the presiding officer: the majority leader. mr. mcconnell: i ask unanimous consent that the quorum call be dispensed with. the presiding officer: without objection. mr. mcconnell: i ask unanimous consent at 7:10 p.m. the senate proceed to consideration of h.r. 2 which was received from the house and that the only amendments in order be the following, cornyn amendment 1114 repealing the individual mandate, democratic amendment number 115 extend s. chip, lee amendment 116 motion to strike democratic amendment number 117, women's health, cotton amendment 118 democratic amendment number 1119 therapy following the use or yielding back of time the senate vote in relates to the amendments in the order listed, that all amendments except the cotton and lee amendments be subject to a 60-vote affirmative

threshold for adoption, the bill read a third time and vote on passage of the bill as amended there be two minutes divide between the votes and that votes after the first be ten minutes in length. mr. reid: reserving the right to object. the reason we've been not moving forward more quickly is first of all we had to get some of the holds lifted and we were able to do that on both sides. and we wanted to make sure that there would be no cuts in the physicians' payments. we -- we thought if we finished this early tomorrow, around noon or somewhere thereabout, that the payments would not be cut but we don't have that assurance yet. so we're going to have to go ahead. if there's something that comes from the office of management and budget or the white house that that would not happen, we could allow people to go to events they have around town. in the meantime, i agree with the republican leader, we should

just go forward. if something happens during some of these votes that we can finish them tomorrow, fine. but in the meantime, to protect not only the physicians but their patients, we should move forward on this legislation now. i have no objection. mr. mcconnell:: mr. president? the presiding officer: without objection, so ordered. mr. mcconnell: mr. president just briefly, the point to remember here is at midnight five hours from now roughly c.m.s. will begin to cut payments to doctors who treat medicare patients. if we do not act tonight these cuts of 21% will be real. i yield the floor.

the presiding officer: under the previous order, the senate will proceed to the consideration of h.r. 2 which the clerk will report. the clerk: h.r. 2 an act to amend title 18 of the social security act and so fortd and -- and so forth and for other purposes. mr. cornyn: mr. president? the presiding officer: the majority whip. mr. cornyn: mr. president i call up my amendment aand -- and ask for its immediate consideration. the presiding officer: the clerk will report the amendment. the clerk: the senator from texas, mr. cornyn, proposes amendment number 1114. the presiding officer: under the previous order there are now

two minutes of debate equally wide toed prior to a roll vote in relation to the amendment offer 1114, offered by the senator from texas mr. cornyn. mr. cornyn: mr. president the speaker and leader pelosi have negotiated a package which enjoyed broad bipartisan support in the house. the one missing element is a pay-for for the so-called doc fix for the sustainable growth rate fix. what my amendment at does is it offers that pay-for so that this is a deficit-neutral bill if it's adopted. in order to find that pay-for we would repeal the individual mandate. this would -- the latest c.b.o. score shows that it would save as much as $400 billion. it hasn't been scored this year so the number may be off a little bit. but there's more than adequate amount of money to offset the deficit caused by this permanent doc fix. and i'd ask my colleagues to join me, along with then-senator

barack obama in 2008, who in his campaign against hillary clinton when he was running for the democratic nomination campaigned against the individual mandate. let's -- let's make that reality. mr. wyden: mr. president? mr. president, i urge colleagues to oppose this amendment. what senator cornyn seeks to do is to strike an idea that originally came from the heritage foundation. if it is adopted colleagues, sick people will definitely sign up healthy people will stay on the sidelined. premiums will skyrocket according to the congressional budget office by as much as 20% and you start then what amounts to a death spiral for the affordability of american health care. i urge my colleagues to oppose this. i yield back. mr. cornyn: mr. president do i have time remaining? the presiding officer: no time remains.

the presiding officer: the question occurs on the amendment. is there a sufficient second? the clerk will call the roll. vote:

vote:

vote:

the presiding officer: is there anyone who wishes to change their vote? anyone wishing to vote? if not on this vote the yeas are 54 and the nays are 45. under the previous order requiring 60 votes for the adoption of this amendment the amendment is not agreed to. a senator: mr. president? the presiding officer: the senator from colorado. mr. bennet: thank you mr. president.

i'd ask you call up amendment 1115. the clerk: the senator from colorado mr. bennet, for himself and others proposes amendment 1115. mr. bennet: this amendment provides two years of funding for the chip l program. i want to thank senators brown wyden, stabenow, casey and reid for their leadership on this amendment. we have made great strides in recent years to ensure americans of all ages have access to quality health care, but a huge part of the success to increase the access to quality health care comes from chip which provides insurance to low- and moderate-income children and pregnant women. we know chip works. it serves more than eight million children including more than 150,000 in colorado. this is health care they might not otherwise achieve. unfortunately the house failed to take full advantage of this moment and this moment to compromise and extended funding for two years.

chip is authorized through 2019. this would extend it for two additional years. the very physicians who would be helped would see increased reimbursement when they treat these children -- the presiding officer: the senator's time has expired. mr. bennet: i yield the floor and ask my colleagues to support the amendment. mr. grassley: mr. president? mr. president? the presiding officer: the senator from iowa. mr. grassley: remember that 212 republicans and 180 democrats supported h.r. 2 the decision to extend chip for two years with the current payment rate was part of the house bipartisan agreement. this amendment seeks to rewrite that agreement. this amendment is not a vote to show who really cares more about children's health, because h.r. 2 extends the chip program for two years. everyone who supports the underlying bill is supporting children's health. if you oppose this amendment you're no less a supporter of children's health than the 392 members of the house who

supported h.r. 2 including 180 democrats and leader pelosi. you're really saying that leader pelosi didn't care enough about kids in forging this agreement. i yield the floor. a senator: mr. president? the presiding officer: the senator from utah. mr. hatch: mr. president the pending amendment number 1115 offered by senator bennet would violate the senate paygo rule and increase the budget deficit over a ten year period of fiscal years 2015 to 2024. therefore i raise a point of order against this measure pursuant to section 201-a of s. con res. 21, the concurrent resolution on the budget for fiscal year 2008. mr. bennet: mr. president? the presiding officer: the senator from colorado. mr. bennet: pursuant to section 904 of the congressional budget act of 1974 and the waiver provisions of applicable budget resolutions i move to waive all applicable sections of that act and applicable budget

resolutions for purposes of the pending amendment and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there is. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber wishing to change their vote?

the presiding officer: on this vote the yeas are 50 and the nays are 50. three-fifths of the senators duly chosen and sworn not having voted in the affirmative, the motion is not agreed to. the point of order is sustained and the amendment fails. falls. a senator: mr. president? the presiding officer: the senator from utah. plft lee: mr. lee: mr. president i call up my amendment which is at the desk. the presiding officer: the senate will be in order. the clerk will report. the clerk: the senator from utah mr. lee proposes an amendment numbered 1116.

the presiding officer: the senator from utah. mr. lee: mr. president just two weeks after the senate passed a 10-year balanced budget we find ourselves on the very brink of passing a bill that would promptly unbalance it to the -- the presiding officer: the senate will be in order. mr. lee: we find ourselves on the brink of passing a bill that would promptly unbalance the balanced budget that we just passed. to the tune of $141 billion over the next decade. this is exactly the kind of bait-and-switch behavior that has eroded the public's trust in congress in recent years. to honor the promises we made to each other and that we made to the american people my amendment would simply subject h.r. 2 to the same pay-as-you-go budget rules that cover other spending bills in congress. paying for the new spending in this bill is the right thing to do and we just passed a budget promising that we would do exactly that. my amendment does nothing more than hold us to this very

promise. i implore my colleagues to join me in supporting this amendment. thank you. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: i rise in opposition to the lee amendment. colleagues, the lee amendment is the bluntest possible instrument that would cut spending across the government on every possible program. the s.g.r., the doctors' reimbursement formula has always been a fake. and the $140 billion in this bill eliminates the budget fakery that democrats and republicans believe has gotten out of hand. the yurpd lying bill gets -- the underlegislative process bill gets rid of the fakery. i urge colleagues on both sides aisle to reject the amendment and i yield back. mr. lee: mr. president i call for the yeas and nays. the presiding officer: is there a sufficient second?

there appears to be. the clerk will call the roll. vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote? if not on this vote, the yeas are 42, the nays are 58. the amendment is not agreed to. mrs. murray: mr. president? the presiding officer: the senator from washington. mrs. murray: mr. president i call p amendment number 1117 and ask for its immediate consideration. the presiding officer: the clerk will report. the clerk: mrs. murray prose an amendment numbered 1117. mrs. murray: thank you, mr. president. mr. president --

the presiding officer: the senate will be in order. mrs. murray: mr. president many of us have been working for years to protect medicare access for seniors invest in our community health centers and expand access to health care for for our children. i am a glad that the democrats and republicans in the house were able to come together on these issues much it is disappointing that in a bill which takes so many good bipartisan steps forward republicans have insisted on trying to score political points with their base on women's health. the house s.g.r. bill includes language that is one more example of using women's health as a political football. it is redundant and unnecessary. i am offering an amendment tonight, mr. president -- the presiding officer: the senate will be in order. the senate will be in order. mrs. murray: mr. president i'm offering an amendment tonight that shows that we are making sure that women have a comprehensive access to health care. it focuses on moving women's health care forward by providing

a clean extension of community health care funding for four years, not two to provide certainty. it would invest $2 billion in safety net providers for women and their families through title 10 clinics. and finally it will invest in strengthening the women's health care workforce. the presiding officer: the senator's time has expired. mrs. murray: i hope my colleagues will support this amendment and i ask for the yeas and nays. the presiding officer: is there a sufficient second? mr. hatch: mr. president? mr. president? the presiding officer: there appears to be. the yeas and nays are ordered. mr. hatch: mr. president? the presiding officer: the senator from utah. mr. hatch: may we have order mr. president? the presiding officer: the senate will be in order. the senate will be in order. senator? mr. hatch: mr. president as has been mentioned repeatedly by the 10-day c.m.s. hold period.

it will expired tonight. doctors who serve our seniors will be facing a 21% cut. senator murray's bill costs $21.1 billion over ten years and is not offset. therefore, mr. president the pending amendment number 1117 offered by senator murray would violate the senate paygo rule. therefore, i raise a point of order against this measure pursuant to section 201-a of s. con res. 21 and concurrent resolution on the budget for fiscal year 2008. mrs. murray: mr. president? the presiding officer: the senator from washington. mrs. murray: mr. president pursuant to section 904 of the congressional budget act of 1974 and the waiver provisions of applicable budget resolutions i move to waive all applicable

sections of that act and applicable budget resolutions for purposes of the pending amendment and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. is vote: vote:

the presiding officer: are there any senators in the chamber wishing to change their vote? on this vote, the yeas are 43, the nays are 57. three-fifths of the senators duly chosen and sworn not having voted in the affirmative, the motion is not agreed to.

the point of order is sustained and the amendment fails. a senator: mr. president? the presiding officer: the senator from arkansas. a senator: i would like to call up my amendment at the desk. the presiding officer: the clerk will report. the clerk: the senator from arc a, mr. cotton, proposes an amendment numbered 1118. the presiding officer: can we have order please. the senator from arkansas. mr. cotton: i want to replace the s.g.r. permanently but i also want to do it correctly. this bill has two payment modeled for the future. for the first four years we get payments increased in a percentage. in the out-years -- the presiding officer: the senate will come to order. mr. cotton: in future years c.m.s. would issue qualitative subjective rules evaluating physician performance and patient outcomes. my amendment would simply extend the half-percent increase indefinitely. i think there are many reasons to vote for this amendment.

c.m.s. has not effectively used a blunt bureaucratic tool like s.g.r. we shouldn't give them a nuance tool. second c.m.s. itself predicts we're going to have future doc fictions -- fixes which undermines the plan. finally, c.b.o. estimates this will save $10 billion. so i urge a "yes" vote. let's have a permanent doc fix that works for all doctors and patients. mr. wyden: mr. president? the presiding officer: the senator from oregon. mr. wyden: mr. president i rise in opposition to this amendment. today the medicare program is a seize for volume system. the underlying bill junks this and turns the lights out on business as usual. the underlying bill says what the future -- a senator: can we have order. mr. wyden: the underlying bill says that the future will be about rewarding value and

good-quality care for our medicare patients. the cotton amendment embraces the outdated status quo and says that there is no need to coordinate care no need to pay for value no need to pay for quality for our medicare patients. i urge my colleagues to oppose this amendment. the presiding officer: the question is on the amendment. mr. cotton: i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. vote:

vote:

the presiding officer: are there any senators in the chamber wishing to vote or change their vote? if not, on this vote, the yeas are 11, the nays are 89. the amendment is not agreed to. a senator: mr. president? the presiding officer: the senator from maryland. mr. cardin: i call up amendment number 1119. the presiding officer: the clerk will report. we'll have order in the senate. the clerk: mr. cardin for himself and others proposes an amendment numbered 1119.

mr. cardin: mr. president i explained in amendment a little bit earlier and i would ask unanimous consent that senator klobuchar be added as a sponsor. this deals with the therapy cap that we now have had 12 patches. it is almost the identical problem we have with the s.g.r., which is the underlying bill. it deals with seniors medicare beneficiaries having access to therapy services, those who have had strokes, who have had serious issues and need rehab therapy. the cap never made sense in 1997 when it was put into effect. it was not the right policy. we've had bipartisan support to correct this, as we have the s.g.r. my underlying amendment does that. with that, i would ask my colleagues to support the amendment. mr. hatch: mr. president? the presiding officer: senator from utah. mr. hatch: this bill is far from perfect but we cannot let -- the presiding officer: we'll have order in the senate.

we'll have order in the senate. would the ladies and gentlemen please take your conversations out of the well. the senator from utah. mr. hatch: thank you mr. president. this bill is far from perfect but we cannot let the perfect be the enemy of the good on this bipartisan compromise that passed the house with almost 400 votes. the house leader has made it clear to us they will not pass another package. i don't blame them. fipple is of the essence. -- time is of the essence. the therapy caps provision may not be the best policy but it is in place to ensure that there was a governor on unnecessary utilization and spending in the medicare program. congress should use the next two years to find a solution to this problem and work for -- to pay for that solution, and i intend to do that. but to have that on this bill would just be a catastrophe at the end of what has been a really really very tough-fought bill.

mr. president, if the pending amendment number 1119 offered by senator cardin would violate the senate paygo rule and increase the on-budget deficit over the ten-year period of fiscal years 2015 to 2024. there have, i raise a point of order against the measure pursuant to section 201-a of s. con. res. 21, the concurrent resolution on the budget for fiscal year 2008. mr. cardin: mr. president? the presiding officer: the senator from maryland. mr. cardin: mr. president pursuant to section 904 of the congressional budget act of the 1974 and the waiver provisions of the applicable budget releases, i move to waive all applicable sections of that act and ally kablg budget resolution for purposes of the pending amendment and i ask for the yeas and nays. the presiding officer: is there a sufficient second? there appears to be. the clerk will call the roll. vote:

vote: