we do need to get together and talk about how we try to bring cheaper health care for people in our country. mr. mcconnell: you know, the tragedy of all this, correct me if i'm wrong, but we passed a 2,700-page bill on a totally partisan basis, got about 20,000 pages of regulations now issued. i used them in a speech recently. they were seven feet tall. had to put it on a dolly to get it out on the podium. and i would ask my friend and colleague from kentucky, didn't i read the other day that even after we do all of this, the $2,700-page bill, the 20 -- the 2000-page bill, the 20,000 pages of regulations, there are still 25 million or 30 million people uninsured? mr. paul: i don't think it's actually fixed the problem. i think we were at 45, so i don't think we fixed half the problem. the other thing is of the people who didn't have health insurance, a third of the people without health insurance were young, healthy and made more

than $50,000 a year. they weren't getting health insurance because it was too expensive. what did we do to help them? we made health care more expensive. mr. mcconnell: well, look, i think this law has no chance of working. i don't believe that even if we are unable to defund it here in the next few days that we're necessarily stuck with it. i have been here a while and you have been a long-time observer through your father's career and your own, and i think it's pretty safe to conclude that things that can't work don't stick, don't last, because we are after all a representative democracy. people complain and discuss and tell us how they feel. i don't think this law can possibly stand. it's pretty hard to predict exactly the day upon which it

ends, but it's cracking. when you have got jimmy hoffa, the president of the teamsters union, saying you're destroying the 40-hour workweek, and their cadillac health care plan, don't you think this thing can't possibly work? mr. paul: no, and i think once the bill has come due at the state level, you will have a real uproar on your hands because there is a printing press in washington that runs 24 hours a day printing money. in the state capitals, they don't have a printing press. they are limited at least to a certain extent on their borrowing. when the medicaid bills come due in kentucky, our state and other states, it is really -- i think there will be another war over obamacare, and the question then will be do we throw out the governor who increased our medicaid by 50% and bankrupted our state in the process? mr. mcconnell: well, i thank my colleague from kentucky for the opportunity to exchange some views here about the impact of this on our state and our country, and, mr. president, i yield the floor.

mr. leahy: while the distinguished republican leader is still on the floor, i want to propound a unanimous consent agreement which i believe he is in favor of. the house of representatives passed a bipartisan reauthorization of the missing children's assistance act that ensures the national center for missing and exploited children can continue. we cleared it a week ago here on the democratic side. i understand that now it has cleared the republican side. i would ask unanimous consent the senate proceed to the consideration of h.r. 3092, which was received from the house and is at the desk. the presiding officer: the clerk will report. the clerk: h.r. 3092, an act to amend the missing children's assistance act, and for other purposes. the presiding officer: is there objection to proceeding to the matter? mr. leahy: i ask unanimous consent the bill be read a third time and passed, the motion to reconsider be laid upon the

table, with no intervening action or debate. the presiding officer: without objection. mr. leahy: and, mr. president, i appreciate the fact that now that it has passed, i have a further statement by others seeking the floor, and i would ask consent that my full statement be placed in the record at the appropriate place. the presiding officer: without objection. mr. leahy: mr. president, i thank the republican leader and others, and i yield the floor. a senator: mr. president? the presiding officer: the senator from arizona. mr. flake: i come to the floor to urge my colleagues to do everything we can to ensure that obamacare is delayed, guaranteeing the least harmful path forward for patients, providers and for taxpayers. we all have stories from our home state that highlight what many of us have said was going to happen when the federal government began its takeover of the nation's health care system.

because of obamacare, a constituent of mine in arizona who owns a number of restaurants is eliminating the entry level job of busboy because he can no longer afford to employ busboys and pay the new health care expenses for his other employees. eliminating a restaurantwide position, that's a decision that had to be made because of obamacare. another arizonan, michael modey, who runs a historic restaurant in tempe, was recently featured in a national news story because he is being forced to decide between offering health care insurance to his employees working more than 30 hours a week or paying the penalrom the federal government. again, it's likely that employees will be laid off. or not hired. he doesn't want to cut back his employees' hours. that doesn't help his business. and i am sure it doesn't help his employees, but like other business owners, he doesn't have any other option. sadly, these stories are not

isolateed instances. companies like trader joe's and home depot have recently announced that they will end health benefits for part-time workers and those employees who will be direct -- those employees will be directed to the new insurance marketplaces. sea world announced that it will be cutting back employees' hours as well. u.p.s. will no longer cover health insurance for some 15,000 employees' spouses. just when we need a full-bore, full-time economy, america is becoming a part-time economy. these are the effects of obamacare. i believe that it's helpful to have this debate come sharply into focus as it has been over the past 24 hours. like many of my colleagues, i have opposed obamacare from the beginning. i think every republican in the house and the senate has done so. i voted to do away with this legislation more than 30 times. earlier this month, i introduced s. 1490, a bill that would delay

by one year all of the provisions of the affordable care act that are supposed to take effect on january 1, 2014, or later. i believe we all know that the president has already employed -- decided to delay the employer mandate. doesn't it make sense to delay the rest as well? how can you tell individuals there is still a mandate for you to buy insurance but to tell employers you're going to get a year break? as lawmakers, we have a responsibility to our constituents. we have to do everything we can to make sure that this train wreck of a law doesn't continue to wreak havoc. mr. president, as we continue to discuss the need to delay this onerous law, i hope senators will join me in devoting the same time and energy to fix the fiscal problems facing the country. in this debate, we're told we have two choices. we have a continuing resolution with a price tag of $986 billion. that's about $20 billion more than the law allows, or we risk a government shutdown. it's disingenuous, i believe, to

tell our constituents that these are the only two choices, a shutdown or a c.r. that busts our budget limits. the majority leader is going to amend the c.r. to get what he wants. shouldn't other members be afforded the opportunity to offer amendments as well? wasn't this the promise the majority leader made to the senate when we made changes in january? the senate should be given the opportunity to vote on a continuing resolution that respects the budget control act and funds the government at the $967 billion level for the next year. passing a bill above that limit -- above the limit set by law will cause a second round of sequester cuts in january. why would we do this? lurching from fiscal crisis to fiscal crisis is no way to run a country. sadly, you can say what you want about it, but the budget control act has provided us at least with meaningful cuts in spending that we wouldn't make otherwise.

just last week, the nonpartisan congressional budget office reported that our debt is on track to total 100% of our nation's output in just 25 years. interest on our national debt will consume 14% of our annual budget in just ten years' time, up from just 6% today. those projections demand that we take a harder look at our spending. at the very least, we should be allowed to vote on a fiscally responsible continuing resolution that meets the 967 budget threshold. mr. president, i yield the floor. the presiding officer: the senator from montana. a senatormr. baucus: mr. presidk unanimous consent that when i finishing speaking, that the senator from maryland, senator mikulski, be granted the floor for 15 minutes and upon the completion of senator mikulski, that senator alexander of tennessee be allowed to have the floor for 20 minutes. the presiding officer: without objection. mr. baucus: mr. president, i rise today, as i often do, with

a quote. it comes from a conservative leader speaking out about a new health care law. he said -- and i quote -- "we're against forcing all citizens, regardless of need, into a compulsory government program." he went on, he called the pending legislation socialism. he went on saying -- quote -- "our natural unalienable rights are now considered to be a dispensation of government and freedom has never been so fragile, so close to slipping from our grasp as it is at this moment." those are frightening words, mr. president. when were they spoken? not spoken in 2010 or 2011. not spoken in 2012 or 2013. rather, these words were spoken in 1964. and who do you suppose spoke

them? ronald reagan, president reagan, who was speaking out against medicare which became law the following year. fast forward 20 years and things were quite different. president reagan said in 1984 -- quote -- "millions of americans depend on the medicare program to help meet their health care costs." and he continued -- and i'm quoting -- "we must ensure the long-term solvency of the medicare program and i'm confident that we can find the right solutions in a bipartisan manner." well, what do you suppose happened in that 20-year period to change president reagan's mind? well, the hysterics ended. people gave the new program room to breathe and it worked. medicare gave america's seniors access to health care they'd never had before. the same pattern emerges when you look further back into history.

consider social security. in 1935, one senator said that social security would -- quote -- "go a long way toward destroying american initiative and courage." another member of congress said "the lash of the dictator will be felt." these are chris simples o critik legislation, monumental laws that are now vital to every health and welfare of our nation. while criticizing their conception, social security and medicare are now considered the most successful large-scale federal programs in our nation's history. and i'm confident history will treat the affordable care act in a similar fashion. i'm confident the complaints of those have gone so far as to call the affordable care act a crime against democracy or a centralized health dictatorship will soon be drowned out by the voices of the american people whose lives are better off, why? because of the affordable health

care act. already the a.c.a. has done more than any other law in the past half century to expand health coverage. in the past three years, the a.c.a. has provided 71 million americans free preventive services. more than 6 million seniors have received discounts on vital prescription drugs. more than 3 million young people have peace of mind and knowing they're allowed to stay on their parent's health plans until they turn 26. and i'm especially proud of the fact that now no child -- no child -- can ever be denied health coverage because of a preexisting condition. all that and the full benefits of the law have not yet taken effect. the american health care act is not -- the affordable health care act is not a perfect law but neither were social security or medicare when they passed congress. adjustments may need to be made to improve the a.c.a. as well and to make it stronger, make it better.

it would be easier to make improvements if everyone on capitol hill pampe participatedt we're not getting that chance from half of congress. instead, opponents are making every effort to destroy the affordable care act, fighting to take away its many benefits from america's families and businesses. last week, the house passed a continuing resolution to pay for the government for the remainder of the year but that bill, the bill before us today, included amendments to eliminate all funding to implement the affordable care act. i want to be very clear here -- we are not going to let that happen. we are not going to go back to the status quo. we are not going back to a broken system where more than 50 million americans lack health insurance. we're not going back to a system that allows the costs of medical care to overwhelm a family and force them into bankruptcy. we're not going back to a system that allows the simple lack of insurance to contribute to the death of thousands of americans each year.

we are not going back to return to the status quo. no, we're not going to do that. rather, we are full steam ahead on implementing the affordable care act. in just six days, the health exchanges or marketplaces will open for business and the affordable care act really kicks in. now, what does that mean? for the majority of americans, nothing really. despite all the scare tactics, despite all the rhetoric, nothing will change for the millions of americans who already get health insurance from their employers or who are getting medicare or medicaid or from the veterans administration. but for those almost 50 million americans who don't have health insurance, they will now have access to affordable care and peace of mind. thanks to federal tax credits and subsidies, for the first time, millions of working-class families will pay less than $100 a month for health insurance. and for the most vulnerable

among us, they'll receive care through an expanded medicaid program. no one, no one can be denied health insurance anymore, that is unless some in the house have their way. their intention, clearly spelled out in the continuing resolution before us, is to undermind and defund america's health care law. for years we've been trying to solve the problem of rising health care costs. for years we've been trying to help working families gain access to comprehensive coverage that doesn't make them go bankrupt or complete their household budgets. past presidents, congresses, and other policy-makers have tried to fix this problem time and again and we sit here today with a solution -- at fordable car te care act. for the first time, every american will be guaranteed health coverage. it will no longer be illegal for health insurance insurers to

deny someone coverage for a preexisting condition, like breast cancer or pregnancy. yeah, before the a.c.a., being pregnant was a for instance, you can believe it. that's what the health insurance industry thought. that's just wrong, and with the passage of this act, it's no longer the case, pregnancy is not a preexisting condition or a basis to deny health insurance. but the house wants to stop this and continue limiting consumer protections and access to affordable care. the a.c.a. also provides free preventive services like wellness visits and mammograms. and since the law passed, 71 million americans have received preventive benefits like these for free. oh, but the house wants to take this away. under the a.c.a., insurers can no longer impose lifetime or annual limits on care and this means that more than 105 million americans no longer have a cap or a limit on their coverage, no longer can insurance companies say, no, no, no, no more. but the house wants to take this away, too. approximately 3.1 million young

dawls have gaineadultshave gaine a.c.a. provision that allows them to stay on their parent's health insurance until age 26. we've all heard so many favorable comments about this provision in our home states. but, no the house wants to take that away as well. i'm concerned about the effects of the house continuing resolution, not only on health care reform but also on seniors and medicare. leader reid and i wrote a letter last week to health and human services secretary kathleen sebelius and we asked her what impact the house c.r. would have on the operation of medicare. specifically, we asked how the c.r. would affect beneficiaries' access to care. and last friday we received a response that confirmed our fears. the house bill would have much broader and more harmful implications for the medicare program and for seniors. in her letter, secretary sebelius said the c.r. would --

quote -- "severely impact the medicare program." she goes on to note that the house c.r. would eliminate funding for medicare prescription drug coverage, forcing seniors to pay more for their prescriptions. the secretary also said the house c.r. would disrupt payments to doctors and cut off annual welfare visits, forcing seniors to pay out of pocket for preventive services. in addition, medicare beneficiaries may be forced to drop their medicare advantage plans and enroll in traditional fee-for-service. it's clear that the house c.r. would have dire consequences for the more than 46 million americans who rely on medicare every day. in her letter, secretary sebelius also stressed the severe impact the house c.r. would have on children and on working families, the most vulnerable among us. the a.c.a. expanded medicaid, allowing states to cover low-income adults for the first time. the house c.r. would end this

coverage, sending this vulnerable population back to the emergency room for treatment and putting hospitals on the hook for providing caremen care. the a.c.a. also expanded access to services for people with disabilities and other long-term care needs. the c.r. would put an immediate stop to these programs and send people with disabilities back to the nursing home. the affordable care act also extended the children's health insurance program for two additional years. the house c.r., you guessed it, reverts back to prior law, ending funding for this vital program at the end of this month. the house c.r. also leaves 6 million kids without access to coverage -- on doctor's appointments, no prescriptions, no casts to heal the occasional broken arm. mr. president, for three years, a group of republicans in the house have wasted taxpayer mon money, time and resources again

trying to stop the act over and over again. in fact, they have tried to repeal this act 40 times. they even took their argument all the way to the supreme court. of course, we all know what the supreme court said. the supreme court said affordable care -- the affordable care act is the law of the land. the supreme court upheld it. it's the law. people fear what they don't kn know. i understand that. but let's all take a deep brea breath. as one republican senator recently noted, it is -- quote -- "not rational to think the senate will vote to repeal, delay or defund the a.c.a." you know what? he's right. it's not rational. we won't go back to the status quo. this is complex legislation and i'm open to strengthening the through better serve the american people, just as this congress did with social security and medicare. wouldn't it be better if both parties worked together to improve the law, something that's here with us. it's not going to be repealed. let's work to improve it.

that's what the american people expect of us. they don't want the government to shut down. they don't want america to default on its debt over the a.c.a. a recent poll by cnbc town thece vast number of aamericans, 59%, opposed defunding obamacare. almost 60% say no, don't do that, that's not smart. we all have a responsibility to lead. at fordable care act is the law of the land -- the affordable care act is the law of the land. we all need to work together for the families and businesses who depend on it instead of using it as a political football. enough is enough. it's time for the hysterics to end. people need to give the a.c.a. room to breathe, a chance to succeed. if we do so, i'm confident america will be better for it and we will all object the right side of history -- and we will all be on the right

side of history. thank you, mr. president. i yield the floor. mr. president, i have one request, a unanimous consent request. that the following staff of the finance committee be allowed on the senate floor for the remainder of the 113th session -- kevin mc nillis, carly borth, steven jenkins, sib he will tillson, taylor harvey, matthew deavers, craig t to to e son, lewis evans, daniel parnsa, and robert andres. the presiding officer: without objection. ms. mikulski: mr. president? the presiding officer: the senator from maryland. ms. mikulski: mr. president, i rise to speak about obamacare. and i do call it obamacare. you know, when we passed the law, it was called the affordable care act. and before he leaves the floor, i would like to compliment the

senator from montana on the important and crucial role that he played in passing the affordable care, health care act. and it was his excellent stewardship in the finance committee where we could expand access to health care, modernize the way we do it to go from volume medicine to value-based medicine, and to be able to expand our access in a way that also was fiscally prudent. he also led the way in expanding the children's health initiative. so i know later on he is planning in his life a new future for himself, but i want you to know that while he's thinking about how he will be living a different life, he really impacted the lives of many people. i stand here today to thank him personally in a heartfelt way in

the way he has improved the lives of people, and particularly the lives of children and women in this country. mr. baucus: mr. president? the presiding officer: the senior senator from montana is recognized. mr. baucus: mr. president, i deeply thank and am humbled by the statement of the senior senator from maryland. coming from her, that is a high compliment. i deeply appreciate it. ms. mikulski: so, mr. president, here we are. we are having a national debate on the senate floor about should we provide access to health care to all americans and be able to do away -- do it in a way that is fiscal include prudent and modernizes the way we deliver health care to emphasize value health care over volume health care. and we are having this debate even though we passed the legislation in 2010. now, i thought when you passed a

bill and it was signed into law that it was the law of the land. but oh no, here we go again. we're trying to take legislation that was passed and undo it by defunding it. i don't know what we're doing here. you know, first there was an attempt to delegitimize president obama. well, he's won two elections. the american people said we want barack obama to be our president. when he ran the second time, we had passed the health care initiative, so that was another affirmation that that -- there was public support for that bill. and now here we are on the eve of the funding for fiscal year 2013 expiring that there is a manufactured crisis bringing the

government to the brink of a shutdown because the other party and a few in it are sore losers. they lost the election. they lost the battle to get the votes while they had the opportunity to vote and amend and change the affordable care act. so now here we are, and i think that it is an outrageous use of the senate's time, and we immediate to be able to move on with the serious business governing our country. i worry about unemployment in our country. i worry about the fact that our children are no longer achieving the best in the world. i worry about my small to mid-size business have access to capital. i know that many here call this bill a job killer. you know what's a job killer? our behavior here in the senate. this gridlock, deadlock, hammer lock on the united states senate

means that we cannot do the business of the country in an orderly and predictable way. therefore, when businesses want to plan what are going to be the rules of the game coming out of the united states government, they're not going to know. so if they're planning what they should do about their business, should they expand, what should they do, they need certainty. as long as we play brinksmanship politics, you cannot have certainty. so one thing is certain, though, that we definitely keep the obamacare. i'm happy to call it obamacare because i think obama does care, but i think all of us here who are democrats certainly, in the senate and many on the other side of the aisle also support the fact that we want to increase universal access. so let's go to what the legislation meant. when we passed the affordable care act, number one, it

provided access to more people for health care. when we passed that bill, 42 million americans did not have access to health care. so that means here in the united states of america if you needed a doctor, that doesn't mean that you would have one. if you needed a prescription drug, it doesn't mean that you could afford to buy one. in many instances this worked hardship on many families. but also the affordable care act did, ended abuses of health insurance companies. when we passed that legislation, people were denied health care on the basis of a preexisting condition. that often meant that for children in the united states of america, if they had juvenile diabetes, if they had cerebral palsy their families couldn't get health care insurance

because these children had a preexisting condition. and if you were a woman, it was even worse, that pregnancy was considered a preexisting condition. that in some instances where you had a premature birth and a c-section, you were denied health care because that was considered a preexisting condition. in eight states if you were a victim of domestic violence, you didn't -- that was counted as a preexisting condition and you couldn't have access to health care. now what is that? so in the affordable health care act, we changed that law, so we created the opportunities that the punitive practices of insurance companies would not be a barrier to you being able to get health insurance. then there was this other issue of lifetime caps. that means if you had a condition and you hit a lifetime cap, then tough luck for you. well, what happens if you have a child with hemophilia?

that's a hard, hard thing for that child to face the rest of his life or her life and for the family. don't you think there should be -- there should be no caps on the benefit? what happens if you are struggling with cancer and you hit a cap? it doesn't mean that your need for treatment ends t. just means that your -- it just means your insurance company won't pay for it. we lifted the annual lifetime caps. and for we women, the double insult of paying more for health insurance simply because we were women was repealed. in the health care affordable care act, there is no gender discrimination. we found in our hearings that women were paid two to ten times as much for their health insurance as men of the same age and health status. we don't think that was fair,

and we changed it. we also improved health care for seniors. number one, we added new medicare benefits. one, free cancer screenings, early detection means better treatment and a better chance of surviving that dreaded "c" word. it also provided an annual free checkup where you could go and we could get an identification of those killers, those silent killers early on. so if you have high blood pressure, if you have high blood sugar, we found those early and could intervene before they either moved to a deadly situation or worse. we know that high blood pressure undetected can lead to a stroke or to death. so we helped, i think, get better health care and better value for our seniors for that. then there is the prescription drug benefit. you know, the prescription drug

benefit called part-d, and there was something in it called the doughnut hole. the doughnut hole was hard to swallow because it meant once a senior's drug costs exceeded a certain amount, they went into not a doughnut hole but a dark hole and they had to pay for the full cost until they reached a catastrophic threshold. now, mr. president, for many people with chronic conditions, not only those dramatic things like cancer, but a chronic condition like diabetes, you can reach that doughnut hole pretty quick. but that's exactly what enables you to manage your blood sugar. working with your doctor, following a program of diet and exercise, you still need a

medication to help control that blood sugar. if you don't get that medication, you then could be heading for worse problems related to diabetic knew rop think, to -- neuropathy, to vision loss, to the need for dialysis. you need to be in a program that you can follow and that you can afford. that's why closing the doughnut hole was so important. it saves lives and it saves money. i could go on to other examples about what is in the affordable care act. there were many advances in terms of women. there were many advances in terms of kpheurpb. but i want -- in terms of children. i want people to know because i'm getting a lot of sreut mr. getting a lot of vitriolic tweets that maryland wasn't

being served. when i looked at the data 48,000 young americans were able to go on their parents plan and had health insurance while they looked for a job or finished their education. also 485,000 marylanders were on medicare, were able to get that annual checkup. 72,000 marylanders were able to participate in the eliminating of the doughnut hole. that saved them on the average of $700 a year for a total of $51 million that was pumped back into the maryland economy to do other things and create jobs for other people. so when they say they want to defund obamacare, what is it that they then want to replace it with? do they want to go back to big insurance in their punitive practices of denying coverage for a child with a preexisting condition? let them call the parent of a

juvenile diabetic or cerebral palsy. do they want to defend the fact that young people can't stay on the plan with their parents until 26. do they want to make that phone call and say we know you're working hard to find a job or working hard to finish your education? no. do they want to eliminate caps on benefits? do they want to eliminate closing the doughnut hole? no. they just say they want to eliminate it. well, i would eliminate this from the c.r.. so let me tell you where i come in as the chair of the full committee. i, in a very short time, the democratic leader, the majority leader, will offer an amendment to the c.r. sent over by the house. i want to get rid of this brinks manship, slam-down, slap-down, shutdown politics. the amendment we will be offering will strike the provision to defund obamacare. it will strike the provision

that was put in on debt ceiling, which means the way they want to structure it, the house sent over, is we pay china first and then americans at the end of the line. i then want to set into motion, working with our democrats, it's not i -- we democrats want to have a c.r. -- you're holding your finger up. i want to have an amendment so strike out the defunding of obamacare. strike the language on the debt limit. move the date for the next -- the continuing resolution from december 15 to november 15 so that we can get to a situation where we focus on completing our budget, getting an omnibus and eliminating sequester for two

years. i want to get rid of the theatrical politics and get into the real business of running -- of helping govern america in a way that provides jobs, economic opportunity, and ensures our national security. mr. president, i yield the floor. the presiding officer: the senator's time has expired. the senior senator from tennessee is recognized. mr. alexander: thank the president and will you please let me know when 15 minutes has expired. i have 20 minutes. i would like to know when 15 has expired. mr. president, once after i had made a speech, my late friend alex haley, the author of "root" came up to me and said, can i make a suggestion. of course. he said, when you speak, if you would say instead of making a speech let me tell you a story, someone might actually listen to what you have to say. so i do have a little speech on

the new health care law to make, but before i make a speech, let me tell a story that i think applies to the new health care law. and it is a story about two famous and patriotic tennesseans who went to texas. the two men are sam houston and davy crockett. in the early part of the 19th century, sam houston was the goafn ogovernor of tennessee. he resigned that post because of a problem with his marriage. davy crockett got crossways with andrew jackson and he lost his race for congress in 1835. he went to the courthouse steps in madison county, tennessee and said i'm going to texas and you can go to hell. and he went to texas. that's historic.

i'm not using bad words here. so we had these two famous tennesseans, patriotic, brave men, both of whom went to texas. they had the same goal in mind, the independence of texas. but they had different tactics in mind. former congressman davy crockett said, i think i'll go to the alamo. some people said, davie, if you go to the alamo, you'll get cismekilled. he went to the alamo and he did get killed. we remember him for his brave ir his bravery and we remember the alamo. he was heavily criticizinged by for withdrawing. some said it was a retreat. he waited until the mexican general it was in a siesta with his troops. he attacked him and won the war. so today, mr. president, we celebrate both men. we think of them both as patriots and we remember the

alamo but we celebrate texas independence day on march 2, 1836, because sam houston wasn't won the wample the moral of the- because sam houston won the war. the moral of the story is that sometimes patience is a valuable tactic. that's why i'm in sam houston's camp on this one. i am not in the shut-down-the-government camp. i am going to delay, dismantle and replace the health care law which we call obamacare with a law that actually reduces health care costs for men's. -- for americans. my reason is that shutting down the government won't work. the problem is that even if we vote -- even if we were to shut down the government, according to the way some people argue -- and i understand their passion and i respect it -- obamacare

would just keep going like the energizer bunny. the first reason i, as senator coburn has pointed out, most of it is mandatory spending. so money for the exchanges, money for the subsidies, moneys for the individual mandates -- senator coburn estimated 85% of the funding for obamacare would just keep going. what he h. so we would have shut down the government but 85% of obamacare would just keep going. if that's enough money, the president has the authority within the law to declare some services essential. i would assume that since this is his signature issue and is a president -- and he's president for another three years that he would declare most of obamacare essential services. and so where would we be? as long as we have a democratic majority in the senate and president obama in the white house, it would take 67 votes here in the senate to repeal

obamacare. and we have 45 -- 46 today on the republican side. every one of us has voted against obamacare repeatedly. every one of us would do so again. every one of us would vote to repeal t but in my view, the right tactic is not to shut down the government. it won't work. obamacare would just keep going and we would have shut down the government. what does that mean? what does a government shutdown mean? not everything would cut down but here are some of the things that would or could happen. there are 3.4 million active duty military who would have to report to work, whj at fort campbell in kentucky or tennessee or in afghanistan without being paid for it as long as the government shut down. and at home their spouses would suddenly find the department of defense schools closed. so what are they going to be doing for child care and with the check arriving not at all or late to pay the mortgage?

social security would continue to be pairksd but the offices -- to be paid, but the offices might be closed. more than 20 million of our veterans get disability payments. they might come late. 2 million americans fly every day. there would likely be fewer t.s.a. agents, fewer air traffic controllers, long lines at the airports in nashville, new york, and chicago. how do you think those 2 million people are going it feel about that? the national parks would close. head start might close. 110,000 people at our national laboratories, many of them would be furloughed. the last time the government shutdown 20 years ago, 200,000 people applied for passports, couldn't get them. there are tennesseans going to college in fall who want or in the process of getting a new student loan. they might not get it, at least on time. your gun permit might not come through, neither might your f.h.a. loafn.

loan. the last time we had a government shutdown it cost the taxpayers $1.4 billion extra according to the congressional research service. so one reason i'm in the sam houston camp on this, and i want to show a little patience in terms of trying to win the war, is that if we shut down the government, obamacare keeps going, it costs the taxpayers a lot of money, and inconveniences most americans, which leads me to the last reason it is a bad idea: who do you suspect is going to get imlaimed for this? we will have succeeded in shifting the blame for passion obamacare from the -- for passing obamacare from the democrats, who did it unanimously, to the republicans for shutting down the government. you think the democratic national committee might have come up with that idea, not the republican national committee. that might not be a good public policy reason to take a position here, but it is a fact. and people all over the country are observing. and then there's some who say, to be a good conservative, you've got to vote to shut down the government.

i've been listening to these people who define who is a good conservative a.j. an and who isa good conservative. it is like being in sunday school and somebody new comes into class and says i am a better christian thorn. and if you -- a better christian than you are. and if you don't agree with me, get out of church. we all try pretty hard in our faith. that's really not up to us to judge which one of us on the republican side is a better conservative than another. anybody who looks around knows that, among republicans, most of us are conservative. but we have many different kinds of conservatives. we have neoconservatives, paleoconservatives, fiscal conservatives, social conservatives, cultural conservatives, we have ross perot conservatives, we have opened the door over the last 40 years to every kind of conservative. it's made our party bigger and more successful and more conservative because we've tolerated points of view. so, i'm not for shutting down

the government. for all those reasons. it won't work. the last time it was shut down 20 years ago the congressmen couldn't buy their plane tickets about a being to washington fast enough to open up the government because the voters were absolutely outraged. it would shift the blame for obamacare, which ought to be the referendum in 2014, are you for it or against it, to republicans -- should you shut down the government or not shut down the government? and we shouldn't be in the business of saying i'm a better christian than you are or i'm a better jew than you are, we ought to respect each other's point of view. what should we do? first, mr. president, we ought to delay implementation of the new health care law. and my colleague from tennessee, representative marcia black burn, i've never heard anybody question her conservative credentials, and senator jeff flake from arizona, wrote an editorial the other day -- and i ask consent that it be put in the record following my remarks.

the presiding officer: without objection. mr. alexander: the health care law must be delayed." the presiding officer: without objection. mr. alexander: the reservation t has already delayed provisions of the health care law enforcement it is coming too fast. the chairman of the finance committee saidin said it is goie a train wreck. the employer mandate has been delayed far a year. the requirement that insurance companies report to the i.r.s. information about health insurance products has been delayed for a year. the ability for employers to provide employees with multiple health insurance plan options for their employees is something we call the small business shop exchange has been delayed for a year. the ability for state medicaid programs to send electronic notices to beneficiaries, that's delayed for a year. the start of the basic health program, delayed for a year. other provisions have been delayed for a year, including regulations that the administration has simply not had time to issue.

so why not delay the entire program for a year? that would give the administration time to at least get ready for the program, and it would give the american people a chance to have a rerchg dumb on -- a referendum on the program in the year 2014. that's the first thing we could dovmendo. the second thing we could do is begin to dismantle the program. we should repeal all of the job-killing premium-hiking taxes, especially the medical device tax, an especially onerous tax that's 2.3% on the revenues of those companies. it drives up the cost of medical devices that tens of millions of americans use. and repeal the mandates on individuals, families, and job creators that drive up premiums. but that is not all we should do. that is not all we should do. we have a responsibility to say what we would do as republicans if the voters were to trust us with the government, if they were to give us six more

senators who would vote to delay, dismantle, repeal, and change obamacare. what would we do with it? or if they were to give us in a couple of years a republican president, what would we propose? we can do a pretty good job of saying what we don't like about obamacare. three years ago i was asked by senator mcconnell and speaker bainer to lead off for the republicans at the president's health care summit. i took the opportunity to outline for the president some of the problems that we saw at that time. it turned out that we were pretty prescient in what we were doing because most of the problems we predicted have happened. more subsidies, more spending, more taxes, we said. a 2,700-page 3weu8 bill, more o. probably a lot of surprises in it. we said three years ago. it will cut medicare by a half trillion dollar and spend most of that on new program, not making medicare stronger.

even though medicare is going broke in several years according to the medicare trustees, people won't be able to depend on medicare. it means there will be about a half trillion dollars of new taxes, we said. it means for millions of men's, premiums would go up and the newspapers are filled with stoirs of risstories of rising s today. it is what we said at the president's health care summit three years ago. but we said something else. we said we have an obligation to say what we would do instead. and i said to the president at that time, mr. president, the president's -- your health care larklaw, your proposed law, is n historic mistake because it expands the health care delivery system that already costs too much instead of taking steps to reduce the costs of that health care delivery system. it is a mistake because it attempts to be comprehensive and it's too big -- too big a bite to chew. too much to digest too much to

swallow at one time. that's turning out to be right. that's why we have all these delays. so we suggested in addition, mr. president, why don't we go step by step tegin to reduce health care costs and we suggested at the president's health care summit, working with him in a bipartisan way to do that. we can still do that. we can delay it. we can dismantle the parts i talked about and then what do we do? step one -- make medicare solvent so seniors can depend on it. senator corker and i have a proposal which will do that, offers seniors more choice choi. at the same time, reduce the federal debt by several hundred billion dollars. medicare needs to be solvent because we have many te tennesss who depend on it to pay their hospital bills. number two --

give governors flexibility with their state medicaid programs. medicaid's gone from 8% of the state's budget when i was governor in the 1980's to 26% today. it's soaking up money that ought to go to higher education. governors would like to keep tuitions from going up higher. the reason they're going up is federal medicaid mandates. make medicaid more flexible. i said when the health care debate was on that every senator who votes for it ought to be sentenced to go home and serve as governor for two years to try and implement that law. and now they're trying to do that. maybe that's why we have 31 republican governors who are having a hard time trying to do that. i thank the president. number three, step three, strengthen innovative workplace wellness programs. the administration has a regulation that needs to be repealed that restricts the ability of employers to say to employees, if you live a healthy lifestyle, you can have lower insurance premiums. that's what we should be doing, so that's step three. number four, let small businesses pool their resources and offer lower-cost insurance

plans for their employees. number five, provide families the opportunity to purchase insurance across state lines. number six, expend ack -- expand access to health savings accounts and catastrophic health insurance plans. that would give people an opportunity to buy cheaper insurance rather than more expensive insurance. number seven, incentivize the growth of private health insurance exchanges. number eight, make it easier for patients to compare prices and the quality of doctors. number nine, incentivize states to reform junk lawsuits. now, mr. president, there are two ways -- one way to delay obamacare, two ways to dismantle it, and nine steps to take to move from expanding a health care delivery system that already costs too much, to introducing more choice and competition into our health care delivery system with the goal of reducing costs for most americans. that is a program, that is an

agenda, that is a plan that will earn the confidence of enough independent voters in tennessee and other states across this country to elect more republican senators or democrats if they agree with us that will give us a chance to dismantle, delay, and repeal the health care law which was an historic mistake. so, mr. president, this is nothing new. we counted it up. we mentioned 173 times in the health care debate our step-by-step plan to reduce health care costs. we stand ready still to put it into place. and the best way to do it is not to shut down the government. the best way to do it is to take over the government, take over the government. elect some more senators. elect a president. put in a bill. that's our constitutional system. we all admire the constitution. we carry it in our pocket. we talk about it. we have a constitutional system. we have to follow those rules if we want to make legislative changes. so i greatly respect the passion

and the help diewrn endurance oe senators who argue we should shut down the government if we don't get our way immediately on the health care law. i respect that. just as i remember the alamo and i respect our great tennessean, davey crockett, who went to texas. but on this one, when it comes to tactics, i'm in general sam houston's camp. i think we're going to have to show some patience to win the war. in the meantime, to win the war, let's delay obamacare, let's dismantle it, and let's show the american people that we have a better plan, better steps to replace what's in the law now with step-by-step-by-step to reduce the cost of americans' health care. that's the plan that i'm voting for today and for the rest of this week, for the rest of this year and next year until we get the job done. i thank the president. i yield the floor. a senator: mr. president?

the presiding officer: the senator from indiana is recognized.mr. donnelly: thank you, mr. president. when i was working in indiana last month, there was one thing i heard everywhere i went -- congress should spent last time fighting and more time focusing on creating jobs. mr. donnelly: we've made significant progress in indiana since seeing unemployment rates, mr. president, north of 20% in some of the counties in our state just a few years ago. but there's a lot of work yet to be done. too many hoosiers are still looking for jobs. for all of the fighting here in washington, back home in india indiana, everyone's on the same page. they want good, stable jobs so they can take care of their families, send their kids to college, and retire with digni dignity. that's what hoosiers want and most think congress can do something to help in that rega regard. even if that something is simply

don't make things worse. and what instead do many of my constituents think they're getting from the legislative branch? george smeltser from ninova, indiana, sent me an e-mail, and he said, "enough is enough already. washington is like a bunch of children playing at recess and all fighting for one toy. unfortunately that toy is the american people. i've got news for you, most average americans are not liberal left and are not conservative right, we're in the middle. we're tired of being smashed around like ping-pong balls in a partisan game of politics." mr. president, we were at a critical point in our ongoing economic recovery. in the next week, this congress will decide whether to keep the federal government open and operating. in the weeks ahead, this congress will decide whether to continue to pay the government's

bills, our bills. we can go one way -- the responsible way -- and show the american people we're capable of working with one another. or we can continue to yell at each other, to score political points, refuse to be realistic about the need to find common ground and shut down the government and stop paying our bills. the bills we are responsible f for. clearly i prefer the response i believe wathe responsibleway, td thousands of additional jobs for the folks back home who want and need them. when i first spoke on the senate floor this spring, i discussed my strong belief that government can help create the conditions necessary for businesses to expand and hire more workers and for the american work force to be better ready to hit the ground and be moving on day one. i am offering three

straightforward bipartisan commonsense things that we can do right now to help the econo economy. we should pass the bipartisan america works act introduced by my friend, senator kay hagan from north carolina, and supported by myself and senator dean heller so we're training the next generation of employees to have 9 skills that employers need. -- to have the skills that employers need. we should finish our work on a five-year bipartisan farm bill that the president can sign into law. american farmers deserve that certainty. we should also cut red tape to encourage private investment in infrastructure. i'm working with senators portman and mccaskill on a bill that would cut red tape to improve the permitting process for big infrastructure projects, helping private industry create jobs in indiana, in ohio, mr. president, and across the country.

fights to and possibly beyond the brink about whether or not to have the government up and running and whether or not to pay the government's bills, our bills, in a timely fashion has a devastating effect on confidence and on our still recovering economy. when, however, we do the responsible thing? when we actually do our jobs, we can help the economy and we can help our constituents, and just maybe as a result give them reason to have a little bit more confidence in this institution and in our country's government. sharon o'brien of crawfordsville, indiana, told me in an e-mail -- "i'm sure many hoosiers feel as i do. there needs to be compromise between the parties in order to begin solving the many problems facing our country today. let's start solving not creating problems for our country.

let's help create jobs. let's get to work and let's build america." thank you, mr. president. i yield back. the presiding officer: mr. president? the presiding officer: the senator from main -- from maine is recognized. a senator: mr. president, i want to begin with a story, a stouffer two young men, both married, both with two kids. both contracted cancer the same day, malignant melanoma, the kind of cancer that comes from a mole, not uncomferl unfortunately in our soap. one of these young men had insurance. in fact, he had an insurance policy that provided preventive care, and under that policy, they provided a free checkup. and, indeed, his insurance covered him -- his ability to go and have his checkup in the evening so he didn't even have to take a day off of work.

mr. king: he went in, had the checkup. the doctor looked, found a mole on his back and said, this doesn't look so good. i think we should take it off. a week later he went back to have the stitches out. the doctor said, i think you better sit down. you have a pretty serious form of cancer. the young man went to the hospital, had an operation, removed a hunk of his back of stitches under his arm, took out the lymph nodes and found that the cancer had not yet spread. didn't have to have chemotherapy, didn't have to have radiation; he was okay. the other young man didn't have insurance. so he didn't go to the doctor, he didn't have that checkup. he had the mole on his neck but he didn't really notice it or pay much attention to it. six or eight months later, he noticed a lump in his neck. still didn't pay any attention to it, didn't have insurance, didn't really want to go in and spend the money to go to the emergency room or to go to the doctor so he didn't really pay

much attention and he let it go. six months later, the lump was so large he finally went to the doctor. they biopsied it, found it was the metastasized malignant melanoma. he had chemotherapy, he had radiation, he had surgery, but a year later he died. that story means a lot to me because i'm the first guy. 40 years ago, when i was a staff member in this institution, i went and had that checkup because i had insurance they found the mole, they did the surgery and here i am today. i've often thought about that and wondered, "why me?" just luck. but also because i had insurance. i can tell you to a certainty, mr. president, if i hadn't had that insurance, i wouldn't have gone to that checkup. and if i hadn't had the checkup when i did, within months or

perhaps a year and a half, i would have been gone. a similar story of the daughter of a friend of mine up in maine, dick gould. he had a daughter named connie. she was born with severe asthma. all her life she battled it. she lived in a very rural part of maine, not a lot of money, could never afford insurance. but she fought the asthma that she could. she did the best but she couldn't afford the expensive treatments. and finally, not long ago at the age of 53, connie gould died, leaving a husband, children and grandchildren, one of whom she hadn't ever met. why did she die? because she didn't have insurance.she couldn' she couldn't afford to go in and have the care that she needed. why are we having this discussion here in the united states senate this week about health care? the answer is pretty clear.

there are 50 million people in this country who have no health insurance. the estimates are that between 20,000 and 30,000 of those people die each year, like connie gould, because of the lack of health insurance. why doesn't that bother us? why aren't we spending days and nights here talking about how to solve this problem instead of how to -- how to dismantle the most significant health care program that's come to this country in years? why? i have a theory about that. it's because those deaths are invisible. they happen one at a time in greenville, maine; in portland, maine; in san diego, california; in el paso, texas. nobody knows, it's not listed in the obituary -- "died because of no health insurance." i would submit, mr. president, that if those say -- call the number 25,000 -- that's a conservative estimate -- if

those 25,000 people in this country each all died at the same day in the same place, we'd be turning the world upside-down to solve the problem. imagine, it's the loss of a small town in your state each year, 25,000 people a year. on september 11, 2001, we had a tragedy in this country, 3,000 people died. it was a terrible day. and what have we done as a result of that day? we've turned our society upside-down,ct ourselves at airports, we've spent money for screening and protection. we spend, mr. president, biio on intelligence, just intelligence, in order to protect ourselves from another september 11. and yet quietly, insidiously of yea --insidiously every year ovr

20,000 people die because they don't have insurance. another 700,000 families lose everything because of medical bills. we're the only country in the world where that happens. we're the only country in the industrialized world where people are prone to lose everything because they're swamped with medical bills. that's ridiculous. would we watch someone die in our front yard? of course not. we would call 911. we would call the doctor. we would do c.p.r. we would do whatever we could to keep them alive, but we're quietly as a society watching over 20,000 people a year die, and we are arguing about the details of how to solve this problem. to me, it's a moral question. there is a lot of economics involved. there is a lot of questions of cost, and we'll talk about that, but fundamentally it's a moral question.

the moral question is are we going to stand by and watch people suffer and die because of ideology and politics? no other country in the world has answered yes to that question, and that's the question that's really before us. so what is this thing called obamacare? the affordable care act. what is it called? the first thing to say is what is it not? and what it is not is a tremendous impact on american business. 96% of the businesses in america have less than 50 employees. they are not affected by obamacare at all. in fact, they are probably benefited by it because whether or not they choose to buy health insurance, their employees can get health insurance through the new health exchanges, and that's probably a benefit to those businesses, but 96% of the businesses the law doesn't apply to. 98% of the larger companies, 200 employees and more, already

provide health insurance to their employees. so the law really doesn't apply to them. 94% of the smaller firms from 50 to 199 already provide health insurance to their employees. so we're really talking -- somehow this idea that obamacare is taking over the health care industry in this country is just nonsense. 80% of the people are largely unaffected by it. they are either the 50% that are covered by the employers now or the 22% or 23% that are under medicare now, 7% or 8% under medicaid, but that leaves 15% uncovered, uninsured, unprotected, and that's between 45 million and 50 million people. this is not a government takeover. there is no place in america you can go and sign up for obamacare. if you go into an exchange, you

get insurance from anthem or blue cross or health first or aetna. you don't get obamacare. you get insurance coverage from private insurance companies, just as we have done in this country for most of the 20th and 21st century. it is not a government takeover, but here's what it is. it's a mechanism to make it easier and cheaper for those people who are uninsured to find a way to get insurance, to go online to a health exchange, which is nothing but -- i suppose you would call it amazon or ebay of health insurance where you can see what your options are, make your choices. you get support if you're within certain income levels from the rest of us, and it makes health insurance affordable. now, it's based upon the free market principle of competition

and that group rates are better than individual rates, and that's the essence of the system is a marketplace where people can buy private health insurance. it's also insurance reform. it repairs and improves and mandates some improvements in the way health insurance works to avoid some of the real glaring problems that most people have identified with and many people have run up against. one is a limitation that health insurance companies have to spend 80% of the money they take in on health care. in other words, there is a limit on profit and overhead. i think all of us feel that that's reasonable, and that's already happening, and in fact some people are getting refund checks from their insurance companies because they were spending too much on overhead and profit. under the insurance reforms of the bill, women are treated equally for the first time. there is an emphasis on

preventative care. and i go back to my own story. the preventative care saved my life, and it was a heck of a lot cheaper than the care that was provided to the fellow that didn't have insurance because he didn't catch it in time. he ended up in the emergency room. he ended up having surgery, chemotherapy and radiation, ultimately fiewtly, but that -- futilely, but that treatment cost a lot more than my treatment did because i was insured and had preventative care. it also allows kids to stay on their parents' policies until they are 26. this is a big deal, because it allows kids to take jobs and do things and travel and work but not have to focus on whether or not they have health care, they can stay on their parents' policies until they are 26. that's happening right now all across america. there are no life-time caps. as i mentioned earlier, we are

the only country in the world where people get wiped out by health care costs. nowhere else is that even remotely an issue the way it is here. and then finally, you can't be denied health insurance because of preexisting conditions. that's crucial because there are millions of people across this country through no fault of their own, because of the vagaries of the -- of health care or of health that have problems they were born with or that came on in youth, and they can't -- under the old rules, they can't get insurance. now they can't be denied insurance, and that's going to make a lot of difference to people in this country. now, because of that -- and i watched senator cruz last night, and he talked about this. if you're going to require that insurance be issued to people even if they have preexisting conditions or some kind of

illness, then you have also got to mandate that everybody buys it, otherwise nobody would buy it until they were in the ambulance on the way to the hospital. if you didn't have to buy fire insurance before the fire, everybody would buy it when they saw the flames coming up from their house. i think senator cruz, the senator from texas, used that image last night. to me, that just makes common sense. it also makes common sense because it's a matter of personal responsibility. i always thought that was a conservative principle. i remember in the 1970's and 1980's, it was a conservative principle that people should take responsibility for themselves, and right now in our society, if you -- if you're sick and if you have no insurance, you're treated. the hospital cannot turn you away. but what that means, mr. president, is that we all pay. that person is in effect a free

rider. they have got insurance. it's all the rest of us. and i think it's a basic principle that they should take care of their own responsibility. this is -- people act like this is some kind of radical notion. we have had -- i don't know about your state and other states, but in maine, we have had mandatory automobile insurance for as long as i can remember. and nobody questions it. because it's responsibility. you node to be responsible for yourself. as i say, this was always a conservative principle until lately, and all of a sudden it is and it reminds me of the old line of mort saul, the comedian back in the 1950's who said if you maintain a consistent political opinion in this country long enough, you will eventually be tried for treason, and here we are. what was once a conservative principle is now an an ema, but -- is now anathema, but i think it's all about personal responsibility and providing for yourself. i understand, mr. president, and i have seen press releases that

there are people going around the country telling young people not to sign up for coverage. i think that's outrageous, it's believable, and they are sentencing some of those people to death or to severe injury because they're not going to have health insurance when they are going to need it. all young people are immortal. i was when i went in for that checkup when i was 29 years old. they think they are. but to tell people not to get insurance when it's available and particularly when it's available at a low cost i think is something that should weigh on the conscience of whoever is funding and developing that campaign around the country. okay. so what is the affordable care act? it is a mechanism to buy insurance. number two, it's reform to the insurance industry in terms of what the requirements are. and number three, buried in it are pilot programs that may turn out, in my view, to be the most

important part of the project, the most important part of the bill, because they encourage changes in the way we deliver health care. as i will mention in a minute, the real problem with health care is cost. and these pilot programs that are being used around the country, including in maine, are already having some spectacular results. i talked to two people from our two major maine hospitals this morning. they are seeing a 60% reduction in emergency room use and a 70% reduction in rehospitalization because of what's called the accountable care organization structure that they put in place for medicare patients in maine. they are seeing better care at substantially lower costs, and this is the kind of pilot and innovation program that's also in the affordable care act that nobody ever hears about or talks about that i think, as i mentioned, may turn out to be the most important part of the law. that's it.

limits on insurance provisions, greater access to insurance. i think we need to calm down around here about what this bill really does. now, it's not perfect. it's complicated. it does have some implementation issues that i'm worried about. i'm worried about too much regulation. i'm worried that they will overdo the regulations somewhere in the government as they implement this, and i think that's something we need to pay close attention to. there are problems like the 30-hour workweek versus 40 hours. those are the kinds of things that i think we need to pay attention to and we need to fix. there has never been a perfect piece of legislation and perhaps those ten commandments on mount sinai, but we need to try to fix things and not just say oh, we're going to tear the whole thing apart and start over. i'm a little skeptical on the starting over part because i haven't seen any inclination to

do so. now, as i mentioned, the larger health care problem is cost. we're now spending 18% of our gross domestic product on health care. by far, the highest number in the world. japan is at about 11%. everyone else is at 8% or 9%. we are spending twice as much per capita as anyone else in the industrialized world, and our results aren't that good. by all kinds of international standards of infant mortality, longevity, customer satisfaction, we are in the 15, 17, 20, 25th in the world, and we're paying twice as much. it's also -- this cost problem is what's killing our budget. all of the debt and deficit problem that we are projecting in the federal budget is based upon health care costs. medicare, medicaid and public employees. that's where the deficit is. it's not in the national parks, it's not in head start, it's not even in the department of

defense. it's health care costs. and we need to talk about that and work on it and do something about it, and i think these pilot programs within the affordable care act are showing amazing promise just in the last couple of years that they have been in place. a note on process and then i'll yield the floor. i have never known of a time when a particular -- the repeal of a particular piece of legislation has been used, has been held hostage in order to keep the government running. we have had arguments about budgetary matters at the ends of budget periods, and there was a shutdown in the 1990's about spending and budgets, but i have never heard of a time when a group tried to use a bill and say we're going to repeal this bill or we're going to shut down the government. in the 1950's and 1960's, the

southerners were dead against civil rights legislation. they filibustered. they tried to stop it, but ultimately it was passed in the early 1960's, and a proud moment for this body and this institution. they never said but we're going to shut down the government if you fund it or enforce it. they had too much respect for the institution. they had too much respect for the importance of the couldn't newity of government -- continuity of government, over and above any issue, no matter how passionately they felt about it. i hope that this weekend, we can let go of this idea that a minority of the government can hold it hostage because of one pick piece of -- particular pief legislation that they don't like. mr. president, this is an economic but it's also a moral issue. it's about trying to help people deal with the shadow, with the

shadow of health care hanging over them. it's not perfect, but it corrects some of the most glaring defects in the private insurance system and it provides an opportunity for the millions of americans to escape the day-to-day shadow of a health care catastrophe. to those who want to fix it, i stand ready to help. to those who have ideas and suggestions, i stand ready to listen. to to those who want to destroy it, however, i stand in the way and for those for whom the shadow has finally been lifted, i stand at your side. thank you, mr. president. i yield the floor. a senator: mr. president? the presiding officer: the senior senator from texas is recognized. mr. cornyn: mr. president, i want to start as we discuss our

efforts to support an effort that started in the house to defund obamacare in this legislation, i want to start by congratulating my colleague, senator cruz on his remarkable 21-hour performance. i promise won't try to duplicate that, at least not right now, but i do admire his passion and his energy and i think probably more than anyone in recent memory he's done more to raise this issue to the american consciousness and inspired people by his passion. and i want to say that i share his determination to stop obamacare before it does any more damage to our country. the two of us represent 26 million people in the state of texas and we've heard countless stories of how the president's health care law is already hurting, not just individuals and families and small

businesses, but hurting the economy. i heard the distinguished senator from maine saying the president's health care law is working pretty well, but i have to say even though i disagree with him about obamacare actually working, i must say that it strikes me as one of the -- one point is irrefutable and that is obamacare that hurting the economy and hurting job creation. because we've heard at least from some of the major organized labor organizations in america, people like richard trump ca, who said that obamacare is killing the 40-hour workweek. it's making full-time work into part-time work. that's one reason he and other labor organization leaders went to the white house recently and asked the president for a special optout or waiver. i believe the only solution is

to dismantle obamacare in its entirety, and some have said, well, after senator cruz got through speaking today after his remarkable 21-hour performance, well, the debate's over. to them, i would say the debate has only just begun. because we will be here in the united states senate for the remainder of this week debating the effort to defund obamacare. now, my friends across the aisle have repeatedly said because republicans want to protect the american people from obamacare, we want to take health insurance away from millions of americans. well, nothing could be farther from the truth. democrats argue that republicans have not put forth any alternatives to obamacare. that's false. it's time to set the record straight. when it comes to health care reform, republicans have three main objectives, all of which are failed under obamacare.

one, we want to reduce costs. the president said this is one of his goals in obamacare. he promised that the average family would see a reduction in your health care costs of $2,500. what are the facts? well, we've seen health care costs go up by an average of $2,400 for that same family. we want expand quality insurance coverage and we want to improve access to care. the president has put most of the apples with his health care plan in the same sack, which is medicaid. medicaid in my state only about one there dr. in every three will see a new medicaid patient because it only reimburses doctors about 50% or less of what they charge other -- other patients. so they simply have had to refuse to see new medicaid

patients. so we want to reduce costs, we want to expand quality coverage so that you own your own insurance policy, and we want to improve access to care. in order to achieve those objectives, we first have to remove obamacare from the table. because we know what the evidence has been in the year since obamacare first passed in 2010. obamacare's already causing employers to drop health coverage so if you like what have you, turns out you can't keep it. it's already causing doctors to leave medicare for the same reason as i mentioned they are leaving medicaid. it's already causing insurance providers to reduce consumer choice. we saw a story in "the wall street journal" -- excuse me "the new york times" just a couple of days ago about that. we know it's already causing businesses to lay off workers and turn full-time work into

part-time work. and it's already causing medical device manufacturers to close existing factories here in america and to move their businesses offshore because of the taxes that target that particular part of the health care industry. and it's already causing many physicians to consider early retirement, causing, again, a restriction in access to coverage because unless you can find a doctor to accept you, you don't have effective access to coverage even though you may have something called medicaid or medicare. if and when the law is fully implemented, obamacare will drive up individual insurance premiums, it will cause millions of americans to lose their existing health care coverage, it will jeopardize medical privacy rights by injecting the i.r.s. into the implementation, it will further damage an already broken

medicaid program and it will prompt even more doctors to stop treating medicare patients. the closer we get to full implementation of obamacare, the more we learn about its myriad problems and its unintended consequences. for example, the obamacare exchanges are supposed to open next tuesday, but most people still don't know how much money they'll be paying for insurance. meanwhile, the full-page story in "usa today" talks about a little noticed provision of obamacare which threatens to cost some families thousands of dollars in health insurance and leave up to 500,000 children without coverage. for that matter, even if obamacare is fully implemented on schedule, the congressional budget office projects that about 31 million americans will still not have coverage. i thought obamacare was designed

to make sure that everybody had coverage. so it seems to me it's failed again in its stated objective. my friends across the aisle like to say that republicans are opposed to expanding health insurance coverage but as i've just told you, we're actually for replacing obamacare which will provide people with more access to affordable health care. in reality, what we're opposed to is policies that reduce health care choices and dramatically disrupt people's existing health care coverage. we're opposed to policies that raise taxes by more than a trillion dollars on people like the medical device manufacturers that i met -- that i mentioned a moment ago which hurts innovation, which hurts people's access to the best quality of health care. and yes, we are opposed to policies that kill full-time

jobs in favor of part-time work, and we're opposed to policies that cause insurance premiums to go up rather than down. it is true, we're opposed to policies that put government bureaucrats between you and your doctor when it comes to deciding what access to health care you and your family ought to have. and we are opposed to policies that cause physicians to refuse to see medicare patients. we're opposed to policies that weaken our health care safety net and we're opposed to policies that massively expand the power of the internal revenue service that's currently racked in scandal from getting involved in implementing your health care plan. so, again, we are for reform that helps bring down the cost and improves access to quality health care in a way that doesn't interfere between the doctor and the patient. the kinds of health care roa

we're for are those -- reforms that we're for are those that deal with cost, coverage, and access. for example, we support equalizing the tax treatment of health insurance so that individuals and employers are put on the same footing, unlike today. we support letting individuals and businesses form risk pools particularly across state lines to provide more choices and more competition when it comes to keeping down health care costs. and we support abolishing onerous mandates. why should you have to buy health coverage that includes coverage that you don't need or want? for example, if you're a young man, why should you have to buy a mandatory health plan that has maternity coverage in it? doesn't make a lot of sense. and yes, we support giving more americans choices when it comes to how to pay for their health insurance, using pretax dollars, things like tax-free

health savings accounts. we also believe that making price information more transparent will create the kind of discipline that comes with a market. for example, if people know what their health care costs are going to be and they see what their choices are, they know that the competition that comes through market discipline will improve not only the price, it will bring it down, but it will improve the quality of service. perhaps the best recent example of that is the medicare prescription drug plan which is now coming 40% below projected costs because now seniors have choices when it comes to their prescription drugs, and those plans compete based on price and quality of service. that's benefiting the consumer and providing a lower price. and yes, we do support tighter curbs on frivolous medical

malpractice lawsuits, which drive up the cost of medical liability insurance and drive doctors out of business. in texas we've had a wonderful pilot program of that and i tell you, we've seen doctors move to texas because they want some predictability when it comes to their medical liability exposure and the costs of their malpractice insurance, and that in turn provides people with better access to doctors. and yes, we believe that you can use existing state -- preexisting high risk pools to insure people with preexisting conditions. in other words, the idea that you need to embrace the behemoth called obamacare just to cover people with preexisting conditions is simply false. you don't. we can do it much cheaper and more effectively by supplementing the state high-risk cools so people with -- pools so people with preexisting conditions can get access to health care.

and we support states having a lot more flexibility to manage medicaid. something that can only happen now based upon a special dispensation from the federal government. if we're able to help people coordinate their health coverage, we can do a better job of making sure that even people on medicaid get access to health care at a lower cost. and as i said, we support introducing competition into medicare so that patients and physicians can work together to hold down costs just as they've done in the prescription drug program that i mentioned a moment ago. so here's the bottom line: obamacare is not the only way to expand access to quality health care. in fact, it may well be the worst way to expand coverage because it raises costs and it reduces patient choices.

and you have to depend on the tender mercies of the federal government when it intervenes between you and your doctor, when it comes to your choices. by contrast, we believe that health care reforms such as those i've outlined just a moment ago would allow us to expand access to quality health care at a lower price without interfering with the doctor-patient relationship. mr. president, before i conclude, because i know there are other colleagues who want to speak, i want to explain once again why i support moving ahead with this legislation that's now before us. i note that a hundred senators just voted for cloture on the motion to proceed to the continuing resolution, which contains the defunded provision passed over here from the house. i am committed to defunding obamacare for the reasons i've said, but i also believe that we ought to avoid a government

shutdown, and i believe that to deny cloture, unlike the vote we just had, had 100-0, to vote against cloture on the very bill that we're for that came from the house that would defund obamacare is a little hard to explain. and it may well prompt the government shutdown which i think benefits no one and it could possibly damage our economy, which as i said earlier, is fragile indeed. here's the ultimate irony. if we were to shut down the government because we refused to pass a continuing resolution to keep the government operating, obamacare still gets funded. that's because it has mandatory spending -- in other words, automatic spending that even if the government shut down, obamacare still by and large gets funded. you don't have to take my word for it.

dr. coburn, senator coburn, has asked the congressional research service for their authoritative opinion, and they said even if the government were to shut down, obamacare will continue to be funded. so i support whatever strategy is likely to help us defund and ultimately dismantle obamacare, but in my view, shutting down the government is not the best strategy because it wouldn't work, according to the congressional research service. obamacare would continue to be funded. so to be clear, republicans are united in our desire to defund obamacare and the bill before us does exactly that. so if we proceed to the bill, my hope is that five democrats, maybe the five democrats who voted for obamacare in its first instance but have been listening to their constituents like i have, people like richard trumka and organized labor who

said the promises you made, this simply isn't performing as advertised and we need something to be done to obamacare, and we have solutions that will address that. if we can find five democrats to join us, perhaps those senators who are running for reelection in states that mitt romney carried by double digits, the senate will have voted to defund obamacare. it's just that simple. plenty of our colleagues have acknowledged the harm that obamacare is doing to our health care system and to our broader economy and now they have a chance to do something about it. now they have a chance to actually vote with republicans to stop this law before it's fully implemented. four years after senate democrats voted to enact obamacare on a partyline vote, no republican voted for it, all democrats voted for it -- the consequences of obamacare are plain for all of us to see.

by proceeding to the house bill we're forcing each member of this chamber to take a stand either for or against their constituents when it comes to a failed health care bill. one of the most unpopular laws in the history of the country. i know where i stand on obamacare. and i know where all of my republican colleagues stand, all of us stand united in our desire to protect the american people from this failed public policy. so i'd urge our colleagues across the aisle to think again, listen to their constituents, including people like richard trumka and organized labor, and help us save america from this failed public policy disaster. mr. president, i yield the floor. a senator: mr. president? the presiding officer: the senator from ohio. mr. brown: thank you, mr. president. i ask unanimous consent that after my five or six minutes that the senator from new hampshire be recognized. the presiding officer: without objection. mr. brown: thank you, mr. president. i would remind my colleagues

after hearing senator cornyn's speech and also the very articulate words of senator king talking about a personal story and this is full of personal stories, of people who get preventive care or they don't and the difference that makes in people's lives, the quality of their lives and their life expectancy. i remind my colleagues that just that my state alone about a million seniors have gotten preventive care in various kinds of tests, senior citizens on medicare, at no cost with no co-pay and no deductible. about a million ohio seniors have gotten that benefit from the affordable care act. about 100,000 ohioans in their 20's have been able to join their parents' health plans until they're age 26 and gotten insurance, people in their 20's that didn't have insurance otherwise. there's something called the medical loss ratio. for every dollar of premium in insurance you pay, 80% to 85%

of that must go to patient care rather than profits and executive salaries and marketing. that has forced the health insurance companies to write refund checks to tens of thousands of ohioans. a number of ohioans have benefited in a whole host of other ways. we know this health care law already is working, we know it will continue to work. and when i hear people in washington, d.c. that dress like this, that all enjoy pretty darned good health insurance paid by taxpayers, and then i see my legislature in columbus, legislators who also have health insurance not even expanding medicaid, not allowing people as children especially and -- children and seniors and disabled people and often people who have low-income -- low 0 i wage jobs, deny them health insurance, i think something is dreadfully wrong. i ask that that -- the remainder of my remarks be in a separate

place in the congressional record. the presiding officer: without objection. mr. brown: i want to talk about something else in health care. ancient cultures, mr. president, have been using plant extracts and other mixtures with antimicrobial properties to aid in healing for 2,000 years. we're probably most familiar as americans with the scottish scientist, alexander fleming, who developed pencil inwhich became -- penicillin. last week the centers for disease control and prevention called anti-my control boardian resistance one of our most serious health threats. other antimicrobials have been in essence a victim of their own success. we used these drugs so widely for so long and sometimes not so wisely and indiscriminate that will the microbes they are designed to kill have adapted to them, making the drugs less effective or in some cases totally ineffective.

i stand before you today to remind you of the need for a comprehensive strategy to address microbial resistance. each year about 2 million americans contract bacterial infections in hospitals. 20,000 of these people die because the microbes causing their infections are resistant to frequently used antibiotics. one of the most commonly reported antimicrobial-resistant infections, something called mrsa, it's a strain of staff infection resistant to penicillin and resistant to other related antibiotics. once thought to be contracted solely in hospital settings by older patients, mrsa is now affecting young, healthy patients in our schools and communities. in the last few years, we've heard far too many high school and college-aged students losing their lives to these indispexz the statistics continue to be troublesome. a recent study from the university of chicago revealed that most people are checking

into hospitals -- more people are checking into hospitals with mrsa than those with h.i.v. or influenza combined. we can't noirg that. molly broadneck of shaker heights, contracted mrsa after back surgery. she should have been concentrating on recuperating from her surgery. instead, she spent six weeks on i.v. antibiotics in a nursing home. she had to complete three months of rehabilitation with nursing home to care her wounds. molly's story is far too much in my state and connecticut and across the country. this epidemic, if you call it that, continues to spread the financial cost and the loss of life will continue to rise. 2012 study at columbia found that each drug resistant infection costs $15,000 more to treat than other infections which are not antimicrobial resistant. that's unacceptable. curing mrsa is just one piece of the puzzle in eradicating the superbugs that are resistant to

antibiotics. response to this health crisis, i join the c.d.c. to urge enhanced attention and resources devoted to antimicrobial resistance n. 2008, i, along with senator hatch, the senior senator from utah, introduced the star act, strategies to address antimicrobial resistance. i thank senator hatch for his leadership on this as we begin to see the epidemic of antimicrobial resistance develop. the star act's a multi-pronged approach to revitalize efforts to combat superbugs and prevent outbreaks of mrsa and other dangerous drug resistant infections. the star act establishes a government task force to direct efforts to combat microbial resistance. the bill provides for more research on drug resistant bacteria and explore strategies to ensure the development of new antiinfective drugs. it ensures that antimicrobial drugs will be more wisely used and prescribed. and used more wisely and judiciously and prescribed more

wisely. we've made far too many advances in modern medicine to lose the fight against microbes. i look forward to working on measures to preserve our existing arsenal of antibiotics and other antimicrobial drugs and to ensure that new drugs are developed which can effectively fight superbugs. i plan to reintroduce the star act soon and will work with my colleagues to see it move to passage. mr. president, i -- i yield the floor to the senator from new hampshire. ms. ayotte: mr. president? the presiding officer: the senator from new hampshire. ms. a yolt ayotte: thank you, mr. president. i rise today to talk about what is happening in my home state of new hampshire as a result of obamacare. when i ran for the senate in 2010, one of the reasons i decided to do so is because when i saw obamacare had been passed

and i worried about what was going to happen with this law, we saw that it could offer less competition, limit people's choices, limb thei limit their n who would be their physician and also change their insurance policies, and raise costs in a health care system that costs too much to begin with. and, sadly, we're now seeing all of these fears come true with obamacare. and unfortunately i've seen it firsthand in my home state of new hampshire. in fact, i've heard it from my constituents, whether it's at a town hall, whether it's visiting with a small business, whether it's listening to someone who is having their hours cut because their employer is trying to meet a 29-hour requirement. in fact, right now in new

hampshire, there's only one insurer that was approved to offer health policies on new hampshire's obamacare exchange. and in order to prevent premiums from skyrocketing -- and, by the way, people in new hampshire will be paying higher than the national average of premiums under obamacare -- but to prevent them from skyrocketing even further, this lone new hampshire insurer has been essentially forced to limit its network of providers to exclude 10 of our 26 hospitals. so what does that mean for the people of new hampshire? well, several of the hospitals that have been excluded as a result of obamacare from this exchange and that didn't make the list for coverage are, for

example, the concord hospital, which serves residents in and around our state capital, and that's not one of the providers in the network. the portsmouth regional hospital in portsmouth, the largest city in our sea coast, that the portsmouth regional hospital serves and the surrounding areas, not in the network. other hospitals in new hampshire that aren't in this network -- frisby memorial hospital in rochester, southern new hampshire medical center in nashua, where i live; madanoc community hospital in peterboro; valley regional hospital in clairemont, and; alice pecta hospital in lebanon. this problem is especially challenging for people in new hampshire who live in rural areas and it's particularly

unfair to them. for example, in the upper connecticut valley, hospital in coalbrook didn't make the cut. and so what does that mean? that the upper connecticut valley hospital in holbrook did not make this cut. if you live in coalbrook or stewardstown or columbia and you need maternal care? you have to drive to berlin. and if you have to drive to berlin from some of those areas, this round trip can take you three hours and what does that mean when you need maternal care if you have to drive over an hour or an hour and a half to get to the hospital when, i have to tell you, north country in the winter, that can be some tough driving. and one thing i know about the residents of our north country,

they are resilient, they are tough, they are wonderful people, but they should not be put through this as a result of fewer choices under obamacare. now, i have been making trips across new hampshire directly talking to my constituents, to business owners, and the message that i have heard from them is very clear. in fact, it's been raised with me in almost every stop that i make in new hampshire in august where i had the chance to talk to people from all throughout our state. and i might add this is not an issue that's being raised like i'm a republican, i'm a democrat, i'm an independent. it's just universal concern and worry about the impact of obamacare and the increasing costs that people are seeing in health care as a result of obamacare and fewer choices that

people in new hampshire are going to have. and here are some of the mail i have gotten from some of my constituents about this law. dave in manchester wrote me that he and his wife are in their 40's. here's what he had to say. our freedoms went from quarterly in may to monthly as of june. no birthdays or changes in health. our monthly bill went from 497.39 for myself to $572.67, a jump of over 15%. my wife had her bill go from from $572.67 to $801.84, a jump of over 40%. dave says that he makes approximately $31,000 a year after taxes, and that health

care takes up half of it. carolyn grafton wrote our school district and surrounding ones are cutting back paraprofessional jobs to 29 hours. many of these people were full time. instead, they hired several part-time people to cover the once-full-time positions. this law of unintended consequences is devastating for those whose hours and benefits have been cut. now they are no longer entitled to benefits. many of these individuals have worked for 15 years or more as full timers. john from middleton wrote i'm 61 and retired. i buy my own health insurance privately. since the affordable care act, i have had to change my insurance carrier because they left the state, change my coverage because it became too expensive, and i have had three increases in my premiums. chris from nassua wrote, as a

small business owner and self-insured, i'm very worried about my costs going up. my broker mentioned that we may see a 200% increase in our monthly rate. nancy who lives near a hospital that was left out of the exchange, and we know that ten of our hospitals, which is a huge amount in our state of hall of fame, almost over a third of our hospitals have been left out of this exchange, and nancy wrote i want to continue to have my medical care with the doctors, nurses, therapists, et cetera, whom i know and trust, and with whom i have an established relationship. again, what do i do? this is what the affordable care act did for me? we have seen recently that the headlines of what's happening with the impact of obamacare tell the story.

just in my home state of new hampshire, from today, from the associated press, health overhaul premiums in new hampshire above average. the nashua telegraph, decision to eliminate national hospital from health exchange causes confusion. the union leader, companies look for ways to pay new fees, coming from obamacare. concord monitor, concord hospital not part of provider network for obamacare exchange plan in new hampshire. and then nationally, the minutes are telling the story as well. politico recently, obamacare, one blow after another. "usa today," family glitch in health law could be painful. could leave up to 500,000 children without coverage and cost families thousands of dollars. "washington post," one week away, obamacare's small business

insurance exchanges not all ready for launch. cnbc on main street, obamacare hurts hiring, staffing. "usa today" pew poll, health care law faces difficult future. and, you know, we have seen there are many more i can go through here because it has been one bad story after another because of the reality of implementing this flawed law. the private sector impact of obamacare. we all want our economy to do better than it is doing right now, to provide jobs and opportunity for people in this country, to make sure that everyone in this country can live the american dream, yet the affordable care act is hurting job creation and job hiring in this country.

increasingly, employers are cutting benefits and shifting the burden of health insurance coverage to their employees, and we have seen in the recent impact of this law, the cleveland clinic is probably the best example. the president went to the cleveland clinic during his campaign and cited it as a model in terms of how health care can be delivered in pitching his health care law, and yet the cleveland clinic recently announced, as one of ohio's largest employers, that it would cut jobs and slash 5% to 6% of its budget to prepare for president barack obama's health reforms. walgreens recently announced it's dropping health insurance coverage for 160,000 workers and will instead give them payments to purchase insurance through private exchanges. time warner and i.b.m. plan to move retirees from employer-administered health plans to private exchanges, and we have seen similar stories

from companies like home depot, trader joe's, that they are going to end coverage for part-time employees. u.p.s. is dropping coverage for employee spouses. and in terms of the impact on jobs, what i have heard from companies in new hampshire, from the smallest to the largest, is they want to do right by their employees, but the rising cost of premiums, the questions that have been raised by obamacare this put them in a position where they can't do what they want to do for their employees and their health care, and in many instances, they are forcing, because of higher costs, to not hire that next employee, and if you think about the structure of this law, that it applies to those that are 50 employees or more, some aren't going to open that next business or that next restaurant because they do not want to fall under this law.

what kind of law would we pass here to deal with the issue of health care that actually makes it more difficult to hire people, that actually thwarts the private sector's desire to expand businesses, or if you have one restaurant to have a second restaurant. if you have one shop to open up a second shop. the flaws in this law are not only that it reduces choices for consumers but it's reducing the choices that the people in this country have for jobs. but i think best critic of the law that we have seen actually came from president obama's supporters, and that's the teamsters union, the united food and commerce workers international union and unite here. they recently wrote the president and said we can no longer stand silent in the face of elements of the affordable care act that will destroy the very health and well-being of

our members, along with millions of other hardworking americans. they have also expressed concerns that this law will destroy the 40-hour workweek. as senator cornyn from texas said, as republicans, we are united in repealing this huh. we are iew united in wanting to defund this law and wanting to make sure that we can replace this law with commonsense reforms that drive down health costs, increase competition for insurance companies and give people more choice while making sure that we do not interfere with the doctor-patient relationship, that if you like your doctor, you can keep your doctor, which we are now seeing is not true, unfortunately, under obamacare. and i will do everything i can

to make sure that we repeal this law, to make sure that we make any types of reforms we can to this law, to ensure that people have choice, that they can keep their doctor and that health care is affordable for people in this country. however, i do not support shutting down the government in order to defund this law, and so while some of my colleagues have urged us to shut down the government -- and they haven't said in this term. they have said we don't want to shut down the government, but the reality is they have asked us to vote against a bill that is coming over from the house that will defund obamacare, will continue the funding for the government, and if we were to vote as a bloc against that bill and against ending debate on

that bill, then the result could be to shut down the government. and while americans are opposed to obamacare, what we have seen in a poll as recently as today is that 80% of americans say threatening a government shutdown during a budget debate is not an acceptable way to negotiate, and so i believe that we should make sure that we repeal this law, and i would join in what the senator from texas said, and i would hope that my democratic colleagues would listen to what their constituents are saying about the negative impacts of this law and that they would join us, they would join republicans in ensuring that we do defund this law, that we work together, that we make sure that, by the way,

businesses aren't treated better than individuals in where we are right now with the implementation of this law. one of the most absurd things that i don't even know how you can explain to people is the president has made the decision that the employer mandate is going to be delayed until 2015, but with regard to individuals, they have not been giving a similar delay. how do we justify treating businesses better than individuals with a law that is going to force many people in a position where they're paying higher premiums or they may unfortunately lose the hospital that they prefer to go to in my home state of new hampshire or the physician that they have that trust and relationship with so i would ask my colleagues on the other side of the aisle how is it that we can treat businesses different than individuals here? why don't we join together and

delay the individual mandate, at least until 2015, as businesses are being treated by now the president in his delay of the employer mandate? so i hope that on the other side of the aisle we can work together and listen to the american people who loud and clear are expressing the worries and the concerns and the impact that this law is having on them, and it's not been, unfortunately, a good impact. and finally, i wanted to say, in terms of the strategy of shutting down the government, i don't support it also because it's not going to work. the congressional research service office has said that even if we defund obamacare, we should down the government, that there has been mandatory spending baked into this law

that obamacare can continue. so to those who are asking us to take that step, i would say that even if we were to do so, we will not achieve the purpose of fully defunding obamacare or stopping obamacare from hurting average americans. so i hope that we can work together to make sure that we don't continue to hurt americans, to my constituents that are going to have to drive so much longer distances to go to the hospital they want to go to and the obamacare exchange in new hampshire that are paying higher premiums because of obamacare, that have less choice. i would hope that we could work together to ensure that average americans don't continue to be harmed by this law. and finally, i would say this:

this piece of legislation was a signature of the president's policies. it was something that when he got into office he pushed right away to pass. and the impact that many of us feared about this law, meaning less competition, higher costs, interfering with keeping the doctor that you want, hurting jobs, we've seen it come now to fruition. so why would we at this point try to shut down the government? why would we at this point give the president as his own former press secretary said on "meet the press" this weekend, a president from a white house perspective who has three fairly forgettable weeks at the white house, right? about to lose a vote on syria, immigration reform looks dead, you're sinking in quicksand afford and here the enemies

throw you the reason and want to get in the quicksand instead of you a. why would we put ourselves in a position where we would shut down the government over a law that is the president's signature piece of legislation, to hand him a life line on this issue by hurting average americans, such as our military that could be impacted by a government shutdown, such as our veterans that could be hurt by a government shutdown, such as average air travel that could be impacted by a government shutdown, and, by the way, the last time we shut down the government, it cost us more to reopen the government, $1.4 billion more than what it would have cost to just run the government. so from a fiscally conservative perspective, it doesn't make any sense either. by urge my colleagues on the republican end, we are united in repealing and replacing

obamacare. let's work together to do that. let's work together while keeping the government going forward with responsible spending levels, let's not forget we're $17 trillion in debt, and let that debate get sidelined by this debate of obamacare. and finally to my colleagues on the other side of the aisle, you've been hearing many of the same stories from your constituents. how can we treat businesses differently than individuals? why wouldn't you agree to something like a delay of obamacare for a year for individuals like businesses have been granted by the president? and why would you want to continue to fund a law right now that is already hurting people in terms of their choice with their doctor, driving up costs, and hurting job creation? i know that we can resolve these

issues, and i know that the american people expect us to, and i think that we can do this in a way that helps address health care costs coverage, and in a more responsible way than obamacare has done, allowing people to keep the doctor that they have chosen and allowing people to have greater choice and competition. thank you, mr. president. the presiding officer: the senator from michigan. mr. levin: mr. president, the folks back home will often come up to me after the senate has gone through some crisis or complex procedure and they'll ask me what just happened? usually i can give them an explanation. but i hope nobody asks me about what we've seen last night and today, because to me it's inexplicable. a senator holds the floor overnight, delaying that what turns out to be a 100-0 vote on

cloture on the motion to proceed on this bill. i'm not sure i can explain that back home so let me describe what i expect to see in the days to come. the question question before the senate this week is whether some members of the senate will succeed in disrupting much of the federal government if they do not get their way in one matter on which they feel passionately. this group of senators argues that we should take away health insurance from more than 20 million americans, they urge us to take away cheaper prescription drugs and free preventative care for more than six million seniors, they argue for kicking millions of young adults off their parents' health insurance coverage, and they argue for a return to the days when insurance companies could deny americans health care because of a preexisting condition. the argument over the elements of the affordable care act --

are arguments over elements of the are affordable care act in order? of course, they are. but what should be off the table is the tactic that opponents of the affordable care act are employing, at least some of those opponents. as we just heard from senator ayotte, she is an opponent of the affordable care act who is not going to vote for this tactic and i commend her for it. in order to eliminate the affordable care act, some of these opponents would deny our military members their paycheck. some of them would deny -- shut down our n.i.h. clinics, they would halt small business administration assistance to small businesses, they would close head start classrooms. that and many more operations would grind to a halt if this group had their way in order to eliminate health reforms that would bring insurance to millions of americans and protect coverage for those who already have it. that's not just a policy failure. in my book, that's a failure to

understand the role of an elected official in a democratic government. this system does not function when members of congress threaten to shut down the government and bring about legislative anarchy if they do not get their way on a particular policy. so i'm not going to try to persuade those numbers on the value of obamacare, even though already thanks to obamacare the number of young adults without health insurance has fallen by nearly a million, and a higher percentage of young adults have coverage today than at any time since 1999. i'm not going to try to persuade those senators on the value of obamacare although already inflation in health care costs has slowed to the lowest level in half a century and while the causes for this good news are complex, many health care experts believe the affordable care act focus on quality and

coordination of care is already having a measurable impact. i'm not going to try to persuade those senators on the value of the affordable care act even though more than six million seniors are paying less for prescription drugs because the affordable care act is closing the doughnut hole in drug coverage and even though the nonpartisan congressional budget office projects that by 2016, 25 million americans who otherwise would have no health insurance will be covered, again thanks to the affordable care act. i'm not going to try to persuade those senators about the value of obamacare even though repealing the affordable care act would, according to the independent congressional budget office, raise the budget deficit by about $110 billion over ten years. i'm not going to question the sincerity of the senators who argue that denying the american

people those benefits is a good idea. i do question the willingness of those who are willing to close down this government to achieve their goal, to create legislative and governmental anarchy in pursuit of their goals is acceptable. i believe that that tactic of shutting down or threatening to shut down the government to get their way on an issue is appalling, and that's what the basic question is before us. i have a number of issues that are important to me. so does every member of this senate. i believe very strongly in universal background checks for firearms purchases, and opinion polls show a large majority of the american public agrees with me. should i threaten to shut down the government if we don't pass universal background checks? should i threaten to delay pay to our men and women in uniform to close classrooms and health clinics and research labs, to

waste billions of dollars toy bye creating anarchy in the government if i don't get my way on universal background checks for firearms purchases? i believe very strongly we should close offshore tax loopholes that cost the treasury hundreds of billions of dollars and i'm hardly alone in that belief. should i threaten to default on the public debt and to damage the full faith and credit of the united states if we don't pass a bill to close those offshore tax loopholes? i hold these beliefs and others with the same passion as those senators who oppose the affordable care act, but threatening government shutdown and chaos unless i get my way is, i believe, inconsistent with our responsibilities as senators. so yes, i feel very strongly about background checks and tax loopholes and a host of other issues but i can't imagine

threatening government shutdown or default on our debt if i don't get what i want. the effects of a government shutdown would be devastating to our men and women in uniform who would be told that they must stand at their posts without pay. it would be devastating to patients with deadly diseases who depend oning clinics who -- on clinics who would depend who would close their doors. the cost of shutting down and restarting government operations would run to several billions of dollars. a shutdown could cut gross domestic product by a percentage point or more, putting us back into a recession. when the founding fathers launched this experiment in democracy, most observers -- at least many observers -- expected it to fail. and they did so in part because they doubted that democracy

could exist in a large and complex nation. montesquieu declared in my large democracy -- quote -- "the public good is sacrificed to a thousand private views" -- close quote. the founding fathers designed congress so that it could represent the interests of large states and small states, of populous and rural areas, of north and south, the task they gave to congress was to prove that montesquieu was wrong. it was here that our, quote, thousand private views who are to be weighed and considered and from those deliberations public policies aimed at the public good were to emerge. the form of our government was designed to guard against any one faction from succeeding in

attempts to fies the -- sacrifice the public good to its own concerns. at every turn, the founders designed our constitution to defend against extremism, to help all-too-flawed elected officials transform what could be the anarchy of a large nation with varied opinions into a coherent whole. the tactics that we are seeing in this debate and the tactics threatened in the debt ceiling debate that we will soon face turn the founders' vision on its head. we're told that unless we give in to the demands of one faction, that america will be 34ru6r7b8gd into shutdown -- plunged into shutdown, recession, default and catastrophe. 226 years into our experiment in democracy, this faction of congress is trying to prove montesquieu right. they would, indeed, sacrifice

the functioning of our government to advance one of their own views. now, i oppose the efforts to defund obamacare, and i believe that preserving health care reform is vitally important to millions of americans. defeating this attempt to close down the government unless zealots get their way is important to the very functioning of our democracy. it is deeply destructive to our ability to function as a democracy for members of this senate to threaten to bring down the walls around us unless they get their way. and hopefully, they will not succeed. mr. president, i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

a senator: mr. president? the presiding officer: the senator from north dakota. mr. hoeven: mr. president, i ask that the quorum call be suspended. the presiding officer: without objection mr. hoeven: thank you, mr. president. the presiding officer: without objection. mr. hoeven: thank you, mr. president. in the united states, we have the best health care in the world. we have the best doctors, the best nurses, the best hospitals, the best clinics. across the board, the best health care.

enl theeblg because w health cae individuals make decisions about their care, think design what hospital clinic and disiet decit health care policy to choose. but obama administration changes that. it brings government into running the health care system in a way that we've neverred before in the united states senat80's senate.far bow i don'a level far beyond what we've ever had before. now, the proponents of obamacare say otherwise. well, that's just not the case. the government won't -- the loft go set up exchanges and operate those changes and it actually living on and options to cab

object oangses on those exchanges. takes, the sij also must be offered in policies, and again, racing options, joises for consumer furthermore, effectually, october is, start of the year fix year. clearly the federal government or the state governments are rft to g. to been we will sib budded. why -- the question is, why hasn't president obama also delayed the individual mandate? why would you delay the mandate for big companies across this country but then not at the same time delay the mandate for the american people for individuals across it country. and let thet onc that's just one

inconsistencies in this law and in the administration of this law. that's what i support anything we can do to redeficit-neutral reserve fund or -- refund obamacare and do anything we can to defund or delay obamacare. now, granted, we have some different areas on tactics, how best to do it, we're we're also united in our effort to oppose obamacare. the reality is that instead of obamacare, we should be encoirnlg and competitiomorechot reform. that means tort reform to help reduce the cost of health care. it also means encouraging mortgage competition of health insurance companies along strayed lines.

expanded health save accounts. high dedead i believe insurance policies will impose young people yum lsh much more expensive. again, more competition, more choice, more tarption by people of, and as a result, a system that is sound and a system that truly encowrndle and empowers individuals. that's how we empower people it take control of their medical costs. not with a government-one individuals, at the provide hefltd dollar with short reform and brings consumers more choice, more opportunity and more options. and at the same time we need to reform medicare and medicaid. we can sifn hundreds of millions of dollars -- we can save hundreds of millions

of dollars by reduce waste, fawd and abuse -- reducing waste, fraud and abuse. but we also have to provide incentives. take medicare, for example. right now in my home state of north dakota, on a relative basis, we have lower cost health care thanker in "state. and at the same time that we have lost costs in thissed in, we have bef better outcomes. on a competitive basis, we have very, very high competitive medical care. so think about that. lealower costs, better outcome. but we're not rewarded, we get less reimbursement. that makes no sense. think about t. think about it. so few of a star where you have lost test you get lower medicare reimburse than if you're a state with high losses. think about that. think about that as a system

regard i ho higher county, beanlizing that congress of whrawz what we should be having. and we should reform them had a way that -- and w take medicare. medicaid, same thing. here you have too much of a one-size-fits-all. why not give the states more flexibility so they can respond to the circumstances in their state, find ways to improve care and reduce costs and make sure that those states benefit so i have the right incentives. these are the kind of health care reform that makes sentence, common sense. these are the kind of hm reform that empower people. and they'd are the kind. republican that we need. wreps will volt defund obama administration. we need some democrats to join us. for the same of health care.

for the sake of our economy. full-time employment versus part-time employment. bawrk is hurting our job and ceablght nor ction. snor -- job and the case of job. so for the case of the health care and the economy, this is what the american people want. they want us to fund this continuing resolution and they want us to de-fund obamacare. and i ask ourself colleagues to join us in this effort. with that, mr. president, i yield the floor. a senator: the presiding officer: the senator from delaware. mr. coons: mr. president, here we are again. on monday, september 30, just five days from now at midnight, absent some agreement and cooperation between the parties and the chambers here in the congress, the entire federal government will begin shutting down. mr. president, here we are again. another day, another fiscal

crisis, another politically manufactured crisis. another politically manufactured crisis that is threatening to tear at the economic fabric of our whole country. it would be hard to believe if it weren't totally, completely believable. i have been in the senate now just under three years, but this is my third of these crises. i was actually up in the chair presiding that night back in 2011 when we narrowly averted a shutdown just minutes before funding expired. i was here with all the other senators on new year's eve just this past year when we stopped just short of going over the fiscal cliff, and here we are again. from shutdown to default, from the debt ceiling to the fiscal cliff, now back to threatened shutdown and another default crisis just weeks away, with, of course, unemployment still standing above 7%, 7.3%.

from my home state, delawareans just don't understand how we keep ending back newspaper this place. we have a saying in delaware, mr. president, that our politics are dominated by what we call the delaware way, which means doing what's right, even when it's hard. it means coming together to make tough choices, republicans and democrats listening to each other and finding printed compromise. it means being civil, playing by the rules, putting what's good for our people ahead of what's good for our politics, and it doesn't really look to me as if we have been able to muster much of that delaware way here in washington. last week, the senate considered the bipartisan shaheen-portman energy efficiency bill. now, energy efficiency is about as commonsense and nonpartisan as can you get. it's not about fossil fuels or renewable energy. it's about making smarter choices and reducing our energy consumption. the bill had support on both sides of the aisle. it was supported by business and

labor and the environmental community, the national association of manufacturers, the natural resources defense council, the international union of painters and allied trades, a very broad range of folks and organizations all over our country endorsed that bill. i myself did work in energy efficiency when i was in the private sector at a manufacturing company and then again when i led delaware's largest county as county executive, and i saw the real impact that energy efficiency, technologies and strategies can have on the bottom line, for the private sector, the public sector, for families and businesses, and it's significant. there is so much opportunity to make a real difference for our economy, for our planet, for our communities in energy efficiency, and that shaheen-portman bill gave us a chance to tap into it, it would have given millions more americans a chance to benefit and was scored at creating 136,000 new jobs, but we blew

it. instead of debating energy policy, taking up and amending and reforming and passing that bipartisan energy efficiency bill, the senate was again dragged down into a petty partisan political battle over the affordable care act. a law that, by the way, was debated in both chambers and passed, litigated before the supreme court and upheld, was central to the last presidential election and was sustained. i'm not going to debate the merits of the affordable care act at enormous length again. it's law. it needs to be modified. it needs to be amended, so it can work more smoothly and effectively, but frankly the law needs to be implemented, and every minute this chamber spends reliving the settled debates of the past is a minute we're ignoring the 11 million americans out of work, the 32,000 delawareans currently looking for a job. each minute this chamber spends on a futile effort to strip

middle-class americans of their access to quality, affordable health care is a minute we're ignoring. so many challenges. our country's aging infrastructure, a generation of students ill prepared for the challenges of the future, communities ripped apart by tragic gun violence. there are so many other tasks and challenges before us. mr. president, it is insanely frustrateing. is this really what we signed up for? is this really why all of us worked as hard as we did to get here, why we knocked on doors and campaigned all across our states for months and months? is this really it? is this governing? if congress spent half as much time on manufacturing policy and on manufacturing jobs as we seem to spend on manufacturing political crises, our country could be in far better shape. it can't pass laws, but, man, congress has become very good at manufacturing cries east. i'm not running for president

and i don't have to impress the tea party, so maybe i'm missing something here, but we do have to be better than this. we just have to. there is too much at stake, for our states, for our country, for our families, for the economy, for the world. this morning, the steering and outreach committee had a dozen economists come in and offer their insights on what would happen if the government really does shut down just five days from now, if we do then default on our national debt the next month. what would happen to the 11 million americans still looking for jobs? what would happen to our resurgent american manufacturing industry and the half a million jobs that have been created there? their answers were not encouraging. in fact, depressing, really. what was clear is that these political showdowns in this chamber exact a real cost on our economy. they hurt the ability of business owners to plan ahead. they inject incredible unneeded

uncertainty into our markets. they genuinely erode our nation's credibility and leadership on the world stage. but we keep ending up right here. one of my constituents, john henderson, wrote me last week and said this -- "the strength of our economic recovery is on the line and government's ability to take -- make people's lives better is in jeopardy. congress needs to confront our problems responsibly, but when some lawmakers dig in their heels and threaten to seriously damage america if every one of their demands isn't met, our government can't function. this isn't the time for a game of chicken. it's time to govern. well, john, you're right. mr. president, he's right. and this gridlock, this repeated manufactured crisis environment is just embarrassing. i'm on the budget committee and

under our chair senator murray's leadership, we passed a budget earlier this year. not only did the senate budget responsibly reduce the deficit, not only did it fairly replace the sequester, but it actually invested in economic growth. we took it up here on the senate floor and passed it here, too, so not just out of the committee but at the senate. we stayed up all night voting on amendment after amendment for hours and hours, and in the end it's one of the most functional things we have done this year. the senate passes a budget, the house passes a budget, and then we come together to reconcile the differences. that's how it's been done for 200 years. and this year, finally after years of criticism that we hadn't passed a budget, we had our chance to return to regular order, and so there we are ready to go, budget passed, and nothing. house republicans won't even come to the table, and a few senate republicans are blocking the door. they literally won't even come to the table to negotiate and

resolve our budget differences and lay the groundwork for moving forward. it is insanely frustrateing. ient -- einstein once said the definition of insanity was doing the same thing over and over and over again and expecting a different result. he wasn't wrong. i believe at this point the house has repealed the affordable care act 42 times. doing the same thing over and over again and expecting a different result is the definition of insanity. mr. president, olympic on the appropriations committee, and under the able leadership of our chair senator mikulski, the committee has passed 11 appropriations bill. the house appropriations committee has passed ten of theirs. we took up one of these vital appropriations bills that allows the senate to work its will and to form and shape federal programs and federal spending. earlier this summer, we took up one of these appropriations

bills. the bill to defund the departments of transportation and housing and urban development. but republicans on this floor were so afraid of returning to regular order, of having a responsible, reasonable, regular working process to move forward on spending in this government and our economy, it was blocked. it was blocked, prevented from even being debated. i'll ask again. is this working for anybody? back in june of this year, the senate passed a bipartisan farm bill. great work was done by senator stabenow, chair of the ag committee, along with her ranking member and senators from both sides of the aisle. the ag committee did significant work to reform american farm policy. like moving away from commodity subsidies and toward crop insurance. that alone would have saved taxpayers $23 billion, and we all hear that's important, we need to reduce our spending and make our programs more effective. this was a great bipartisan bill. it would have modernized our

agriculture policies, strengthened programs that help farmers, ranchers and small business owners and created jobs. house republicans won't negotiate with us on that bill either. they passed a bill that guts the nutrition assistance program, food stamps, cuts it by $40 billion but won't work with us on a full farm bill. the current law also expires at the end of the month, and if we don't pass a modernizing farm bill by the end of this year, our nation's ag policies will revert to those of the 1940's. if it sounds familiar, it's because we were in the exact same position on the farm bill last year. is this working for anybody? it is certainly not working for americans. delawareans, from whom i hear all the time, are enormously frustrated. i hope we're able to reach a deal and i hope we're able to keep the government running.

i hope we can come back next week and refocus on our economy and refocus all of this energy on manufacturing and jobs and on manufacturing jobs, not on manufacturing crises. helping american businesses grow and helping our private sector create jobs. mr. president, americans deserve better than this. they deserve better. with that, mr. president, i yield the floor. mr. barrasso: mr. president? the presiding officer: the senator from wyoming. mr. barrasso: thank you, mr. president. mr. president, i come to the floor today just six days now before the -- the obamacare -- obama health care law exchanges go into effect to point out that even those who may support the law say with regard to the exchanges expect trouble. it was interesting that just

today the district of columbia, their health exchange announced that it is not going to be able to be ready to go october 1 for those seeking information regarding tax credits, for those asking about medicaid coverage. people will still be able to submit application online, but apparently they need to then have this information go to so-called experts with an eligibility determination not to be made until some time in november. now, i applaud the district for pointing this out, that this is what they found, because what they attributed the delay to was a -- quote -- high error rate discovered during testing. well, i'm delighted that they were actually doing testing, discovered this high error rate and made that decision. but as people take a look at the upcoming exchanges as they open, i believe that these exchanges

open doors to fraud and to identity theft, and the reason i say this is that we're -- we're hearing this actually reported from supporters again of the health care law. and i will just quote someone who has worked in support of the law in chicago who says that fraudsters are poised to take advantage of widespread confusion over the affordable care act, also known as obamacare. take advantage of widespread confusion to steal americans' credit cards, social security numbers and other personal information. so my goodness, how can that happen? well, it happens for a number of reasons. one is because of all of these so-called navigators, people that are hired by the government or people posing as those hired by the government to help folks sign up on the exchange. when they fill out the paperwork

or fill out the computer forms, the information they're going to have to send in is to go to the -- quote -- data hub, tax information, income information, employment information, patient medical record information, social security number, welfare information, family size, demographic data, and then where does all this information go? well, number one to the department of justice, also to the social security administration, also the department of homeland security to check citizenship, of course social security administration will valid date birth, that they're not dead, the social security number, the department of justice will check on criminal history, the health and human services department, another recipient of the information, will check enrollment or eligibility for entitlement programs, collects and analyzes medical data and then of course the i.r.s. who are the folks who are the enforcers of the obama health

care law, the enforcers will along with the treasury department verify employment status, individual income status, determine premium subsidies, all with the potential for significant fraud, and all because of a lack of providing the privacy safeguards that the law mandates this administration to provide. but yet the administration is not doing so. a number of us have been asking for months to see what's involved with these so-called navigators, what kind of education to they they need, what background checks are there, and we can still not get the information we're seeking, mr. president. we want to know do these people have to have a driver's license? do they have to be of a certain age? do they have to have a high school diploma? do they have to have a criminal background check? yet this administration will

not, will not give that information out about those individuals, even the census takers have to have completed a certain level of education and have a criminal background check. but yet this administration is not asking of those who are supposed to be the navigators handed very confidential information, of course, subject to fraud and identity theft when you give that information and by say to people all around the country it is time to beware when the next tuesday the exchanges open. you know, it's interesting, i just quoted a couple of things that the supporters of the health care law have said, such aspect trouble, and -- expect trouble and worry about con artists. there are other things the supporters have said, people who supported the adoption of this law in the first place. they said it will destroy the foundation of the 40-hour workweek that's the backgoan

boap of the american middle class. these, of course, are union folks who are saying this is going to end up forcing millions out of their multiemployer plans, it will create unstoppable incentives for employers to reduce weekly hours for workers, but we see that, mr. president, we see it all across the country. just last week the cleveland clinic, a wonderful health care institution, one of the major employers in the state of ohio, announced that because of the health care law, because of the cuts in reimbursement, that the cleveland clinic is going to cut hundreds of millions of dollars from their budget and actually reduce their work force because of the president's health care law, and the things that they're learning about the law as time goes on. as interesting to see a union leader say in its rush to achieve its passage many of the act's provisions were not fully conceived. mr. president, people on this side of the aisle were telling

the members of the body that very thing a number of years ago before the law was passed in this body on sole party-line basis. now, yesterday president obama once again tried to bring in help and he provided essentially the warmup act for an infomercial with president bill clinton, the so-called secretary of explaining stuff because the president has failed to explain benefits of the health care law to the point that it would actually convince the american people that it was good for them, because currently the president is under water in the polls regarding his leadership on health care, and this health care law continues to be very unpopular with the american people. more people think that their costs will go up and their benefits will go down than the other way around. so they're looking at their own quality of care, what it means

to them, paying more, getting less, something that the american people don't want. so in an effort to try to provide some solace to the american people yesterday in new york, this is what the president said. he said make your own decision about whether it is good for you. he said what we are confident about is when people look and see they can get high quality affordable health care for less than their cell phone bill, he said they're going to sign up. well, mr. president, i would say if you use that criteria, you're going to have very few people signing up for your health care law. you know, according to the 2012 report issued by the cellular telecommunications industry, average monthly cell phone bill, about $47. so make your own decision, less than your cell phone bill. what the president is saying for less than $47 a month, people will be able to provide -- to

receive insurance. now, the interesting thing is, the president says that's what with the subsidies but for many, many people the subsidies are not in any way going to actually reduce the cost of their insurance at all, and it may not go up as high as many people had feared, but it's still going to be higher than that are paying now because of the sticker shock that is coming and i'll just go to today's "wall street journal" headline -- this is coming out of the administration, prices set for new health care exchanges. across the country, the average premium for a 27-year-old nonsmoker regardless of gender will start, will start at $163 a month for the lowest cost bronze plan. mr. president, that's four times, just about four times the average of a monthly cell phone bill.

so could the president of the united states be mistaken? let's look around the country. they say the least expensive bronze policy would rise to -- talking about philadelphia -- would rise to $195 a month in philadelphia for that 27-year-old. from $73 now. so from $73 up to $195. let's look at my home state of wyoming. this is still the front page of today's "wall street journal." in cheyenne, wyoming, the lowest cost option would now be $271 a month, up from $82 today. which just goes to prove, mr. president, that when washington comes up with something, it really does not one size fit all across this country and in rural states around the country there are huge problems related to the very fact that one size doesn't fit all and in spite of the president's comparison to cell

phone bill, what we're seeing, mr. president, is people all across the country are going to be paying excessive amounts of money for insurance in spite of the president's promises that if you like what you have you can keep it, we know that's not the case for many, many people as the unions have spoken of, and we know that what the president promised of lowering insurance premiums by $2,500 per family by the end of his first term never materialized and the costs continue to go up. so this health care law has turned out to be terrible for patients, for the providers, the nurses and doctors who take care of them, as well as going to be terrible for taxpayers. i would like to point out in my last moments, mr. president, there was an interesting story on the front page of "the new york times" on monday, lower premiums -- for some of course -- lower premiums to come at cost of fewer choices.

in new plans insurers often leave out many providers. i think that's the key, leave out many providers, mr. president. because what we're seeing is that in many locations around the country that hospitals have been secluded, doctors -- excluded, doctors have been excluded and there's going to be significant explaining to be done when people realize that they're not going to be able to continue to go to the pediatrician that their children have been going to since birth, they're not going to be able to go to the hospital in their community, they're not going to be able to keep the health care plan that they have, so it's interesting to see that blue cross/blue shield in new hampshire, one of the nation's largest insurers, has put a plan together, consistent with the health care law, and it has created a fewerror and the reason it has created this fewer orr -- fewer or is it ex

cliewldz 10 of the 26 hospitals from the exchange. the insurance exchanges, regardless of what the president promises is going to be something which potentially causes fraud, abuse and loss of the care that you have, the doctor that you have and the hospital that you have. and the article goes on to say that -- they point to specifically the state of california, and in california it says the statewide blue shield plan has developed a network specifically for consumers shopping in the insurance exchange. the executive vice president of blue shield of california said the network for its exchange plans had 30,000 doctors, 53% of the doctors in the state so they only include about half the doctors, not all the doctors, only going to about half of them, and they said the new network, the new network you

get through the exchange in california -- this is a straight-run exchange that the president has touted as a successful change -- the new network did not include the five medical centers of the university of california, who are all known for their excellent reputation, it is a place that patients want to go for care, or even the cedar sinai medical center near beverly hills, again a highly regarded institution in southern california. so go to the exchange in california, sign up for something that the president has promised you, and then if you need to use that insurance card, you'll learn that you're not welcome and your card is not accepted at the five medical centers of the university of california or the cedar sinai medical center near beverly hills. that, mr. president, is what we have under this health care law, and that's why we need to

repeal it and replace it with patient-centered care so patients can get the care that they need from a doctor that they choose at lower cost. thank you, mr. president. i yield the floor. the presiding officer: the senator from california. mrs. boxer: mr. president, thank you very much. i listened very carefully to my colleagues predicting gloom and doom, and it brings back to me what i have read about what happened when medicare was brought to this country by the democrats and what happened when social security was brought to this body and to the house after the great depression. and i'm going to go into that in a little bit, but somebody said this reminding me one of the

definitions of insanity is doing the same thing over and over and expecting a different outcome. the republicans in the house have voted 42 times -- 42 times -- to repeal the affordable care act or to defund it. health care reform has taken years and years, we finally got it done, and millions of americans are on the cusp of getting health insurance for the first time. and republicans are desperately trying to block this from happening. 42 times, and we told them, senator reid couldn't be more clear, we're not going to delay health care for the people of this great nation. we're not going to go back to the days when people with a preexisting condition were left

to die without health care. we're not going back there. and yet it continues. now, the republicans are so adamant about it that a very large group of them are threatening to shut down the government of this great country. and, again, it's not like they didn't do this before. the republicans did this before. it was a disaster for the people, people got hurt, they didn't get paid, business was disrupted, social security and medicare were disrupted, veterans' benefits were disrupted, parks were shut down, people were hurt. and it cost a fortune for the taxpayers. but somehow republicans feel

they can play games. and i think it is a shame. now, my colleague, senator cruz, spoke for a very long time and said that he would speak until he dropped. he said that over and over. i will speak till i drop. well, if he were to drop and suffered some kind of health episode which he apparently was willing to risk, he would have had health care. because he's insured. if he had to be lifted up on the floor of the senate and driven to a nearby hospital, senator cruz would have had great health care. why does he want to stop that for millions and millions of hardworking americans?

and only he can answer it. i could only say that as i listened to some of his interviews, it sounds like what he's feeling in his heart is, if this goes into effect, the people might like it and woe is us. because there's an ideological split here in the senate where we have senators and house members also in the house who don't think that there's any role for the federal government to play in making people's lives better. some say military spending, fine. highway spending, fine. but when it comes to lifting people up and giving them a fault of life and helping to do that, oh, no. oh, no. so ted cruz is fortunate. if you talked till he dropped on the senate floor, he would have had the best health care, he would have been on his feet and super fine. there's a lot of people out

there who respect dropping because they put off going to the doctor because they have a condition and they have no insurance, and when they drop, they have to go to an emergency room where they could be patched up. and, by the way, taxpayers pay for that. so here's the thing. we have the affordable care act, which republicans call obamacare. so that's fine. obamacare, affordable care act, whatever you want to call it. it is based on a republican suggested model of health care, where you use the private insurance, you go to an exchange, there's a lot of competition. and i'm excited about it, frankly. because in my state of california, we're onboard. covercalifornia.com. that's what you do,

coveredcalifornia.com, and you find out how you can get health care. some people will apply and get a medicaid card, the working poor. the middle class, they'll be able to move forward and got to the exchanges and many will get a subsidy to help them if they're in the middle class. now, here's the thing that really shocks me. republicans act as if this health care bill, this affordable health care, obamacare, just came down off the ceiling and dropped on the floor here and became law here. it took a long time. senator baucus worked and worked and worked and worked. we took many republican amendments. we passed the bill. it became the law of the land three years ago. they took it to the supreme court, said it was

unconstitutional. the supreme court said it was constitutional. and now that it's about to go into play, republicans are willing to shut the government down to stop it. it was a centerpiece of the 2010 election. mitt romney said, if i'm president, i'm getting rid of that law. and the people of the country said, okay, what are you going to put in its place? well, let's see, we'll allow insurance to go across state lines. well, what does that do for me if i have a preexisting condition? they wanted to replace it with nothing. american people are smart. it doesn't mean this law is perfect and we can't make it better. but let me tell you, many of us served under many presidents. i'm looking here at my colleague from maryland who served a long time in the house.

i served with five presidents, a couple of whom i didn't agree w. and i did everything i could to fight against the legislation that they liked that i felt was bad. but once it passed, i didn't try to shut down the government. i tried to work with everybody. and i'm not an exception. that's what we used to do around here, all of us. suddenly it's my way or the highway. i'm taking my teddy bear, my blankie and i'm going home because i don't like the health reform act, it doesn't suit me. some of them are so angry about it they're trying to take away the employer contribution from their own staff. what an outrage, hardworking people who love their country who work here. now, let me tell you -- earth to the republicans. a, you lost the election.

not only for president but in the senate, where colleagues who supported the affordable health care act got elected. b, president obama was reelect reelected, mitt romney lost. health care reform was a major issue on the campaign trail. so wake up, smell the roses, put a smile on your face and know you tried. but don't shut down the government. enough already. now, i want to spend some time showing you how the affordable care act is already working. so i have some charts to go over quickly. in my state, over a million californians are already newly insured. and this includes in my state 400,000 young adults who are now

on their parents' policies. if the republicans have their way and they defund or repeal obamacare or the affordable care act, what's going to happen to those young adults? they'll be kicked off of their parents' policies. is this why mr. cruz stood on the floor for hours and hours until he would drop? to hurt young adults, 3 million of them nationwide? 71 million americans are getting preventive care, like chemups and birth control and immunizations. i don't know -- like checkups and birth control and immunizations. i don't know how many of you heard the senator from maine today speak about when he worked here as a young man and had insurance so he had a preventive care checkup which came with his insurance. they found a melanoma.

had he not gone to the doctor and had they not seen that mole that turned cancerous, he said -- and i quote him -- "he would not be here anymore." health insurance saved his life. so i want to just rhetorically ask senator cruz and the republicans supporting him in this body and in the house, why would you take away free preventive care and immunizations from 71 million americans and consign them to a status where they are absolutely sitting there without any protection because they have no health insurance? let's see what else we have already achieved that the republicans want to repeal. they want to repeal 17 million kids with preexisting conditions like asthma and diabetes can no longer be denied coverage.

and if you ever saw those pictures of a child gasping for air, you know that those kids need coverage, they need help and they need to be able to get that help and get the medication when they need it. insurers can't cancel your health insurance because you get sick. how many stories did we hear, mr. president, as congresspeople and as senators, where people went to get insurance and they said, sorry, you know, 25 years ago you had a suspicious mole and we, therefore, are not going to insure you. or you have high blood pressure. or ten years ago you had cancer. no more. and how many times have you heard the stories where people were kicked out of their insurance because they hit a lifetime cap. that's no more. republicans want to repeal all these benefits.

and ted cruz was willing to talk until he dropped so that these benefits could be taken away from our constituents. now, i heard my friend from wyoming, senator barrasso, say, health costs are rising, theorizing like never before. i guess he missed it when president clinton told the country, "health care costs are growing at the slowest rate in over 50 years." 50 years. and that's because more people are getting covered and you don't have to treat people at the end game or in an emergency room because we're already seeing people get more health coverage. and insurance companies now have to justify a premium hike before they can double your premium.

now they have to diswruf and make sure that -- they have to justify it and make sure that 80% of the premiums they get are spent on the policyholders. so in 2014 -- and we're around the corner from that -- unless ted cruz and his republican friends have their way, there will be no more coverage or exharges for pexisting conditions. right now it's just children have that benefit. but 2014, everybody gets it. in 2014, no longer can insurance companies charge women more than men for their coverage. this is a huge issue. there was gender discrimination. being a woman was considered a preexisting condition. being a woman who was abused by her spouse or a boyfriend and she walked in and the insurance company found out, that was considered a preexisting condition because she might get

beat up again. so she was told, take a hike. that can't happen anymore. and they cannot impose dollar limits on the amount spent on you in a single year, where right now if you have a serious illness, they could say, sorry, you reached your annual cap. so where are we now? obamacare, or called the affordable care act, is already in effect. republicans want to stop it because in 2014 when those exchanges open, they know people are going to like what they say. i'm telling you, when i go home and i go to community health care centers, people are so excited and they -- not enough of them know about it, but when they find out how easy it is, if they qualify for medicaid, they just get their card, they're covered and they no longer have

sneak sp sneak into the emergem when a problem gets so drastic. and all the others will have options. they'll be able to choose from a platinum plan, a silver plan or a bronze plan. and we are very excited about the -- about this law. and senator cruz says he'll stand on his feet till he drops to stop my people and your people from getting health insurance? you know, he's met his match in us because we can stand up until we drop. but you know, we don't have to do that because we have the votes. and the reason we have the votes is this was what the last election was about. now, in closing my presentation, i wanted to share with you a very brief history of what happened when social security was proposed. it's so interesting. in 1935, after the great

depression and our great-grandparents were lying in the street and had nothing and people were jumping out of windows, they had nothing, they'd lost their homes, they'd lost their job, they lost their savings, there was no safety net, this is what president franklin d. roosevelt said when he signed the act in 1935. "we can never insure 100% of the population against 100% of the hazards and vicissitudes of life, but we have tried to frame a law which will give some measure of protection to the average citizen and to his family against the loss of a job and against poverty-ridden old age. this law represents a cornerstone in a structure which is being built, but it is by no means complete." franklin d. roosevelt. so he spoke about the safety net. and 1935 -- just think about

that. and let's see what happened in the debate. let's look at what happened in the debate. representative william ditter, a republican from pennsylvania, took to the floor and said, "security for the individual, whether worker or age, will be a mockery and a sham if in the attainment thereof we allot to our people the role of puppets of a socialistic state." where have we called that before? he called social security part of a socialistic state. "we cannot provide a sense of security by programs for the destruction of wealth. we cannot assure to the people a sense of security by measures threatening their investments of life savings." could this guy have been more wrong? could this guy have been more wrong? he calls social security socialism and said it was going to destroy wealth when, in fact,

it preserved and preserved our people in their old age. now, here's another. representative jenkins of ohio, republican. he talks about social security this way, mr. president. this is a compulsion of the rankest kind. do not be misled by the title. the title of social security says old-age benefits. shame on you for putting such a misleading and unfair title on such a nefarious bill. old-age benefits? think of it! what a travesty. mr. chairman, what's the hurry? nobody's going to get a dime out of this until 1942. what's the hurry about crowding an unconstitutional proposition like this through the house? now, honestly, honestly, this is what we hear them say about affordable health care. socialism, unconstitutional. it's a sham. we have plenty of time. we should delay it. history is repeating itself

right in front of our eyes. now, it didn't stop then. in 2005, republicans continued to attack social security. president george w. bush and congressman paul ryan wanted to do away with social security as we know it. we all remember that. they have proposed abolishing social security and replacing it with private accounts in the stock market. and we all know how safe that is. i'm a former stockbroker. you don't buy stocks when you're ready to retire. that's their plan. had this become law, seniors retiring in 2008 would have lost up to $26,000, but we stopped them, and we didn't allow it to happen. and lastly, let's look at social security's success. before social security became law in 1935, half of america's seniors lived in poverty in the

midst of the great depression, half. today 57 million americans receive social security, and it lifts 14 million elderly americans out of poverty. it is the most successful and the most popular antipoverty program. the republicans said it was unconstitutional. they said it was socialism. they said it was a sham, a disaster, and they are back here saying the same thing just as we're on the cusp of delivering a benefit to so many, probably 50 million americans. so this is my last discussion about medicare. when president lyndon johnson signed the medicare act, he said no longer will older americans be denied the healing miracle of modern medicine. no longer will illness crush and destroy the savings that have so carefully been put away over a lifetime so they might enjoy dignity in their later years. no longer will young families

see their own incomes eaten away simply because they're carrying out their deep moral obligations to their parents, to their aunts and uncles. this was -- this was president lyndon johnson in the 1960's. some of us actually were around in the 1960's, remember it, and this is what the republicans said about medicare. listen carefully. this is a history moment here. we're looking at what the republicans said every time we were about to get a new benefit for the people of this nation. 60% of republicans and 50% of house republicans -- i'm sorry. 60% of republicans in the senate and 50% of house republicans voted against medicare. representative durward hall of missouri, republican, said we cannot stand idly by as the nation is urged to embark on an ill-conceived adventure in government medicine, the end of

which no one can see and from which the patient is certain to be the ultimate sufferer. this is what the republicans said. and senator milward similarson of wyoming said i am disturbed about the effect this legislation would have upon our economy and upon our private insurance system. well, of course, what we found out is this turns out to be one of the most successful programs. medicare is a success. before medicare became law, the majority of seniors had no health insurance. today nearly all seniors are receiving guaranteed health care benefits. eight out of ten seniors aged 65 and older feel the program is working. with few exceptions throughout its history, medicare has been more successful than private insurers at holding down costs. and we still have to fight for medicare. i need to see the medicare

chart. we still have to fight. in 1995, dick armey, the republican house majority leader, said medicare is a program i would have no part of in the free world. a bit of an overstatement. dick armey. that same year after leading an effort to raise premiums and costs for seniors, newt gingrich predicted medicare was -- quote -- "going to wither on the vine." senate majority leader bob dole bragged in 1996 i was there, fighting the fight, voting against medicare because we knew it wouldn't work in 1965. and paul ryan's budget ends medicare as we know it today. so all this brings us to the moment we're in. now republicans are trying to defund the new health reform law, and john boehner, speaker

boehner said passage of health reform is armageddon because the law will ruin our country. they said it about social security, they said it about medicare, and now they're saying it about the affordable care act, and the republican party platform in 2012 said obamacare was the high water mark of an outdated liberalism, the latest attempt to impose upon americans a hero style bureaucracy to manage all -- a euro-style bureaucracy to manage all aspects of their lives, unquote. so i felt it was important to put into the record the historical context of the battle we face today. i try to tell my kids and my grandkids, when we fight these battles, we sometimes forget the context, that it's not that much different than what went before

us. we look different. certainly the women weren't around here then. but the fact of the matter is they are the same battles. it's about what is the role of the national government of the greatest country in the world. and i certainly for one believe making life better for our people and doing it in a smart way and a fiscally responsible way is the way to go. we'll have to make our changes to the affordable care act if we see we can make it better, and we invite our republican friends to work with us. i was one who didn't vote for the drug benefit because i didn't like that big, fat don't hole that came in there -- fat doughnut hole that came in there. which put people on the spot, they had to stop taking medicine, they couldn't their money, but we worked with our friends, we ended that, and by the way we did it in this bill, the affordable care act.

so yes, working together, yes, but standing up until we drop in order to stop important benefits from going to america's families, that's wrong. i yield the floor. the presiding officer: the senator from maryland. mr. cardin: mr. president, first let me thank senator boxer for putting into the record the history of how we fought for medicare, how we went through a lot of the health care fights and what we have stood for in protecting the american public for affordable, quality health care. i applaud her and agree with the comments that she has made. i think it is very interesting to point out the contrast to the passage of the affordable care act that has been law now since march 23, twen. it went through hearing after days of hearings in the house and in the senate, went through

days of markups in the committee where hundreds of amendments were offered in both the house and the senate. we had a long debate on the floor of the senate floor of the house. we reconcile differences between the two houses. it went through the regular process, and we spent as much time on that bill, i think, as we spent on any major bill, and yet there was differences. the bill was passed, signed into law. when we expanded medicare, and i was in the house at the time on medicare part d, i also voted against it and most veterans voted against it. voted against it for the reason you just said of the coverage gap, the doughnut hole. there was no public option, as you remember. it was all private insurance. they didn't pull the total purchasing power to reduce the costs of prescription drugs, another matter that we felt very strongly that we were overpaying and we are overpaying on prescription drugs as a result of that change. and by the way, it was not paid

for. it was estimated to cost $400 billion, and there was no offset of cost, so we were worried that it would have an impact on the affordability of the federal government to pay the bills, so we all voted against it, many of us did. it became law. and senator boxer is absolutely right. when that bill passed, we came together and said let's make it better. we lost the battle on the floor, it became the law. let's try to make it work. and we did that. democrats and republicans. we're now into three years under the affordable care act, and all we get from the republicans is repeal after repeal after repeal. no effort to deal with legitimate problems of implementation that we would like to work together to do. what a difference. instead, they are using a process of holding hostage the federal government from being in operation in order to advance

their extreme agenda. it has been nearly 20 years ago when government shut down because the republicans decided it would be better to close government to prove their point. well, they were wrong then. they recognized the costs of a government shutdown and an inconvenience to the american people and the damage to our economy, and yet, mr. president, monday night we run the risk of another government shutdown because the republicans are holding hostage the continuation of government to try to move forward their extreme agenda. so let me talk a little bit about this. let me talk about what it would mean if we were in fact to pass the continuing resolution that was passed by the house. we're not going to do that. we're not going to pass that. everybody knows we're not going to pass it, but i think the american people need to know what would happen if that did pass, and we did defund the affordable care act. i could talk a lot about

provisions that have already taken effect. i could talk about the fact that in my state of maryland, 46,000 families have taken advantage of putting their children on their health insurance policies to age 26. you repeal the affordable care act, those 46,000 families will have to find another way to take care of the health insurance for their children. or i could talk about the fact that come january, we will eliminate lifetime caps on health insurance. how many families have had to go through bankruptcy because they can't afford health coverage. they may have insurance but the caps put them into bankruptcy. that's gone. you repeal the affordable care act, we're back to the arbitrary limits. how many families have told us about preexisting health care condition restrictions that are in their health insurance policies? we have already corrected that for children.

that's already the law. come january, there will be no further preexisting conditions. women won't be discriminated against in health premiums. pregnancies will no longer be considered a preexisting condition. being a victim of domestic violence will no longer be considered a preexisting condition. i could cite -- i'm sure the presiding officer could, too, examples in our own state where people have not been able to get full coverage. i have a family in montgomery county that had to take out two insurance policies and pay two separate premiums for the family because of preexisting condition restrictions. that's history. they passed the resolution that came over from the house, that's all gone. we're back to how it used to be. and i know we talked a lot about affordability, and i want to talk a moment about that because before we pass the affordable care act -- passed the affordable care act, we got letter after letter from individuals and businesses about their premiums going up and they have to cut back coverage and

they require the employee to pay more, the benefits are less and the freedoms are higher. we were seeing double-digit cost increases in health care. well, now we have got a quality product, a guarantee essential benefits are going to be in there. we got protection that at least 80% to 85% of the premium dollar must actually go to benefits. if it doesn't go to benefits, you get a rebate, you get a refund. in my state of maryland, we're going to have 44,000 marylanders are getting rebates because their premiums were too high. the average rebate is $140 a family, $13 million in repatriots. now, with the house-passed continuing resolution, that's

gone. those protections are no longer in the law. we're back to how it used to be. no guaranteed coverage, no guaranteed benefits, no guaranteed value. and there's another aspect to, one i'm very proud of. the united states will at last join the industrial nations of the world and say we're going to make affordable health care available to every person, every american in our country. i think that's an important point. i have 800,000 people in my state of maryland who don't have health coverage today. 800,000. now, come october 1, next tuesday, they're going to be able to go to the maryland health connection and get health coverage. but guess what, they're going to have a variety of plans they can choose from and they can make their decision, but a large number, over 85%, 87% of the people who will be going to

the maryland health care connection, it's been estimated, are going to be entitled to help in paying for those premiums. 87%. we talk about the individual mandate, we've provided an affordable option so everyone can be in the system. we want universal coverage because we think it's the right policy, everybody should be covered, we want universal coverage because we think it's wrong for someone who has health insurance to pay for someone who has health insurance because they use the facilities and we pay more as a result of that. hospital costs are more, doctors' costs are more. everybody should pay their fair share but we make it affordable. 87% are entitled to help. those who go through the maryland health connection and are rolled in medicaid, obviously they're going to get their help and we've expanded that coverage and those who go into the exchanges in maryland is one of those states that the state will be operating the exchanges. the overwhelming majority will be entitled to some help in the

payment of those premiums. if the house-passed resolution were to become law -- and, mr. president, it's not going to become law. the purpose for sending it here was to make hostage the closing of our government. but if it became law, that help is gone. these uninsured have no prospect of getting health coverage, and the inefficiencies of our system continues, the use of emergency rooms, the lack of preventive care continues. the senator from california, senator boxer, talked about the medicare system and let me talk a moment about the medicare system because this is very important. the so-called doughnut hole, that prescription drug gap of coverage is being closed as a result of the passage of the affordable care act. how many seniors fell into that doughnut hole and literally could not afford their prescription drugs? we closed that in the affordable

care act. in my state of maryland, 50,000 seniors benefited from that. 50,000 seniors. if we pass the bill that came over from the house those 50,000 seniors will be calling our office every day finding out what happened to that coverage that they just lost. you better believe our phones would be ringing about why are we taking away their benefits. it's even more that are benefiting from the preventive health care services, they don't have to pay co-payments. about half a million marylanders of eligible for that benefit. and they're taking advantage, 34 million nationwide. they would lose that preventive health care services that they have today as a result of the passage of the affordable care act. that's gone if the house-passed resolution were to become law. and probably even more serious than that and senator boxer

alluded to it, the passage of the affordable care act improved the solvency of medicare for a decade. you repeal the affordable care act, you're back with whether medicare itself will be a solvent program. i could go on and on. we have provisions in the affordable care act that are working to prevent fraud within the medicare system, saving taxpayers' dollars. that's gone. we help make sure the medicare advantage praps plans are properly paid, that's gone. all that is repealed if the house resolution were to pass, which it will not. it was sent over here to us with a strategy to put the government operations in jeopardy, there are many on the other side who believe it's a good idea to close the government. that's their objective. even though the republicans admitted that this strategy would not work to actually defund the affordable care act, but i think we should at least talk about what impact it would have. i hear my colleagues talk frequently about small business

and i've had a lot of forums on small business in maryland, and i must tell you yes, small businesses are concerned about whether they can afford the cost of their employees and health benefits. they are concerned about it. that's a legitimate issue but let's talk about what is the circumstances without the passage of the affordable care act? they're on their own. they don't have large markets, they have to pay more than large companies have to pay, they don't have a lot of options. well, under the exchanges, under maryland health connection, they'll get different opportunities that they didn't have before, more affordable coverage that they didn't have before. there's credits available to help them pay for their health insurance. and, mr. president, if you have less than 50 employees, there's not a single new mandate in this law for a small business. so this is good news for small companies.

that's gone if the resolution that passed the house were to become law and, mr. president, it's not going to become law and my republican colleagues know it's not going to become law. so i think it's important to point that out. so what happens if we don't get to an agreement by monday night? and that's possible. that's possible. we're going to send back a resolution, a continuing resolution to the house, don't want know whether they're going to accept it or not. what happens? well, i can tell you this: i represent the state of maryland, i represent a lot of federal workers, and i tell you something, they've been through furloughs, they've been through pay freezes, they have been put to the test, asked to do a lot more work with less workers, we have less per capita workers than we've had in modern times. on a per capita basis of federal workers. they've been asked to do more with less, contributed greatly to reducing the deficit. and once again, come tuesday morning they're going to be asked in some cases to show up for work not knowing whether

they'll get paid or not, other cases staying home, not getting paid, trying to figure out how to pay their bills. they got rent payments and mortgage payments and food payments and guess what, that's going to have a major impact on our economy, make no mistake about it, it will hurt our economy. we've been through this. we've seen this movie before. it hurts our economy, it hurts our country. this is a self-inflicted crisis. this is totallied a avoid -- totally avoidable. if that happens, people will be terribly inconvenienced. you asked the 10,000 people who would like to enroll in medicare and there's no one to enroll them in medicare what they're going to do. you ask a person who needs a passport and can't get a passport what they're going to do. i'm not going through a whole host of things, in 1995 and 1996, it was estimated nine million people who planned to go to national parks didn't go to

national parks. it's a cumulative expect. why are we doing this? to advance our agenda? no, it's not going to pass. why aren't we using regular order? this is costly. it's costly to our economy, costly to american families. and it's causing a slowdown in the recovery of our economy. now, even greater concern is that in just a couple of weeks, the middle of october, we're talking about going through this again perhaps on whether we will pay our bills. the limit that we have deals with whether we can pay the expenses that have already been incurred. this is not about new spending. this is about money that has already been spent, will we pay the bill when the bill is received? so in the house-passed resolution they said, well, we'll just prioritize,

prioritize. we'll pay some but not all. now, mr. president, i don't know how you can do that. administratively i don't know how you can do that. you certainly are going to make it much more difficult to deal with those that are not in the priority category so we become a secretary selective deadbeat? we're not going to pay contractors, workers? who are we not going to pay? they've already done the work. they've already provided the services. and they have responsibilities and they expect us to pay our bills. it doesn't work. it's a permanent stain -- we've been through this before in the last congress and we saw, it hurt america's reputation, we claim close, we didn't go over the cliff but just coming close presented a huge problem for this country.

if we actually go over the cliff and don't pay our bills, it will be very costly to the american taxpayers. interest rates will go up on our national debt. it will go up. that will cost the taxpayers more money. for what? another self-inflicted crisis by the republicans to advance their extreme agenda. we have the votes here to pass what we call a clean c.r., a clean extension of paying our bills. we have the votes here. there's a majority of us prepared to vote for that. we've said that. he we've shown that. but instead it's being held hostage to an are extreme agenda and trying to shortcut the regular process. what is the regular process? the regular process, we do our work, they do their work, the house, the senate does its work, go to conference, work it out. yes, there's a republican-controlled house, yes, democrats control the senate, we don't have 60 votes

but we have the majority. and the white house, it's president obama. so that's what the voters gave us. our responsibility is to work with that. so okay, we did. the house passed a budget. i didn't like the budget. i didn't like their budget. but that's a democracy. they passed their budget. we passed a budget here, mr. president. our republican friends said i probably won't do it, we did it. we didn't pass that last week. we passed that months ago. months ago. and what we said is okay, let's go to conference, work out the difference. it won't be everything i want, it won't be everything the republicans want. that's how the process works. the republicans won't sit down and talk with us. they won't let us go to conference. they won't let us work out a budget. so when you look at why we haven't been able to reach a budget by october 1, it starts with the fact that we haven't been able to sit around a table

to work out our differences because the republicans won't let us go to conference. that's a fact. so we got to get to conference, we got to get that done but in the meantime don't hold the government hostage, don't hold paying our bills hostage because all that does is create additional costs, hurts america's reputation, hurts our economic recovery and it doesn't at all advance a final resolution of an ordinarily process in which we work out the problems of this country. so i urge my colleagues to put america's interests first, stop these games we're playing and threats that we're playing, we're coming too close, too many people we are again telling, well, we don't know whether you're going to get a paycheck next week. what do you do if you're a worker or a contractor? you don't know if you get a paycheck next week. you're already cutting back on your commitments. that's already hurting our economy. every day we wait it hurts our economy. that's why a lot of us are upset

that we're waste -- had to waste yesterday, it would have been nice yesterday to resolve the issue. every day we wait costs our economy, costs our country. let us pass the necessary legislation to keep government operating, to pay our bills, and let's sit down as we should and work out the budget problems in a way that is befitting the transition of -- tradition of the united states senate. with that, mr. president, i would yield the floor. a senator: mr. president? the presiding officer: the senator from south dakota. mr. thune: mr. president, i would ask unanimous consent that the conclusion of my remarks that the senator from connecticut, senator blumenthal, be recognized. the presiding officer: without objection. mr. thune: mr. president, we are going to have a vote here in the next few days, depending on how the schedule and the calendar works out, on whether or not to defund obamacare. that's a vote that i think many of us in this chamber want to have. i know that many of our colleagues on the other side,

the democrats, would prefer not to have that vote, but it is time for us to go on the record and to indicate to the american people, who are very fed up with this law and, frankly, haven't had a good opportunity yet to see much of it being implemented because much of the implementation will occur in the next few months. but we're going to get to that vote here in the next few days one way or the other, and the pressure's o. the pressure's o on -- pressure's on. the pressure's on senators here. the pressure's on republicans and democrats to stand up and to indicate one way or the other about whether or not they're willing to stand with the american people and against obamacare, which is having a harmful impact on so many different levels across the country. and i want to just point out, if i might, a few of those impacts. obviously many of us here in the chamber are very concerned about the economy and about jobs and about creating a better economic future for the people that we represent, and we are suffering

through a very sluggish, anemic economy. growth rates that are hovering in that 1% to 2% range but certainly not a range that get americans back to work or increase the take-home pay for middle-income americans. and if you look at the economic data, it's pretty sobering. we've had this chronic high unemployment rate that's been contained -- or i should say sustained now for -- for several years in a row, 7.5%. if you add in the number of people who have quit looking for work or are yurn employed -- --n other words, they're working part-time but to want work for time -- the rate is much, much higher. there are about 22 million unemployed today. and if you factor in those who have quit looking for work and those who are underemployed, who are working part-time instead of full-time, the unemployment rate goes up to well over 10%. and so you've got a lot of americans who are looking for jobs. at the same time the jobs that are being created in the economy

part-time jobs, so what's happening? well, a lot of americans who would love to be working full time to be able to provide for thatheir families are now being forced into part-time jobs. in fact, 0% of the jobs -- 60% of the jobs being created this year are part-time jobs not full-time jobs. if luke at the labor participation rate it's at the lowest level wean seen in 35 years. you have to go back to the administration of jimmy carter when the number of people in the work force is as low as it is today, 63.2%. and so the economic data just rolls on and on. this is a very sluggish, a very weak, a very anemic economy. and so when you ask people, when you ask businesses why is that, why are you not hiring full-time workers, why are you hiring part-time workers, why are you reducing the size of your work force or not hiring people that you otherwise might hire, why is this issue of take-home pay

going down relative to what it was when the president first took office? and the answer in most cases comes back pretty simple. it's obamacare. it's the cost of -- and the mandates and the requirements and the uncertainty associated with the president's health care law and some other, i might add, government regulations. but policies coming out of washington, d.c., that are making it more difficult, more expensive for our small businesses, our job creators to create the jobs that are necessary to keep our economy going. and that's why you have this sluggish economy and this high -- chronically high unemployment rate and part-time jobs rather than full-time jobs and lower take-home pay and the slowest recovery that we've seen literally in the last 50 years. i mean, that's the economy that we're in the midst of right now. now, the -- as we talk about abt obamacare -- and my colleagues and i come down here, and i was

here when we voted on that back here in 2009 and 2010, i was here on the floor on a regular basis talking about why i thought this was going to be a disaster for the economy, for health care costs, and offering up alternatives that we think would be much. and better there are many that would work much better in terms of making health care more affordable and more accessible to more americans. but we were unsuccessful. they the votes. they passed it. it was a partisan vote. it passed by a single vote. it was a party-line vote. and i think now why that's why the american people rejected it. they know it was a partisan piece of legislation passed without any input from -- from the other side and ideas and alternatives that might have made more sense in terms of addressing the health care needs of the american people say they want to see addressed. but that being said, it's not just us who come down here and talk about this. we've now seen, as this thing has been slowly implemented, some of the impacts, some of the

taxes have kicked in, you're starting to see, you know, some of the additional costs that we said would impact middle-income families many this country when it comes to the cost of their health insurance. and you don't have to look invest to see the -- and you don't have to look very far to see the people who are writing stories about that. in fact, you know, instead of listening to just republicans who come down here on the floor and talk about this, you can look at the headlines of the newspapers across this country. and these are just this last week. we're not talking about a long period of time. these are just headlines from the last week. the national review on-line, "sorry, mr. president, there is serious evidence obamacare is bad for economic growth." the associated press, census, "no sign of economic rebound for many in the united states. states." "washington times," "georgia health care company cuts a hundred employees due to

obamacare." reuters, cleveland clinic cuts jobs to prepare for obamacare. lancaster on-line, how part-time workers are feeling the pain of obamacare. and you can go on and on and, mr. president, with just the headlines talking about the impact on jobs and the economy of this obamacare legislation, which is in the process now of being implemented. and -- and i think the other thing that -- that we've said all along would happen, and that's what we're seeing happen as well, health insurance costs are going up, not down. if you look at the data on thi this -- and, again, these are -- these are some of the news stories that i mentioned. again, these are headlines from just the last week. national public radio -- health care costs are projected to outpace economic growth. associated press -- premium concerns lead some small businesses to temporarily sidestep health law.

and i could go on, mr. preside mr. president. but point very simply is that the val day or twos of the things -- validaters of the things that we're saying here are out there every single day in the media. and there's a study, of course, that came out accident or i should say a -- came out, or i should say a report that came out from h.h.s. that was supposed to give us an idea or a glimpse, if you will, what the premiums will be on the exchanges when they're fully up and running and that should be sometime next week. so the health and human services department issued some information about that yesterday. but what's ironic about it is with less than a week to go before these exchanges are supposed to go on-line, it's a 15-page report and a press release that summarizes some of the premium data. but what they did is they compared -- h.h.s. compared what the congressional budget office projected rates might look like in 2016 to its own findings. it didn't compare it to what it

cost last year. it didn't compare it to the reality that most americans are experiencing in items of the health care costs that they deal with -- in terms of the health care costs that they deal with on an annual basis. so we're not getting any information that gives us any insight into what actually these costs are going to be. now, fortunately there are others who have looked at this same information, the data dump that was released yesterday by health and human services department, and compared it to what insurance costs are before the affordable care act passed. in other words, these are -- these are -- you know, we heard the promises from the president when this was being debated that health care costs were going to go down by $2,500 per family. obviously we're seeing the exact opposite. there was a c.m.s. study that came out just a few days ago said that said health care costs because of obamacare actually are going to go up by $621 billion. you decide that by the number of families in this country and a family of four, that's $7,450 per family of four increase, not

decrease, in health care costs. that's the c.m.s. actuary's estimate. but when you look at what these -- the information coming out of h.h.s. suggests and you compare it to a baseline of what health care costs are before this becomes implemented, you get a very different picture. and some of the analysis that's been done suggests that obamacare is going to increase underlying insurance rates for younger men by an average of 97% to 99% and for younger women by an average of 55% to 62%. it says the worst off is the state of north carolina, where individual market rates are going to triple for women and quadruple for men. and you can go down the list of state-by-state and you get sort of a detailed explanation of people at various stages in li life, 40-year-old woman -- and this is -- i'm looking at some charts here and comparing my state of south dakota. but this is the affordable care

act bronze premium versus the pre-affordable health care act premiums with people in similar circumstances were faced with. for a 40-year-old man in my state of south dakota, it says it's going to increase their premiums by 146%. for a 40-year-old woman by 96%. so the evidence just keeps piling up out there. and the news stories, the people who are -- the businesses that are talking about the impact that it's going to have on them, the analysis that's being done that actually compares not -- what this is going to do, what the exchanges -- the premiums are going to be with the exchanges with what people are actually experiencing today, not some hypothetical, like the h.h.s. numbers suggested, and you find that it's a picture -- a picture is being painted of a very serious situation for middle-class families who were hoping -- hoping, when all the promises were made -- that they were going to see their health

insurance costs go down, not up, and the exact opposite is happening. and so you can go through again state-by-state, look at the various analysis of this, but i think the point is, mr. president, that instead of having health insurance costs go down as a result of obamacare, they are going up and they're going up dramatically. and this c.m.s. estimate by the actuary that just came out a few days ago, $621 billion increase in health care spending in this contribute attributable solely, singularly to obamacare divided by the number of families in the country, and as i said, that's a $7,450 increase. so why are people rejecting this? well, i think that's the obvious reason, they realize, most people do, at least, that this is a -- these are pocketbook issues, these are kitchen table issues, these are the types of things that as americans are trying to figure out how to pay their bills, how to keep their family covered, how to save a little money for their

children's college education, how to make ends meet and just keep things afloat, they're very concerned about what they're seeing and the impact of this legislation on what they're having to pay for health care coverage and also very concerned about what it might mean for the jobs that they have today and hopefully aspire to in the future, many of which are in jeopardy because businesses who are -- who are hit with these new mandates, these new penalties, these new requirements under obamacare are finding it more and more difficult all the time and more expensive to create the times that will -- that will be -- that will help these middle-class, middle-income families meet the needs of their families and try and provide a better future for their children and grandchildren. now, one of the reasons i think at the end of the day that, as people are assessing this, there is so much now information coming in, too, polling data, survey data that corroborates

the anecdotal data we're hearing from individuals and businesses out there. people are increasing the skeptical, increasingly -- increasingly skeptical, increasingly suspicious and increasingly frustrated with the obamacare legislation and they want to see it -- they want to see a do-over. and one of the biggest examples of that probably were the biggest advocates of this, which were the labor unions. if you look at what the labor unions are now saying, there was a letter a few weeks back from three of the largest unions in the country, including the teamsters union, led by jimmy hoffa, in which they said that obamacare would shatter benefits for their members. they said it would create nightmare scenarios. and they said that it would destroy the -- the foundation, the backbone, if you will, of middle-class families and that's the 40-hour work week. and the reason they're saying that is because, as i mentioned, the number of jobs that are being created in america today are primarily part-time jobs. why? because small businesses have incentives to hire part-time workers. one, if they hire above 50

employees, they're covered by the mandate that says they have to provide government-approved health care to their employees. and, two, a -- the part -- the full-time employee hour limit is 30 hours. so you've got more and more employers who are trying to stay under 50 employees and trying to employ people for fewer than 30 hours a week so that they're not hit with these mandates under the obamacare legislation. that is not a good scenario for someone who is out there looking for a job or someone who's looking for a better job, and it certainly isn't going to help americans improve and increase the amount of take-home pay that they get on a weekly and a monthly basis. and that's why if you look at -- again, these are some headlines from newspapers. washington examiner says -- just 12% think obamacare will have a positive impact on their families. fox news poll -- 68% concerned about their health care under the new law. nbc news poll -- obamacare

remains highly unpopular as implementation looms. "washington post" poll -- many americans confused about the health care law. cnn money poll -- most employees still in the dark about health care reform. there is anxiety, there is frustration, there is skepticism and i think most of these folks share the view that was expressed by the unions, who were perhaps the biggest advocates of the health care law when it passed, and that is we would like a do-over. this either needs to be fixed or it needs to be repealed. that's essentially the message that was coming out of the unions in a meeting that they had in california a week ago. and so it goes on and on and on, mr. president, and we are going to have an opportunity to right that wrong. we are going to have an opportunity to get that do-over, and to have a vote. the vote's going to occur in the next few days. it's going to give us an opportunity to go on the record about whether or not we think we ought to continue to fund a program that we now know is not

working, and all the evidence that i mentioned here today, all the conversations that you have with businesses in your home state, with hospitals. i mentioned earlier cleveland clinic which is reducing its work force to prepare for obamacare, that's going on all across this country, but it's not too late for us to get this right, and we can -- we can correct this. there is a better way to do this. it didn't take a 2,700-page bill and 20,000 pages of regulations to fix the things that were wrong with the american health care system. now we have a government takeover of literally 1/6 of our economy, massive amounts of red tape and bureaucracy and regulation and uncertainty associated with that, higher costs for individuals, much higher costs, dramatically higher costs, as i pointed out, and fewer job opportunities for families around this country, at least for full-time jobs, and lower take-home pay and lower

labor participation rate and a sluggish economy. that's what this has wrought, that's what we need to correct, we need to fix, and we're going to have an opportunity to do that with a vote later this week. so, mr. president, i hope that -- i know it's very hard to acknowledge sometimes when something's not working and something that you have invested in, something that in this case a number of our colleagues voted for when it was passed here several years ago, but in the interests of the american people, in the interest of doing what's right for jobs, for our economy, for the health care needs of american middle-class families across this country, it is time for us to fix this, to right this wrong and to move in a different direction, and so i hope that we will have the votes. there will be some of our colleagues on the democrat side who will vote with us when we get to this vote here in the next few days and send a very clear, loud message to the american people that we are listening, that we hear you, we understand your frustration.

we want to fix this, we want to get it right, we want to go in a different direction. i think that would be a welcome -- welcome relief to americans as who in overwhelming numbers are finding this less and less to their liking. the more they find out about it, the less they like it, and the more concerned they are about the future for them and for their families. mr. president, i yield the floor. mr. blumenthal: mr. president? the presiding officer: the senator from connecticut. mr. blumenthal: thank you so much, mr. president. i rise today to talk as well

about the affordable care act, and perhaps cut through some of the rhetoric and talk a little bit about specific realities and the reason to preserve its funding, along with honoring our other commitments in the continuing resolution that will keep the federal government open and working for the american people. i want to say right at the outset i hear from folks in connecticut about the need for improvements and minor changes in the affordable care act, which should be possible, but what should be impossible is holding hostage the work of the united states government to achieve changes in the affordable care act and make improvements that may be necessary but should be done separately from keeping the government open for our veterans

and social security recipients who may need services in connection with the checks that they are issuing, in paying our troops here and abroad, serving and sacrificing for us, in the countless ways that our federal government makes a difference in people's lives, and most important the threat of closing the government helps to create uncertainty and confusion, which in turn undermine investment and job creation and economic growth, indeed recovery from the great economic recession which has so financially crippled our nation. now the health care reform measure, the affordable care act, obamacare, call it what you will, has already made achievements, enabling young people to stay on their parents' policies, moderating if not eliminating many of the insurance coverage abuses that i

fought as attorney general, achieving advances in health care delivery reform for greater efficiency and lower cost, and as we have noted on this floor countless times, the affordable care act was passed by a majority in this body in the house of representatives and signed by the president. it predated my service here, but it is the law of the land, and the effort now is in effect to achieve through the back door what was not accomplished through the front door. it is to achieve by indirection what opponents of the affordable care act wanted to achieve directly, which is to block it, to stop it, to halt it. that should not be the objective

of this measure. and certainly should not be achieved by a small minority, a fringe extreme group of ideologues who have in the house of representatives threatened to hold hostage the entire federal government. i am disheartened that some of the same senators that rightly decry the pace of our economic recovery are themselves now undermining that goal by demanding an end to the affordable care act and engendering uncertainty and confusion so enimical to job creation and economic growth. forums in connecticut, my conversations and discussions with health care providers or hospitals, our medical professionals have convinced me that one of the central achievements already of the affordable care act relates to preventative care, and i want to talk for a little while about

those specifics, about the reality on the ground in connecticut that i have seen and heard, not the predictions or prognostications, but the realities of preventative health care achievements in connecticut that have already been demonstrated, and they relate specifically to the prevention and public health fund. let me repeat that term. the prevention and public health fund, not exactly a household word to many americans, but it should be credited along with obamacare and the affordable care act with specific tangible accomplishments in helping people learn how to make smart decisions and prevent the onset of obesity, diabetes, heart disease and cancer. these conditions and diseases have real cause and -- real costs and preventing them has

real savings. so we can seriously reduce not only the overall levels of spending on health care but also save people a lot of suffering and families a lot of heartbreak. in my home state of connecticut, the funding from the prevention and public health fund has supported vital care and services in three critical areas -- mental health, tobacco cessation and women's health care. not the only three that has those accomplishments, but they are three. on mental health services, last year the state of connecticut received nearly $900,000 from the prevention and public health fund for use by the state's department of mental health and addiction services and the direct care providers in the state. let me give you an example of how that money was used. community mental health affiliates, which serves more than 8,300 children, adolescents and adults each year in 17

locations throughout connecticut, receive some of those funds to provide direct care. in particular, they are using those funds to create the allied health system, and they're doing it with the hospital of central connecticut, which means having advanced nurses and practical help from the hospital of central connecticut to come to their outpatient facilities to provide case management and wellness programs and suicide prevention and screening programs. they are helping save lives and health. now, we know that investment in mental health makes a difference. in fact, it ought to be a centerpiece of a comprehensive gun violence prevention measure. we know that reaching dangerous people, along with keeping guns out of the hands of dangerous people, but reaching them before they commit acts of violence is central to what we have to do to

make our nation safer and better, and investment in behavioral health services so they can address the diseases, the psychoses, addiction, depression, posttraumatic stress, help reach people before tragedy occurs. we know that lack of investment makes a difference as well, not only in violence but in heartbreaking failures and life-changing illnesses that are perhaps invisible but in children can transform lives for the worse. the connecticut children's medical center recently came to my office and shared with me what the lack of investment in preventative health care means for them and the children who come to this children's hospital. they have seen numbers of children arriving in a behavioral health crisis

unmatched in our history, nearly quadrupled since the year 2000. last year, that meant 2,300 children seeking care in the emergency department of that children's hospital. the emergency departments are not equipped to provide the kind of specialized care that children need who come to them in these traumatic, life-changing situations, in crises, and for some kids who wait over a week for placement in an appropriate in-patient facility, that's a crisis not only for them but for their family and their communities, and we have seen the tragic results of failing to address that crisis that affects individuals so heart breakingly. on tobacco, which i have fought and made my life's work, tobacco prevention and cessation

programs, my colleagues want to talk about reducing federal spending. well, let's talk about the $96 billion a year in direct health costs that are necessary to treat tobacco diseases caused by tobacco addiction. $96 billion a year in direct health costs, nearly $55 million of it from the federal government. i hope to work in a bipartisan way to reduce that figure with my colleagues through the affordable care act. a study in the lancelet on tips from former smokers, the campaign of the federal government, found that 1.6 million additional smokers making a quit attempt because of this campaign and over 100,000 people have quit tobacco since 2012 because of that campaign. i'm going to continue my remarks, mr. president, if i

may, but interrupt for the majority leader. thank you. i will continue briefly, i will conclude briefly. the final area that i think is so important is women's health care, and in this area, the affordable care act has been monumental in maternity care in our hospitals, in contraception coverage, in health insurance provisions that make a difference in women participating equally in our economy as well as having the health care they need that in turn saves money, not just for themselves but for children who are born in hospitals and have the kind of care they need in those first days of birth. the prevention and public health fund has made a difference in those lives, and it's made

meaningful improvements to the lives and health of women and children across this country. now, cost savings to the nation resulting from preventative health care are huge, but those economic benefits also accrue to our families. more than half of all the bankruptcy families today are cawed by health bills that people simply can't pay. i know because i see the results, and try to help the families who are affected by them. one is, for example, a family whose son struggles with lyme disease and denials from insurance companies and they had to exhaust their retirement savings and their health care funds as well as their college funds for medical treatment. my office was able to persuade the insurance company t