we're log at a bill that is going to cut medicare for our seniors who depend on medicare, and we're looking at a bill that -- and the numbers are huge. almost $500 billion. and we're looking at a bill, we're looking at a bill that's going to raise taxes on american people. as i just heard the senator from maine who was talking about this -- and she can jump in and correct me if i'm wrong -- what i heard her say is it's not just a tax on the rich. it's a tax on people all across the board because the taxes are going to be passed on with medical devices -- and i see the senator nodding her head in the affirmative, when taxes are raised on medical devices, on medication, on one thing after another after another. those are costs that are just going to get passed on to all the consumers of health care in the country. and right before -- before the -- this party took the floor, we have the senator, the senior senator from minnesota

talking about the mayo clinic and the wonderful care that is given there, and it is wonderful care. but the mayo clinic has also said they don't want any part of this bill, nothing to do with it, to the point that they have sent doctors in my home state and states surrounding the mayo clinic who refer patients -- and i practiced medicine in wyoming for 25 years, taking care of families there as a physician, and we sent patients to the mayo clinic. they just said stop sending patients on medicare or medicaid. we want nothing to do with it because the government is the biggest deadbeat pair. the government doesn't pay. and the mayo clinic said, you know, every time we get one of those patients, we have to charge the people that pay their own way, the people that pay their own bill, the people that have insurance, we have to charge them more and we don't want to take any more of these patients on medicare and medicaid. the hospitals in the communities of maine, and i see the senator from south dakota here and the senator from nevada here. hospitals in those states have to take all of those patients.

so what happens to people that pay their own way, that have their own insurance either because they buy it themselves or they get it through work? the hospitals have to charge them more to make up for the biggest deadbeat payer of all time, the federal government. so what happens? and i see the senator from nevada taking to his feet. i imagine the exact same thing is happening in the hospitals in nevada. so premiums are going up on the 85% of the people that have insurance that they like, but yet we -- we in the senate tonight -- tomorrow night are going to vote on a bill which to me the people of america don't like. and you know who doesn't like it the most? seniors. you know why? they're concerned. they know medicare is being -- is going broke, and by the year 017, there will be $500 billion of cuts in medicare. and yet, the money that's being cut from medicare isn't being used to save medicare. it's to start a whole new program that's going to cause americans who have insurance to pay more.

it's going to cause people that don't have any insurance to make it harder to get, or if they go to an emergency room, have to pay more, that bill is going to be higher. all because of what i believe is an irresponsible piece of legislation that is going to be a huge weight on our american economy at a time when you have 10.2% unemployment. but i see the senator from nevada has -- he has a similar copy of the bills next to him and he may want to chime in on what he is seeing in his home state and what he is hearing from people who live in nevada and the small businesses as well as the hospitals and providers. mr. ensign: if the senator would yield? we -- these pieces of legislation that we have before us, we put them on our desks to show the american people exactly what we're dealing with. we have only just started going through these bills, and already we found major problems with the legislation. let me just -- what we're going to talk about over the next few minutes is the premium increases that are going to be caused to

the american people. if you have insurance now, your premiums are going to go up because of all of this legislation that we have before us. probably other ways we don't even know about yet we'll discover in the future, but we at least know some ways that are going to cause the premiums to go up. but let me talk just generally first about the bill and what some of the problems that i believe in the bill, and then -- and just briefly on some alternative ideas that republicans have come up with in more of a step by step type of an approach. we know that this bill cuts medicare by $465 billion. we know that. including $118 billion in medicare advantage cuts. that means that millions of seniors who are on medicare advantage today will lose the plan that they have, and medicare advantage plans in my state are incredibly popular among senior citizens, and i know they are across the

country. we know taxes are going to go up by almost $500 billion, and i'll talk a little more about those in just a second. we know premiums are going to go up for millions of americans, as i stated. we also know that the overall cost of health care in america america -- you know, this was supposed -- this bill was supposed to what's called bend the cost curve. they say because it is actually deficit neutral, maybe helps the deficit a little bit because of the smoke and mirrors that they play with it, they say that that bends the cost curve. but when we look at the american people and the actual costs that they're going to be paying for health care, their cost curve continues to go up and up and up into the future. this bill will also lead to rationing. we saw this week this federal board that talked about mammograms. and it caused an outrage with women across america. well, that's the sort of thing that's going to happen because

of this legislation. federal bureaucrats are going to be in charge of your health care , not your doctor and you. we need to have legislation that focuses on that doctor-patient relationship that should be so sacred in our health care system today. so republicans have come up with the idea, let's bring in medical liability reform and start driving down the costs of all of this defensive medicine that's practiced. we all know doctors order all kinds of unnecessary tests to prevent themselves from being sued in all these frivolous lawsuits. let's -- we free i think with both sides. let's eliminate the pre-existing conditions. that's kind of a given. that's something we all agree on. that's part of that step-by-step approach this side of the aisle would certainly be willing to do. i also believe we need to encourage healthier behavior in america. 75% of all health care costs are because of people's behavioral

choices: smoking, people who are overweight. we know that obesity contributes to every kind of cancer. it contributes to heart disease, all kinds of -- diabetes, and it's epidemic this country. and look at our young people. if we don't turn around people's behavior in this country, getting them to exercise more, eat right, quit smoking. i don't care what health care reform that you pass in this country, we are not going to do anything about driving down the costs, and cost, the high cost of insurance, the high cost of health care is the number one problem with our health care system in america. we believe that we should have small business health plans where small businesses can join together to buy health insurance, take advantage of purchasing power that large businesses have. we believe that individuals should be able to buy across state lines like you do car insurance. if your state is too high on insurance, buy it in another state where it's cheaper, where maybe they don't have as many mandates.

doesn't that make sense? we also believe that we should have transparency on cost and quality. when you walk into your doctor's office, you should be able to get a written estimate of what it's going to cost. you should be able to shop that estimate so that we have more consumers making more intelligent choices on health care in the united states. when was the last time you went into your doctor's office and actually got a written estimate or knew how much something was going to cost? i happen to have practiced veterinary medicine for many years. you walk into my practice, you get a written estimate. we actually have you sign that written estimate because we've got to give that. that's part of our general practice. we need to bring that into human medicine, whether it's hospitals or dors practices -- or doctors' practices. we need to have transparency for cost and quality. now, how does this bill drive up premiums for americans? first of all, there are nine new taxes, nine new taxes put in by the democrat majority. there is a 40% insurance plan tax -- insurance plan tax for

what are called the cadillac plans. there is another tax on insurance -- on your insurance companies. there is an employer tax, a drug tax, a lab tax, a medical device tax, failure to buy insurance tax, a cosmetic surgery tax -- brand-new in this bill -- and also an increased employee medicare tax, a brand-new tax structure on the medicare taxes. who pays for these kinds of taxes? it just isn't insurance. on the failure to buy insurance -- put the next chart up -- 71% of that tax is going to be paid for by people who make less than $120,000 a year, and almost every one of the taxes that i just put up of those nine new taxes, the vast majority of them are paid by people who president obama when he was campaigning said they would not pay one dime more in new taxes, and he repeated that promise time after time. he said no new fees, no new

taxes, capital gains. he went through the whole litany of the types of taxes that would not be raised, and yet in this plan, approximately 80% of all of the new taxes are paid by people making less than $250,000 a year. another way that this massive piece of legislation raises premiums in this country is this thing known as cost shifting. the senator, the doctor from wyoming, practiced medicine. he was talking about the mayo clinic and why the mayo clinic, cleveland clinic, other places and other doctors around america don't want to take medicaid patients, medicare patients anymore. why? because the government pays 20% to 30% less than private health insurance when it's reimbursement to doctors. isn't that is correct? mr. barrasso: that's absolutely the case, plus when you read this bill, one of their so-called solutions is they're

going to put more people, more people on medicaid rolls. mr. ensign: i would ask the senator how many more people are going to go on the medicaid rolls? mr. barrasso: it's millions and millions of people with the cost to the states -- they say we'll take it out of here, you won't see it in this bill because they're going to make the states pay over $20 billion in money because it's a matching program. so they get it off the washington books, but it's still the taxpayers of the states, and we all come from states and that's going to drive up the costs for individuals as well as increasing taxes around the country. mr. ensign: because you were in the practice of medicine, i would ask the senator from wyoming also -- i've heard numbers as high as 15 million new people on medicaid, plus we have a new public option so there will be even more people on another government plan. what will happen as far as cost shifting to those of us who have private insurance, for those tens and -- tens of millions of americans who have private health insurance, what will happen to their cost of

insurance when more people are on government plans? mr. barrasso: well, those costs are going to have to go up. the premiums are going to go up for all of the people that have insurance, private insurance, and the numbers -- and the senator from nevada is correct. some people think the number is 15 million more who are going to go onto the medicaid rolls because there is a -- medicaid roles because there is a difference between the senate bill and the house bill as to how many more folks they move onto the medicaid roles. but either way, you're talking tens and tens of billions of dollars that are going to come out of the taxpayers' pockets around the state, but that's still for a government-run program that doesn't reimburse, doesn't pay the hospitals, doesn't pay the doctors even what the cost of delivering the care is. across the board, across the board hospitals will tell you they cannot keep their doors open if everyone paid at medicaid rates or medicare rates. the only way they could even --

pay the nurses, keep the lights on, take the food around on the trays to the patients, do all the things that a hospital has to do or keeping a doctor's office open, the only way they can do it is because they charge more to people who have private insurance than they get paid for people on medicare or medicaid, and medicaid is worse than medicare in terms of the payment. so it's this cost shifting that occurs, and who pays that? people that have regular insurance. it's the hard-working men and women of america through their jobs, as we just heard from the senator from maine, and any time you try to help that individual -- and i see the senator from south dakota is here as well, and he may want to jump in as well because south dakota is a state like my own where we have lots of small businesses who are going to be hit specifically hard as they try to continue to provide insurance. this doesn't allow small businesses group together to get better deals. the senator from nevada talked

about buying insurance across state lines to help get the costs down. this prevent that. it also prevent small business groups to get together, which would be great help. i know the senator from south dakota, who is interested in getting in the discussion, and i invite him to discuss this very aspect and the impact of all these increasing premiums on the folks of his state. mr. thune: wyoming is not a lot unlike south dakota, as the senator from wyoming knows, or nevada, although they have a few larger businesses in nevada. the people who get hit hardest under this bill are small businesses. you heard the senator from maine, senator collins, point out the impacts on small businesses. the ironic thing about that is a lot of small businesses that you would want to encourage to offer health insurance to their employees will be discouraged from doing so under this bill. and, in fact, what most of them are probably going to do is pay the $750 penalty and then just push everybody off into the government plan. and the assumption that's being made in here is the government plan that, you know, it will

grow over time obviously. i think 5 million people will lose their private insurance, according to c.b.o. my guess is@@ á@@@@ the whole purpose of this exercise, at least the minds of most americans is let's drive the cost curve down. i heard my colleagues get up and talk about the plan that is going to decrease costs in this country. the blue represents the cougher.

that is what will happen if we do nothing. ironic is the red represents what happens under this bill. and so instead of bending the cost curve down, it actually increases the cost curve. so we're going to spend $160 billion more on health care in this country by enacting the bill, this monstrosity of a bill right here, which as my colleagues have pointed out, this is 2,074 pages. but look at this thing. and you think somewhere in here, in all this volume of paper that there would be a way to actually do something to bend the cost curve down, but all that represents more spending. in fact, if you look at the amount of the spending in the bill when fully complemented it is -- when fully implemented it

is much more than c.b.o. estimated it would cost. when we unveiled this plan a couple a days ago they said it would be under $1 trillion. they used a lot of scoring tricks, a lot of ways to obscure the true cost of this thing. in fact, even the first ten years it understates the cost, which is over $1 trillion. but the ten-year fully implemented cost of this bill is $2.5 trillion. $2.5 trillion expansion in the size of the federal government. and if you look at how that plays out and how it's paid for over the fully implemented phase, we've all talked about $500 billion in medicare cuts. ten years fully kpwhrepltd, it's over $1 trillion that they have to cut medicare to pay for this thing and then to raise taxes by another $1 trillion. so you're talking about not only cutting medicare senior citizens, as you've all talked about, about raising taxes substantially on small businesses. but at the end of the day, after

it's all said and done, what do you end up with? you end up with an increase in costs above and beyond what we would see if we did nothing. tell me how you can call that reform. the other point i'll make before i yield back to my colleagues is that if you're someone who already has insurance, and 182 million people in this country have insurance, you're not going to be able to participate in exchange. you get no more options out of th-fplt there are 19 million -- options out of this. there are 19 million people who might benefit from exchange. if you currently have insurance, you can't get into an exchange. you don't get any subsidy. what you get are big fat tax increases and increases in your insurance premiums for all the reasons that have been mentioned. because when you tax the health insurance companies like this bill does, when you tax the medical device manufacturers like this bill does, when you tax the pharmaceutical companies like this bill does, and when you create all new kinds of mandates on insurance companies,

including changing these age band ratings going to a 3-1 age band rating, you're going to raise premiums for a lot of people in this country and you're going to raise them the most for people who are 18 to 34. what the people who are 18 to 34 don't realize what's coming at them today but about a 69% increase in their insurance premiums. they are the ones who get stuck the hardest. if you're any of these 182 million people, your taxes are going to go up, your insurance premiums are going to go up, and you're not going to see any benefit from being able to participate in any sort of exchange. these are the cold, hard facts. i've heard countless democratic colleagues come down here and talk about benning the cost curve down and reducing premiums for people in this country. this is the congressional budget office number. this isn't anything that the republicans put together. this is the c.b.o. cost estimate of what it would do to the cost curve. as i said before, the red represents the increase, $160 billion increase in health care

spending over ten years, all of which is going to be borne by those 182 million americans in this country who already have insurance. a senator: if senator from south dakota would yield, i'd like to get your comments maybe from both of my colleagues on a couple of quotes from the congressional budget office as well as the joint committee on taxation dealing with this premium increases and who's actually going to bear the taxes. mr. ensign: a lot of people think that, well, let's just tax the insurance companies. let's just tax the medical device companies. let's just tax somebody else. this is what the congressional budget office -- let meet read a couple of quotes. one quote is "although the surcharges would be imposed on the firms, workers in those firms would ultimately bear the burden of those fees just as they would in a pay-or-play requirement. many of those workers are more likely to have earnings at or near the minimum wage." it's the low-income people who are going to end up paying when

you actually put some of these taxes that we've talked about. here's another quote from the congressional budget office. let's remind folks, the congressional budget office is nonpartisan. it's not republican, not democrat. they are kind of the objective scorekeeper around here. another quote that they say: "these taxes would increase costs for the affected firms which would be passed on to purchasers and would ultimately raise insurance premiums by a corresponding amount." the last quote is this. this is by the joint tax committee. "generally we expect the insured to pass along the cost of the excise tax to consumers by increasing the price of health coverage." this is what you're talking about on that other chart that you have up. we would like to hear your comments on that. mr. thune: you're absolutely right. i think what the c.b.o. has pointed out is -- and i've got the joint tax committee there,

the data that they produced on this is very similar to what c.b.o. said. 84% of the tax burden is going to fall on people making less than $200,000 a year. half of the families making under $100,000 a year are going to get hit with new taxes under this bill. and so, it is going to fall. it's going to fall on those people in this country -- and i think they like to think that they're taxing medical device manufacturers and everybody else. but at the end of the day a lot of this stuff gets passed on. and the taxes in the bill, premium increases in the bill are going to be borne by the people who are probably least able to absorb that and to take that. and it's going to be the people in the lower-income categories. and so, the gentleman from nevada is absolutely right, and, again, i come back to the basic premise of this whole purpose of health care reform, which should be to get health care costs down, not raise them. and you have alluded to, the senator from wyoming have

alluded to a number of things that we believe would do that, that actually does put downward pressure on health care costs in this country. it's done in a step had i been-step -- step-by-step way. it is done that is not throwing out everything good in health care in this country, creating a massive expansion peer tphao*er washington, d.c., $2.5 trillion in costs when fully implemented. who knows, if a lot of these things don't happen, if the tax increases don't occur, medicare cuts don't occur, it means borrowing from future generations. they talk about reducing the deficit by $130 billion only because they didn't include the physician fee fix, only because they had a revenue from something called the class act which is never going to become law. if it does, it's a huge money loser in the out years. and so you've got all these things if they did, including delaying the implementation date by five years so it understates the tree cost of this -- the

true cost of this thing. all these things have been done to try to make this turkey look like something other than what it is, which is a massive increase in spending, massive tax increases on the american people, and increased premiums for americans, particularly americans, those 182 americans who already have health insurance who are going to get hit the hardest under this legislation. mr. ensign: maybe we could have the senator from wyoming comment. one of the big things republicans have been talking about, instead of driving premiums which this bill does, driving premiums down, maybe discuss the medical liability option which the a very conservative estimate says it would save $100 billion in medical expenses in this country. as a practicing physician, talk about the unnecessary tests that are ordered, the huge increases in medical liability insurance costs physicians face today.

mr. barrasso: you do a poll of doctors and say have you ever ordered a test, ever ordered a test that is really not going to help that person get better, but you were doing it for fear you didn't want to miss something for fear of a malpractice suit, all hands would go up. massachusetts has their new health care plan. the dean of the harvard medical school had a publication this last week and said i give this whole thing a failing grade. he said people that support this, the legislation that's being proposed, are engaged in collective denial. we need to do some things that will help with cost, with access, with quality. all this is going to do is drive up the cost with no improvement at all in quality. so there are step-by-step things we can do. letting people buy insurance across state lines, getting the same tax break as others. you talked about helping people

stay healthy, exercising, getting down the cost of health care by getting their cholesterol down. also you have to deal with abuse. just the same thing as loser pays. there are people that would oppose that all the way, about it would help eliminate -- eliminate -- a lot of the unnecessary tests and certainly a lot of the costs of the system. two-thirds of that cost of that whole liability system go to the system. it doesn't even go to the injured person. if somebody's injured, you want to take care of them, but this doesn't do it at aufplt one of the things that -- doesn't do it at all. one of the things that the senator from south dakota mentioned was age banned rating, which flies in the face of the things we've been talking about, about individual responsibility, opportunities for people to stay healthy. the big problem is 50% of all the money we spend on health care in this country is on 5% of the people. the people that eat too much, exercise too little and smoke. yet, under this

government-forced insurance where people are going to be forced to buy insurance and if young people don't buy it they're going to be listed as tax cheats or criminals because they're going to get fined and they're going to get taxed an amount for not buying the insurance, they're going to have to buy insurance. as the senator from south dakota talked about a 3-1 ratio and the senator from maine mentioned the same thing, what that means is for the youngest, healthiest person buying insurance, got out of the college and staying healthy, working construction, in good shape, going to the gym, what they're doing on a 3-1 ratio is that person has to pay a lot of insurance compared to the person who does eat too much, exercises too little and smokes. the ratio of their insurance premiums, this person can pay no less than one-third of what this person, when realistically you might have 100 young people that their total health care bills for a year would be equal to that one person that exercises too little, eats too much and

smokes. so these young people are going to end up paying the cost. and it's their premiums -- and i think we heard that from the senator from south dakota, and if you want to jump in -- their premiums are going to go up. did i hear 69%? mr. thune: 69%. if you're 18 to 34, that's what you're looking at in the form of a premium increase, not to mention future generations are going to continue to deal with the pile of debt we're going to put on them. this is not a good deal if you're a young person in america. mr. barrasso: it's the wrong prescription for america, mr. president. well, i am going to continue to speak on the floor, mr. president, about the things that i think are problems with this bill. i think it is the wrong approach. i think that it costs way too much. i think it raises taxes on all americans. it cuts medicare, and what we've

heard now -- and what we know for sure -- is that it is going to raise premiums for people who have insurance, who like the insurance that they have, who want to keep the insurance that they have, and their costs are going to continue to go up if this becomes law at a rate faster than, as we saw from the graph, faster than it nothing was passedmrs. boxer: thank youy much, mr. president. i listened to several of my republican colleagues, and i want to note that they have the bill in front of them, and they're attacking this health care bill, but nowhere on their desks do we see their bill. they have no answers, no solutions -- a senator: will the senator from california yield? mrs. boxer: i can't yield. they have no solutions at all on an issue that affects every single american, and what we have before us in the reid bill,

i think, is an excellent piece of legislation that will make life better for every single american, and i will spell that out in the course of my remarks. we all know change isn't easy. it is easy to come down here and demagogue and pound your fist and complain. it's human nature to resist change. >> it's human nature to c change but every once in eye while, a situation cries out for change. that is the case today with our healthcare system. the status quo is not benign. i would like to share the story of nikki white in the book, the

healing of america. he talks about nikki in the prolouing as he possesses the moral question of what to do about healthcare. this is what he writes. >> if nikki white had been a resident of any other rich country, she would be alive today. around the time she graduate frommed college, nikki white contracted lupus. that's a serious disease but one that modern medicine knows how to manage. if this bright, dazzling young woman lived in, say, japan or germany or britain, france or italy, spain, canada, et cetera, the healthcare system there's would have given her the standard treatment for lupus. nicky white wrasse a citizen of the -- was a citizen of the world's richest country, the united states of america.

once she was sick, she couldn't get health insurance. like tens of millions of her fellow americans, she had too much money to qualify for health care under welfare but too little money to pay for the drugs and the doctors she needed to stay alive. she spent the last months of her life frantically writing letters and filling out forms," mr. president, "pleading for help. when she died, nicky white was 32 years old." that is a story that should move every one of us, move every one of us, to action. look, we've spent years studying and analyzing what's working in our health care system and what's not working. what it comes down to is this: too many of our fellow citizens are suffering because of the

broken promises of a health insurance system that abandoned them when they needed it the most, too many cannot afford health insurance, too many are getting sick after praying to god that they wouldn't because they knew that sickness could leave them in economic ruin. mr. president, praying is not a health care insurance plan. americans will spend over $2.5 trillion on health care next year, $2.5 trillion n all, we spend twice as much per person on health care as other advanced nations. yet the united states of america, our great nation, ranks near the bottom of the 30 leading industrialized nations in basic measures of health such as infant mortality rate and life expectancy. the bottom of the list.

that's where we are. so we spend twice as much and the results are not anywhere near where they should be. it's clear why. too many people don't have affordable health insurance, and they wait too long before they get the help they need. or they're like nicky and they never get the help they need. health care premiums have more than doubled in the last nine years, more than doubled in the last nine years, and onerred nonpartisan study says if we fail to act, the average american family will have to spend 45% of their income on health insurance premiums alone, and that's by 2016. by 2016. 45% of their income, the average family, by 2016, if we do nothing. and my friends on the other side

stand there with the bill and downglobal aids we're doing and never address that issue. -- and downgrade what we're doing and never address that issue. it's time for change. when we know that twoirds of all bankruptcies are due to health care -- when we know that two-thirds of all bankrupts are due to health care issues, we know it's time for change. every day another 14,000 americans lose their health care coverage. that tells me it is time for change. i know there are many people listening who think the uninsured, that that's not their problem, that it doesn't affect their health care. they're flat wrong. right now every one of us with insurance is paying $1,100 a year -- each of our families -- for those who are uninsured. why? because we have to pay for the emergency room services that they get when they're rushed

into the hospital because they've neglected a health care problem, and it's very expensive, and we're paying for it. that tells me it's time for change. when family after family tells us they paid for insurance for years but when they had a crisis their insurance company walked away from them. in t.r. reid's book, we hear about a man who paid all his life for insurance and he got struck by an automobile and he was in the hospital with a terrible situation, and the insurance company knew it was going to cost them a lot. you know what they did? they rescinded his insurance. they told him that years earlier he didn't tell them that he weighed more than he should have, and they walked away from him. story after story. good, hard-working people unable

to get health insurance, knowing that their future is dark. it's time for a chaifnlgt and today -- it's fipple for a change. and today i want to say to america's families, change is definitely on the way. it won't be easy, and it's going to be tough. but all these things that i have said are truth, and everybody here has to be moved by that, and i believe we will finally bring change. i'm hopeful. i'm hopeful because of the work of so many of our colleagues and the work of senator harry reid. he has put a bill before us that, as i said, will make life better for every single american. it's called the patient protection and affordable care act. first and foremost, if you have health insurance that you like, this bill gives you the security

of knowing it will be there for you when you need it. and if you don't have health insurance, you'll be able to get affordable coverage through a new exchange which includes the public option. ultimately, under this bill, we are expanding health care to cover more than 94% of american people, and all the while we are cutting the federal deficit by an estimated $130 billion over ten years because there are real savings and real revenues in this bill to offset the new, important programs. when this bill is signed into law, mr. president, america's families will see immediate improvements to their health care. they won't have to wait. for example, right away when president obama signs this bill, your insurance company won't be able to kick you off your plan for some made-up reason because

they no longer want to cover you and they will no longer be able to cap your coverage. i can't tell you how many people think they're safe because they had a $500,000 cap on their insurance. they never dreamed they would use it up. but one difficult and terrible illness can use it up, and then they're out of luck. no more rescissions, no more caps. parents will be able to keep their children on their health care policy up to the age of 26. small businesses will have immediate access to tax credits to make covering their employees more affordable. and seniors -- seniors will have a more generous benefit through their prescription drug coverage. we all hear about that doughnut hole that comes onto seniors as soon as they need to buy more

pharmaceuticals. this will give them another $500 before they reach that point. those are just a few of the immediate benefits of the patient protection and affordable care act. here is a sample of other major provisions. this is a very important one, mr. president. in this bill, no family of four making less than $88,200 a year will have to pay more than 8.7% of their income for health insurance premiums. let me say that again. no family of four making less than $88,200 a year will have to pay more than 9.8% of their income for health care premiums. so if you make anything between the, say the poverty rate all the way up to $88,200, you never

have to pay more than 9.8% of your income for health care premiums and if you're on the lower end, it's even less. it goes down to about 2%. so it ranges from 2% to 9.8% at $88,000. that means that more than 62% of all of our families will be able to be insured, that they will not have to go broke to buy health insurance. and remember what i said ... a respected study has already stated that if we do nothing, by 2016 people will be paying 45% of their income on premiums, and in this bill we ensure that our middle class down to our working poor do not have to worry about those kinds of premium increases. now, for the rest of our nation's families that are more affluent, there's the security

of knowing that the insurance company reforms in this bill are going to help you. the insurance company can't walk away from you, if you have a preexisting condition, they can't turn you down, if you have a child you want to keep on until age 26, you can. if you're a small business, you'll get tax credits to help you pay for your employees. there are many other benefits, including some free prevention coverage that kicks in right away. so no more discrimination against those with a preexisting condition, and, by the way, no longer will insurance companies be able to discriminate based on gender. right now women in my home state of california are paying almost 40% more for the same insurance as men. there's gender discrimination. that will end when this bill becomes law.

this bill, we increase competition, which is perhaps one of the most important things we can do to bring down costs to our families. we have the health care exchan exchange, which includes a public option, that will compete on a level playing field with insurance companies to keep them honest. nerdz, therin other words, thera goption, but there won't be -- a goption, but there won't be -- a government option but there won't be anything in terms of the way it negotiates with insurance companies. now, there's been a lot of shouting from my colleagues about the public option. why shouldn't the american people have access to a public option? i ask that question. i don't hear my republican friends coming down to the floor saying they're going to give up their public option, mr. president. more than 90% of us have a public option right now, the

federal employee health care benefits program. i don't see one of my republican colleagues who've been trashing the public option coming down to the floor and saying, oh, i want to get rid of mine. oh, no, they like it, but they don't want it for the rest of the people. i do not understand it. to me -- to me, i just don't understand it. let's leave it at that. there are lots of public options that we have here. medicare's a public option, run by the government. i don't hear my republican friends coming down here saying we should end me medicare. they used to say that. they don't say it anymore. now they say they defend it. it's a public option. 45 million americans are covered by it. not one of them said get rid of medicare. i don't hear any of my republican friends coming down

to the floor saying we should get rid of another public option called medicaid. that public option is for the poor. it works well. it's tough. there are problems with it, but it works well and it covers 60 million americans. so you've got 45 million americans in a public option called medicare, 60 million americans in a public option called medicaid. how about the veterans alth >> how about the veterans healthcare program. i don't hear one of them coming down and pounding the table to say get rid of the public option for our veterans. maybe they want to but they won't say it. the veterans would be at their door. that public option cover 7.9 million veterans. not one of my republican colleagues says they want to end it. i don't hear my republican friends coming down to the floor

to say we should end our trihtier floor for our military. i don't hear them saying stop that public option. again, their own healthcare that they have brought to them by fehbp. federal employees healthcarejñ benefit program. that cover 8 million people including them. t comes to everybody else, they come down here and they basically say, a government takeover of health care. false. the public option is just one option in the exchange. and it has to run by the rules of all the other insurance companies. and i say, if it's good enough fofor a republican member of the senate, a democratic member of the senate, a public option ought to be an option for the

people that we represent. small business, mr. president, really needs help here. i don't know if everybody's aware of this, that small businesses pay as much as 18% more for the same health insurance as large businesses. and in california, we've seen increased premiums to small businesses that meant the choice between laying off employees or not providing health insurance at all. more and more of these businesses are dropping health care coverage. if you're in a position where you work for a small business and you're loyal to them and you want to stay there, when this bill goes into effect, you can go into the exchange and then you'll have some buying power or your small business can go into the exchange. this bill, mr. president, will protect our seniors and it will strengthen medicare. medicare is a success story.

before medicare became law, half of our senior citizens went without health insurance. now 98% of our seniors are covered by medicare. they believe in the program and they want it to continue, and those of us supporting this bill want to make medicare stronger, and we do. this bill, "the patient protection and affordable care act," will ensure a stronger, more sustainable medicare program. it lowers prescription drug costs, as i mentioned before. it increases access to preventive services for our seniors, and it extends the solvency of the medicare program by four to five years. now, my republican colleagues are standing here saying democrats want to hurt medicare. by the way, a public option, medicare. they're saying the democrats want to hurt medicare, a public option.

honestly, who could believe that? in 1964, george h.w. bush called medicare socialized medicine. newt gingrich, when he was speaker of the house, said he wanted to see medicare -- quote -- "wither on the vine." in 1995, while seeking the republican nomination for president, senator bob dole bragged that he voted against creating medicare in 1965. he bragged about it. he said, "i was there fighting the fight, voting against medicare because we knew it wouldn't work in 1965." so the republicans are saying that the democrats want to destroy medicare in this bill that. is beyond ridiculous. the american people know who's on their side when it comes to protecting medicare. you know, we didn't just wake up this morning.

we know who brought us medicare. this bill expands medicaid. that's medicaid, for the poor, to ensure that the poorest and sickest among us can get into the program. and we're going to get into the program those with incomes below 133% of the poverty level. now, that means that more than 1.5 million of my californians who are now uninsured or struggling with the cost of health carehealth care, that wiw them to be covered. i want to thank the majority leader for working with us to ensure that california receives increased federal support as we expand medicaid. for the first three years of this expansion, the federal government will fully cover the cost of expanding medicaid. now, i talked a little bit about prevention. today, only four cents of every dollar we spend on health care

is spent on prevention, yet more than half of our people live with one or more chronic conditions. five chronic diseases -- heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes -- are responsible for more than two-thirds of the deaths in america. this bill will eliminate co-pays and deductibles for preventive care so people don't get to that serious illness. and those preventive services go into effect immediately. so that's an overview of the patient protection and affordable care act. my friends on the other side have already come out against this bill. they say it's too long, it's too complex. they said -- one of them said it's holy war, this bill is going to, for some reason, caught them to fight a holy war. again, where is their bill? they don't have one. after all the things we know are

wrong with this system, you don't have to agree with us on everything, but where's your bill? it seems like my republican friends care more about playing politics than protecting our families. that's what it seems like. that's what it feels like. they seem to care more about bringing down our president than bringing down the cost of health care. they care more about all that than tim and josi e hintas of los angeles, california. tim is retired from raytheon and he gets his health care through his retirement plan. during 2007, the first year of his retirement, their monthly health care premium was $460. during 2008, it rose to $630. 2009, $850. that's an 85% increase in two years for this retiree. mr. president, tim wrote to me, he said, "i understand that compared to many, we're

fortunate to have good health care and insurance, but we look forward to you, senator boxer, the senate and the house addressing the seemingly unbounded increase in health care costs." and, mr. president, we do it in this bill. people like tim will be protected. but my friends across the aisle say no, we're not going to help tim. what about madeleine foote of costa mesa, california? she turned 25. she lost her health care coverage that she had under her parents. she tried to get coverage but because she had taken medicine, she was denied. they said it was a preexisting condition. they said, oh, you can have health care but you have to have a $3,000 deductible and premiums of $300 a month. she wrote, "as a young person working in a restaurant, repaying student loans and trying to make it, this is a huge financial burden. i can't afford insurance that charges me so much. for now, i'm forced to hope that

nothing extremely bad befalls me." so she's another one who's praying not to get sick. that is not a health care plan. but my friends on the other side of the aisle, they say, no, sorry, we're not going to help you, madeleine. and i have so many other stories. douglas engolspie, a small business owner in santa barbara. he had 11 employees. he couldn't afford to get them insurance anymore. he asked that i support a public option, and i do. and my republican are saying, douglas, no, we're not going to help you. and it goes on. the stories go on, and i'll put them all in the record. one of these stories is from a doctor, a retired pediatrician in sacramento, california, dr. robert meager, who wrote to me and said, parents begged him not to write on the form after

he saw a child with asthma, please don't write down asthma; please say it was bronchitis. please. because if you write down that my child has asthma, they'll have a preexisting condition and when they go out on their own, they can't get insurance. can you imagine a doctor has to face a parent like that? my republican friends don't seem to to want think about that. they just seem to be thinking about politics and the next election, and we all know the bill before us isn't perfect. they should vote to start deba debate. they can try to make it better. there are many issues i'm working on for california. the disproportionate share hospital program. i'm working to get even better prevention for women. but at the end of the day, mr. president, this is where we stand. health care coverage for all of america's families has been an illusive goal since teddy roosevelt first proposed it nearly a century ago.

our dear friends, ted kennedy, senator ted kennedy, whom we miss so much, fought for health care right here on this senate floor from the moment he arrived in the senate in 1962 to the moment he died. today i am proud to say we are moving closer to fulfilling this promise of health care for all. robert kennedy once said, few will have the greatness to bend history itself, but each of us can work to change a small portion of events, and in the total of all these acts will be written the history of this generation. mr. president, this is our time, this is our moment, this is our moment for us to come together as a nation nation and make surr people never again have to face what nikki white faced in her

last days, filling out forms, praying to god she could get health care and not being able to get it and dying at age 32. that is immoral. it isn't necessary. and we can fix it. and we should. and i thank you very much, and i yield the floor. the sparn healthcare hub at c-span.org/healthcare. a look at two healthcare ads.

one criticizes christopher murphy's discussion, another defending chris murphy. >> washington is thanking chris murphy on healthcare. >> insurance companies know the reform bill would stop them from raising premiums and stop them from denying coverage when you are sick. the reform bill will strengthen

medicare. that's why it issen doored by the vo$aarp. tell congressman not to back down and keep fighting for us. . . . .