want to consider here. my bottom line is that we're hearing from a lot of folks and 11 do not make a lot of money. for to put -- $14.6 billion worth, that is a big tax increase. >> to pay is that for two $0.6 billion? it is at the lower income people or the higher income people? i think it is wrong for the lower and middle income people to pay the $40.6 billion. >> -- the $14.6 billion. >> this is a tax break. it falls on the entire tax paying public in general. i think it is that two-thirds of the taxes are paid by the top third inning come.

-- in income. >> take the vote. >> mr. carey. >> no by proxy. >> mrs. lincoln. >>no by proxy. >> mr. schumer. >> no. >> ms. cantwell. >> past. >> mr. nelson. >> no. >> mr. menendez. >> no by proxy. >> mr. hatch. >> aye. >> mr. kyle. >> aye. >> mr. craigcrapo. >> aye. >> mr. kenzi.

>> aye by proxy. >> mr. chairman. >> no. > the clerk will tally the vote. >> the final tally is 10 ayes, 13 nays. >> the amendment fails. >> let me call-up amendment f one as modified. >> f1 modified. i am not sure that i have it. >> i will wait. >> ok. that would be a good thing to do.

>> go ahead. let us proceed. >> this is a simple amendment like the other three simple amendments that i have offered on this bill. it sunsets in 2009 every tax increase in this bill. note that this is a different amendment from my earlier amendments, which only affected tax increases that increase costs for consumers. we have already had discussions on how the tax increases in this bill will be passed along to consumers and drive up out of pocket health care costs. i will now rehash that again. -- i will not rehash that again.

congress -- in order for congress to enact the health care reform is to enact a tax increase. i do not believe that. at least, we can ensure that this new tax burden does not last forever. especially when so many of these tax increases would cause permanent increases in the health-care costs. one of the sunday talk shows this past weekend, former president clinton was asked if tax increases would be necessary in order to have health care reform. he first equivocated the question. but when pressed to answer it, president clinton said that tax increases might be necessary in the short run, but, in the long run, health care reform would reduce costs so that tax increases would not be necessary.

so let's put president clinton's. to test. since tax increases will only be required -- so let's put president clinton's theory to test. we will have several years to see why impact all of these taxes will have on health care costs and whether they have made health care more affordable or less affordable for the american people. how many of us remember the astonishment from our constituents when they found out in 2001 and 2003, the tax cuts would end in 2010. apparently, it is ok when tax relief expires, but every tax increase was left into eternity. earlier today, the chairman was

quick to point out that cbo said the bill is a net tax cut. but i think most americans would strongly disagree with that statement. to most americans, tax relief means that you get to keep more of the money that you earn. but here's how it works under this bill. you earn your money. you send it to washington. and then washington forces you to buy health insurance. and then, for some lucky americans, the government will send your money to insurance companies. united to keep this so-called tax relief -- you do not get to keep this so-called tax relief to use as uc best for your family. i think most americans -- to use as you see best for your family. i point out that billions of

dollars of this so-called tax cut will go to people who do not even pay income tax at all. even the cbo considers this to be a government spending outlay rather than a tax reduction. i am not saying that this is the right policy or the wrong policy. but it is certainly spending rather than tax relief. early today, the chairman said that we would be irresponsible if we did not make all of these tax increases last forever. let me repeat the reasons that this is not the case. i hope every deficit hawk will be paying attention. if we are worried about what will happen to our deficit after 2019, there are three solid options for you under this amendment. first, president obama and

former president clinton have said repeatedly that health reform will reduce cost. if all those savings we were promised magically appeared, there will be no need for tax increases to finance health-care reform. or, if the savings do not magically appear, there is a second option. congress will have 10 years from 2010 to 2019 to find spending cuts rather than tax increases to finance the mandates in this bill. surely, we can find spending cuts and efficiencies in the trillions of dollars americans spend on health care. and there is a third option for our future congress. by 2019, americans will be sold in love with the health reform

they have gotten that they will not mind paying higher taxes. in that case, our constituents will joyfully contribute their share of responsibility and a future congress will have no political problems simply restating the tax increases. in fact, they will probably be hailed as heroes. if anyone claims that my amendment does not ban the cost curve after 2019, and this is a stunning admission that the only way this mark can claim to bend the cost curve is to raise taxes. i hope my colleagues will stand up for their constituents and their taxpayers and support my amendment. thank you, mr. chairman. >> i didn't see anyone who wishes to speak.

-- i do not see anyone who wishes to speak. >> i mentioned the fact that i had offered a similar -- >> that is right. this is essentially says that this will sunset the paperwork. it would be more responsible to sunset to both. that is not your amendment. it is to sunset the paperwork, but not sunset spending. >> let me just remind the chair that, if in fact the savings in this bill rokeoccur as you and r

people have predicted, there will be no need in 2019 to have any kind of tax increases. we will have the spending we need. the american people will have their health care. and they will be overjoyed with the health care that they do have. >> we have a problem as it is with the accumulating deficit. all things being equal, the projection is $1 trillion over the years. i don't think we want to take action after that. most of us would like to get the deficit spending down a little bit, not up. that is why i do not think we should support this amendment. >> if i may respond, if what you

say is true, that there is $40 billion in savings in this bill -- no, i said $40 billion in net tax cuts. >> $40 billion. then why would we have more taxing at the end of that time? you're going to save $40 billion. >> it because, at the end of the 10-year period, we have to offset [unintelligible] you want to discontinue the offsets. i was surprised at that. most people in the senate will not like the deficit spending as well. >> i agree. but i think your statement is contradict a exactly what you promised in your mark. so i would urge my colleagues to

vote for this amendment. >> call the roll. >> mr. rockefeller. >> uno. -- no. >> mr. kerry. >> no. >> mr. schumer. >> no. >> ms. cantwell. >> past. >> mr. nelson. >> no. >> mr. menendez. >> no by proxy. >> mr. grassley. >> aye by proxy. >> ms. snowe. >> no. >> mr. roberts. >> no.

>> mr. enzi. >> aye by proxy. >> mr. chairman. >> no. >> the clerk will tally the vote. >> the vote is 9 ayes, 13 nays, and one pass. >> the amendment fails. >> we set this aside because those trying to get a different offset than the one we have been using in the past. >> i appreciate that. that is a good sign of good faith here. i do appreciate that.

>> yes. and because you have not agreed with any of my amendments so far, that offset is still available. [laughter] it is not that i am trying to enact a policy of the offset. i have a different idea in mind. >> ok. >> this is a simple amendment dealing with a health savings account. the effect would be to conform the amount that individuals can contribute to high deductible health plans and enable contributions to savings accounts to equal the same amount. it would allow them to contribute amounts to the hsa's vehicle to the amount of the high deductible health care plans. we are well aware of the advantages of a fha's. republicans have generally believe that we want consumers

to take more direct responsibility. part of that has to do with getting in the game so that they will be better health consumers. as a result, these hsa's have proven to be a popular way to have a relatively low-cost insurance policy but still provide for catastrophic coverage and not to bankrupt you if you have something really bad happened to you. the other point that i wanted to make is that there is kind of a misconception. let me make this point first. the difference, for example, on the average, is that -- in other words, you can get an hsa for less than the employer-sponsored family premium. the second thing i want to mention is that there is kind of

a myth that people who invest in these are younger and more wealthy and so on. we just got these statistics together that i think will put down that myth. 46% of the people with hsa's -- these are last year's numbers, by the way -- live in lower income neighborhoods. a total of 80% live at best that middle income neighborhoods and a lesson that i. small employers were one of the fastest-growing markets for these kinds of products. so these are popular with the folks that we want to try to help, small business folks, as a way to write cheaper insurance coverage to make sure that they have what they need. there is no reason why we should not, therefore, allow them to contribute more.

the of this amount would be the same amount that can be contributed to a high deductible health plan. so the amount that they should be able to deduct in the hsa's should be conformed. i have those numbers. i think senator conrad pointed them out the fore. -- pointed them out before. this would be a substantial benefit for folks who rely upon hsa's. >> thank you, mr. chairman. >> thank you, senator. i am sorry, i miss -- what is the revenue and shipped? >> is $15.2 billion -- it is $15.2 billion. >> a dinallo to get into an

argument here. -- i do not want to get into an argument here. it is the same offset that we have been talking about. >> yes, sir. depending on the schumer amendment, i have one more minute on this subject and it will follow the schumer amendment pursuant to your request. if i have the misfortune of not prevailing on this amendment, this of said could be offered one more time. [laughter] >> i really do appreciate your -- >> unless somebody else has a better idea. >> again, it is tantamount to income shift. lower income people to higher income people. that is not the right thing to do.

the clerk will call the roll. >> [unintelligible] >> we need eight. 1, 2, 3, 4, 5, 6, 7. we do not have it. >> [unintelligible] >> we had eight. we do have a quorum. the clerk will call the roll. >> mr. rockefeller. >> no. >> mr. bingaman. >> no, by proxy. >> mr. schumer. >> no, by proxy. >> ms. cantwell. >> pass. >> mr. menendez. >> no, by proxy.

>> mr. grassley. >> aye by proxy. >> mr. hatch. >> aye. >> mr. kyle. >>aye. aye. >> mr. roberts. >> aye by proxy. >> mr. corn anin. >> aye by proxy. >> mr. chairman. >> no. >> mr. chairman, the final tally -- >> i have not requested it yet.

the clerk will tally the votes. >> the result is 10 ayes, 13 nays, and one pass. >> [unintelligible] >> mr. chairman, i would like to call my amendment d11. this amendment is to avert horn a portion of medicare regulations that significant cut reimbursement on radiation oncology services based on what i believe is a faulty assumption. in its national physician fee

schedule released this year, vms reap balances in the reimbursement to physician. i recently was joined by 31 senators in sending a letter to the administration expressioexpe had concerning the assumption is determined -- assumptions for determining the payment rate. mr. chairman, the cms rule changed payments in a budget- neutral way so that any primary care specialists received raises in payments and other physicians received reductions. i applaud the at mission for recognizing that primary physicians -- i applaud the

administration for recognizing that primary physicians [unintelligible] we have been talking about coverage and that does not equate access when you live in areas where it is difficult to find access to health care, where medical providers are not there. so i certainly applaud them and recognizing that primary care physicians do need to be reimbursed adequately, whether they are serving in large areas or small areas. however, as a part of the payment rate, the rules established for radiation oncologist, cms use the data that should have never been applied to radiation oncology. when we talk about radiologists, we are talking about diagnostic imaging. some of what we have seen here

stems from a misreading of a proposal by the medicare payment advisory commission, medpac, which we have talked about a lot here. i have expressed my concerns to make sure that they are adequately represented by rural areas, which i think will be critical. but the misreading of the proposal by medpac regarding diagnostic imaging services, there is a clear distinction between radiation therapy and diagnostic imaging. radiation therapy, many of us certainly remember our good friend, senator kennedy, when using radiation therapy, oncologist used radiation to actually pinpoint cancer in difficult to reach spaces or sensitive spaces, but it is used as a therapy, instead of

imaging. in fact, in a comment letter, on the proposed rule, medpac did not contemplate applying this equipment utilization policy to radiation therapy machines. in other words, those machines that are radiology therapy are going to get the same 90% utilization and will be subjected to the same 90% utilization rate that diagnostics imaging is going to see. so, mr. chairman, i think there's clearly a mistake in the way that cms interpreted this. medpac was clear that it was misunderstood. it was not their intent to see that happen. i would like to see that we recognize that, particularly for those radiation oncologist that to really need this equipment

and oftentimes, because of its specialization, will not see that 90% utilization that you would see any regular diagnostic therapy practice. i hope, mr. chairman, that he will work with me to solve this problem. i think many of my colleagues understand this issue. i had 31 other senators join me in my letter to cmf, and i would appreciate the opportunity to work with you, mr. chairman, and the administration to make sure that the cancer patients will continue to have access to the vital radiation oncology services that they are now receiving. it is wonderful that we have these technologies. they are miraculously in many ways. i would hate for us to lose that technology because we have misinterpreted or that cms has misinterpreted what that actually was.

>> thank you, mr. chairman. i want to thank senator lincoln for her amendment and join her in expressing great concern about the cuts to radiation oncology in the upcoming physician fees schedule proposed rule. i share the concern that this could create serious risks for patients in michigan, ark., and across the country. the cost of certain families for radiation procedures provided in freestanding centers is more than 35%. up to 44% or more for certain procedures are critical for the provision of radiation therapy. in michigan, their 24 free- standing religious centers, which represent one-third of our capacity to treat cancer patients with radiation therapy. more than half of the centers are considered at risk for closure under the estimates of the proposed rules impact. obviously, this would be very

bad for patients. that would increase the travel time for cancer patients and would impose a burden for cancer patients, but also would impact patient compliance. i think the senator for bringing it to our attention. >> i would like to thank senator seven out and the other senators. -- senator stabenow and their senators. this will drastically decreasing our ability to serve cancer patients. you are exactly right. the distance the cancer patients will have to travel to get that specialized care is going to be enormous and disproportionate because of this misrepresentation. so i think the senator from michigan. >> thank you, senator. i share your concern.

>> i appreciate it. i appreciate the chairman's willingness to work with us on this. >> we have three votes on the floor shortly. we have about 10 amendments left to complete action on this bill. my hope is and my expectation is that we can perhaps work out some of the amendments and then, we come back. i hope the senators can keep their marks short and then we can take the amendment by voice or two. within striking distance, i can see the light at the end of the tunnel.

i can do my best tonight to make sure that we wrap up. iron -- i appreciate for working so cooperative on this bill. my intention is to recess until 8:30 p.m. tonight and we will come back at a 30 p.m. and, with a little extra effort and cooperation, we can continue. the committee stands recessed until a 30 p.m. [gavel]

>> there is a break in the senate finance committee until 8:30 p.m. eastern time. there are about 10 amendments to consider. here is what the associated press is writing about the marquettmark-up. the outcome appeared inevitable with finance committee chairman max baucus declaring that he had the votes for approval of the bill, increasing president barack obama's to extend coverage to the uninsured. during the recess, we will hear from president obama of. he attended a fund-raiser to dave and talked about the health care plan -- he attended a fund- raiser today and talked about

the tashealth care plan. >> we have home to thousands of entrepreneurs. all too often, the economic pioneers are made to give up on their dreams and some of them never follow up on them in the first place because of what it would cost them to provide health insurance for themselves and their families and potential employees. right now, the cost of covering an employee could be prohibitively expensive. a new study came yesterday from the robert wood johnson groups say what would happen in the next 10 years if we failed to enact health care insurance reform. under the worst-case scenario, businesses would see premiums more than double in [unintelligible] even under the best case scenario, employers would see premiums go up by 60%.

that kind of future is bad for entrepreneurs. is that for businesses. it is bad for the united states of america. we cannot afford insurance that hampers the america in the 21st century. we need a system that unleashes its potential. that is what reform will help us achieve. i know some folks say that we should focus on fixing the economy instead of on health insurance reform. through the recovery act, our financial stabilization measures, what we're doing in education, we are doing very possible step to spur economic growth and spur job creation. but i also believe that health insurance reform is an absolutely critical to fixing our economy. it is how we will encourage more to the north to take a gamble on a good idea. that is how we will make sure that, if they do, they will be able to cover the costs to

insure their employees. we will do that by setting up a health insurance exchange, with a different affordable health care options. while there will be a requirement for individuals to carry insurance and businesses to cover their workers, 95% of all small businesses would be exempt from this requirement. we will make it easier for them, particularly because a lot of them are already providing coverage at exorbitant rates to their employees. insurance should not be 80% more expensive for small firms as it is -- should not be 18% more expensive for small firms as it is for large firms. this will sponsor of the opener ship and jump-start job creation. this is what else it will be for state. it will mean stemming rising premiums and costs to state

governments of roughly $95 billion a year. it will mean reducing drug costs by increasing the mccain drug rebate. it will for the benefit state and federal governments alike and it will mean curbing the up to $141 billion worth we are expected to spend each year caring for the uninsured. that is what it means for states. that is what it will mean for business. that is what it will mean for america. we are at that rare moment where we have been given the opportunity to remake our world for the better. it is that rare moment when we have the chance to seize their future. as difficult as this sometimes is, what is apparent about the american spirit is the fact that we do not claim to the past in this country -- we do not cling to the past in this country. we always move forward. that movement doesn't always begin in washington.

it often begins in states. it begins in neighborhoods. it begins in communities. it because -- if begins because american people decide to start a new direction. it is because all of you have decided it is time for change. if you do it now, not only will we pass health insurance reform, not only are we finally going to make this an economy that is not reliant on boom and bust and max that credit cards, it will be on reliance of the ingenuity and hard work of the american people, but we're also going to do what earlier generations have done, which is build something that is better for our children and our grandchildren. that is our project. that is what this white house is devoted to doing. we're grateful that all of you are partners in the process. thank you very much. god bless, everybody. [applause] >> the senate finance committee is expected to return here at

8:30 p.m. eastern time. although chairman baucus of the finance committee will not vote on the measure until next week, the senate democratic leader harry reid says the full senate could start voting on health care read -- health care legislation as early as october 12. we have two senators on tomorrow morning's "washington journal." you can see it every day starting at 7:00 a.m. eastern here on c-span. as this break continues, debate from earlier today on a couple of amendments that would set limits on who would have to pay taxes, fees, and penalties based on income is next. >> this amendment is intended to bring the bill in line with one of president obama's pledges to the american people. i think virtually everybody in america has probably heard president obama describe the parameters of the health-care proposal that he thinks -- that

he seeks to have congress adopt. one of the core points he has continuously made is that he will not impose a new tax on those in this country -- individuals making less than 200 -- families making less than to under $50,000 of your -- less than $250,000 a year. he said, if you're a family making less than $250,000 a year, my plan will not raise your taxes one penny. not your income taxes, not your payroll taxes, not your capital gains taxes, not any of your taxes. similarly, in august or september of last year, in new mexico, the president said, you will not see any of your taxes increase one single dime. if you make less than $250 -- 2 vetter $50,000 a year, you'll

not see any of your taxes -- $250,000 a year, you will not see any of your taxes increase. again, last year in september, in new hampshire, the president said that no family making less than two hundred $50,000 will see their taxes increase. i can make a firm pledge under my plan that no family making less than $250,000 will see their taxes increase, not your income taxes, not your peril taxes, not your capital gains taxes, not -- not your payroll taxes, not your capital gains taxes, not any. the paper in front of us does propose tax increases that people who earn well less than $250,000 will be paying. the amendment is very simple. it provides that no tax or fee or penalty imposed by this

legislation shall be applied to any individual earning less than $250,000 a year. let me identify just briefly what taxes i have identified in the bill that i think this amendment would apply to point in one of the amendments i brought earlier, you would recall that i made a strong argument that the play pay, for employers who do not provide health insurance to their employees have to pay a penalty and it would be directly passed on to their employees who would then pay higher taxes that were higher fees because of those taxes. i am not counting that as a direct tax. i actually believe that should count. i believe that those pass through costs that we are passing through two employees of small businesses or any

businesses that do not provide support to their employees should be counted. but just looking at the direct tax increases in the bill, first, the individual mandate to have health insurance under this bill would impose an excise tax of $750 per person, and to a maximum of $1,500 per family for anyone between 100% and 300% of the poverty level. the tax would be $950 for an individual and into 1900 dollars per family above the 300% of the poverty level. a study has shown remarkable statistics. the jct and cbo numbers show that of the estimated two $0.8 billion that this tax will collect in 2016, 71% would come from people earning less than

500% of party. -- of poverty. 71% of this tax will fall on people making less than $120,000. a lot of it will fall on those making $48,000 a year. another portion will fall among those who make between $48,000 a year and $75,000 a year. another $300 million will fall on those making between $96,000 and $120,000. 71% of that tax will fall on those making less than $120,000 a year. we don't have statistics between $120,000 and $250,000.