To repeal the CLASS Act.

HEALTH CARE AND EDUCATION RECONCILIATION ACT OF 2010

The ACTING PRESIDENT pro tempore. Under the previous order, the
Senate will resume consideration of H.R. 4872, which the clerk will
report.
The assistant legislative clerk read as follows:

A bill (H.R. 4872) to provide for reconciliation pursuant
to Title II of the concurrent resolution on the budget for
fiscal year 2010, S. Con. Res. 13.

Pending:

Gregg-Coburn modified amendment No. 3567, to prevent
Medicare from being used for new entitlements and to use
Medicare savings to save Medicare.
McCain amendment No. 3570, to eliminate the sweetheart
deals for Tennessee, Hawaii, Louisiana, Montana, Connecticut,
and frontier States.
Crapo motion to commit the bill to the Committee on
Finance, with instructions.
Enzi motion to commit the bill to the Committee on Finance,
with instructions.
Barrasso amendment No. 3582, to ensure that Americans can
keep the coverage they have by keeping premiums affordable.
Grassley-Roberts amendment No. 3564, to make sure the
President, Cabinet members, all White House senior staff and
congressional committee and leadership staff are purchasing
health insurance through the health insurance exchanges
established by the Patient Protection and Affordable Care
Act.

Mr. REID. Mr. President, would the Chair report how much time is left
on general debate on the bill.
The ACTING PRESIDENT pro tempore. The majority has 7 hours 32 minutes
and the minority has 8 hours 30 minutes.
Mr. REID. Mr. President, I yield back all time remaining on the bill
on the majority's side.
The ACTING PRESIDENT pro tempore. The leader has that right. The time
is yielded back.
The Senator from Tennessee is recognized.

Motion to Commit

Mr. ALEXANDER. Mr. President, I ask unanimous consent to temporarily

[[Page S1924]]

set aside the pending motion so that I may offer a motion to commit,
which is at the desk.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
The clerk will report the motion.
The assistant legislative clerk read as follows:

The Senator from Tennessee [Mr. Alexander] moves to commit
the bill H.R. 4872 to the Committee on Health, Education,
Labor, and Pensions of the Senate with instructions to report
the same back to the Senate within 1 day with changes to
reduce the interest paid by student borrowers by 1.5
percentage points and to add an offset.

The ACTING PRESIDENT pro tempore. The Senator from Montana.
Mr. BAUCUS. Mr. President, I wonder if the Senator from Tennessee
would agree to modify his request so that the earlier amendments be set
aside until a time designated by the leaders and this motion then be
taken up at a time to be decided by the leaders, which is the customary
practice we have been utilizing with previous amendments.
Mr. ALEXANDER. Mr. President, I wonder if the Senator from Montana
would permit me to consider that request and then respond to him within
a few minutes.
Mr. BAUCUS. The Senator would withdraw the request and make the
request later?
Mr. ALEXANDER. If I may consult with Senator Gregg, then respond. If
you will make the request later, I would be grateful.
Mr. BAUCUS. OK.
Mr. ALEXANDER. Thank you very much.
The ACTING PRESIDENT pro tempore. The Senator from Tennessee is
recognized.
Mr. ALEXANDER. Mr. President, 19 million American families will be
interested in this motion because it will reduce the cost of student
loans which 19 million Americans have. This is the season of the year
when a great many students have been admitted to a college or a
community college and are making plans and looking for where they are
going to get their money. This motion is aimed at reducing the interest
rate on 19 million student loans from 6.8 percent to 5.3 percent. For
the average student loan debt of about $25,000, it would save that
student $1,700 or $1,800 over their ten-year loan. More specifically,
it would not only help the student, but it would prevent the Federal
Government from overcharging 19 million American college students on
their student loans to help pay for the health care bill and other
government programs.
One may say: Wait a minute, I thought we were debating the health
care bill. How did we get to student loans? That is a very good
question because it just came up over the weekend. Of course, we have
talked about student loans. There have been proposals, but there have
been no hearings in the Senate, no consideration in the Senate
committee of which I am a member. Yet over the weekend, the Democratic
majority said: Well, look, while we are at it, let's have another
Washington takeover. Let's take over the Federal student loan program.
Let's take a program which is working very well, in which 15 million
American students have voted with their feet to say they would prefer
to get a regular student loan backed by the government, which they get
at their college campuses, through their community bank, through a
nonprofit institution. Even though they do have an option for a
government loan, three out of four students have said they prefer the
student loan through the private lender. Yet over the weekend, the
Democratic majority has said: While we are at it, let's take over the
Federal student loan program.

That means that starting July 1, students have no choice. They go to
the Federal Government to get their student loan, all 19 million of
them, which is a new experience for 15 of the 19 million.
The way they are going to do it--and this is all going to be set up
in a very short period of time--is they are now going to have to go to
four Federal call centers. So instead of going to their local lender or
to their nonprofit institution, that can help them with their
application form and see what their options are and encourage them as
they make their plans for college, welcome to the new government loan
program. They have no choice. That is what they are going to do.
What are the other aspects of this? Well, other than denying choice
to 19 million students on more than 2,000 campuses who prefer the
Federal loan program, the Federal Government is going to have to borrow
another $\1/2\ trillion in order to make these loans. Let's think about
this for a moment. What is the No. 1 issue that most Americans worry
about today? It is that we have too much debt. So what did this weekend
takeover do? It adds about $\1/2\ trillion to the Federal debt in order
to make student loans, at the rate of about $90 billion or $100 billion
a year for 4 or 5 years.
So we take away choice, we add to the debt, and we also put 31,000
people out of their jobs. These are a lot of loans, and so we have a
lot of people in these organizations, such as Edsouth in my State, a
nonprofit organization that helps students get their loans. So all
these lenders are out of business and we have one big bank--the Federal
Government.
The Education Secretary is the new banker of the year. He is a very
good Education Secretary, but I don't know how good a banker he is
going to be.
But here is the rub, and this is what my motion is about. The Federal
Government is going to be borrowing money at 2.8 percent and loaning it
to students at 6.8 percent and taking the difference and spending it on
new government programs, including the health care bill. So we are
going to be overcharging 19 million students to help pay for the health
care bill. And, according to the most recent Congressional Budget
Office estimates, about $8.7 billion of the overcharged money is going
to go to pay for the health care bill.
My friends on the other side have already spent the money, of course.
They have announced to everybody that we are going to spend it on this
and on that and on this, but what they do not tell you is, where they
get the money. Where they get the money is overcharging students--
overcharging students.
These aren't Wall Street financiers we are overcharging. This might
be a single mom going to a community college in Tennessee who has a job
but who wants a better job and so she borrows some money to go to the
community college and the Federal Government is going to overcharge her
to pay for some government program. She might not like that.
In fact, I think there will be about 19 million student loan holders
across the country who will go to school next year and say: Wait a
minute here. You mean you are overcharging me on my student loan to pay
for this health care bill and to pay for other government programs? The
answer will be: Yes, that is what we are doing, unless my colleagues
support this motion.
The estimate by our friends on the other side is that their Federal
takeover of the Federal student loan enterprise will save $61 billion.
If they are correct, let's give it to the students. Let's reduce their
interest rate. I mean, $1,700 or $1,800 per student in interest over 10
years is the average amount of savings, and that is a lot of money. It
may not seem like a lot of money to Congressmen and Senators in
Washington, but to the single mom going to the community college who is
borrowing the money to go to school in order to get a better job,
$1,700 or $1,800 is a lot of money.
So in addition to the higher premium numbers, the higher taxes, the
Medicare cuts, and the new cost to States, we are going to be
overcharging on student loans. Let me use a specific example from
Tennessee, if I may. I was at the University of Tennessee earlier this
week. This is the University of which I used to be president. The
University of Tennessee has 30,000 students, and 37 percent of them--or
11,251--have Federal private loans today. The average student debt is
about $20,000. After July 1, all 11,000 students at the University of
Tennessee, with these Federal loans from private lenders, are going to
have to switch to the government loans, and the government is going to
overcharge 11,000 students who go to the University of Tennessee at
Knoxville and use that overcharged money to pay for new government
programs, including the health care bill.

[[Page S1925]]

They are going to do the same thing to the University of Tennessee at
Martin. There they choose to use the private loan program. They like it
better than the government loan program. They think it is more
convenient for the students. They have chosen--3,600 students at UT
Martin--have chosen Federal private loans. They are going to be out of
those loans by July 1. They are going to have government loans, and the
government is going to overcharge them to help pay for the health care
program.
Maryville College--I will be there Saturday night to help dedicate
their arts center. There, 824 students have Federal loans today. They
are going to have government loans. They are going to switch from
private to government loans. They will have no choice after July 1. I
know a lot of these students. They come from modest families, in most
cases. They are not going to be very happy to learn that when they
switch to a government loan after July 1, and if they have an average-
size loan, which is about $25,000, that over 10 years they are going to
pay $1,700 or $1,800 to help pay for the health care program or other
new government programs.
In Carson-Newman College, it is 1,259 students. In East Tennessee
State University, it is 8,187 students. In all of Tennessee, it is
200,000 students who have student loans who are going to be overcharged
an average of $1,700 or $1,800 a year to help pay for the health care
program or some other government program, and this amendment would say:
No, we are not. If we are going to take over the student loan program,
at least we are not going to overcharge the students and use it for the
health care program. We are going to give the money back to the
students.
The point of my amendment is very simple. We are going to reduce the
interest rate we charge on 19 million student loans from 6.8 percent to
5.3 percent and let the students have the savings instead of letting
the government have the savings. That is what the other side has not
told people about the student loans.
If we had an ample opportunity to debate this in the Senate, if we
had a committee hearing on it, if we had taken it through the regular
process, maybe we could have pointed this out, but no, we do it over
the weekend, put it in the House bill, send it over here, jam it
through with great breast beating and protestations: Look what we have
done for the country. I am accustomed to that. I used to be a Governor.
I remember lots of Members of Congress who would say I did a great
thing in Washington and then send the bill to me to pay. And then, as
Governor--in this case the health care bill will do the same thing. It
will send to the Governors and to the States new costs. Our Governor
estimates it is $1.1 billion over 5 years, to $1.5 billion. That is
about $300 million a year new costs that State taxpayers will have to
pay.
As the Medicaid cost goes up, we will get the second blow to the
students of Tennessee because either the State is going to have to
reduce funding for public higher education--which I believe this health
care bill will help permanently damage--or they are going to have to
raise taxes, or they are going to have to raise tuition, or they are
going to have to do all three. If I am a student at Maryville College,
Carson-Newman, or the University of Tennessee, first this health care
bill is going to overcharge me on my student loan to help pay for it;
second, it is going to send such big new costs to the government that
the Governor is going to have to reduce funding to my college or
university and my tuition is going to go up.
All those students in California who are protesting a 34-percent
increase in tuition probably do not realize the reason for that
happening. The main reason is that over the years the Federal
Government has so regulated the Medicaid program that the States pay
about a third of, that the State budgets have grown and grown and the
Governors, such as Governor Schwarzenegger in California, have had no
choice except to cut, knowing that when you get down through the budget
process you have had no choice except to cut other programs. Governors
know when you get down through the budget process in the State, it
usually comes down to Medicaid or higher education. So a great
university such as the University of California is on its knees, and if
it even hoped to keep its quality, it raises tuition 34 percent.
My amendment will not help that problem. The law the President signed
yesterday already will transfer to States these huge new costs that are
going to permanently damage higher education and raise tuition. But
what my amendment will do is say we are not going to overcharge 200,000
students in Tennessee for their student loans and use $8.7 billion to
help pay for health care.
Sometimes I think the motto of the Obama administration is: If you
can find it in the Yellow Pages, the government ought to be doing it.
This is breathtaking. While we are taking over cars, banks, insurance
companies, while we are taking over more of health care, we will also
take over the student loan program, add $\1/2\ trillion to the Federal
debt, overcharge 19 million students, cause 31,000 people to lose their
jobs and say ``all in a day's work.'' That is what happened last
weekend. Over the weekend that is the decision they made. Then over
here bragging about how much we are going to do for everybody. We are
going to do a little more for everybody if we have a chance to vote on
this amendment because when we go home we will have a chance to say
either I cut the interest rate on your student loan from 6.8 to 5.3
percent and give you the savings, or I voted to overcharge you $1,700
or $1,800 a year and give the money to the government to help pay for
the health care bill.
Mr. President, I ask unanimous consent to have printed in the Record
following my remarks a few communications I received from Tennessee.
The ACTING PRESIDENT pro tempore. Without objection, it is ordered.
(See exhibit 1.)
Mr. ALEXANDER. Here is a letter from Vanderbilt University to
Congressman Cooper from the Chancellor which says:

Our overarching concern with [this proposal] is that the
legislation forces institutions, including Vanderbilt, to
switch to direct lending.

Here is a distinguished university, one of the top research
universities in the world. They have chosen--they believe it is best
for their students and for their campus to use the private banks and
non-profits. We know better, of course, than Vanderbilt University,
what is best for the campus and best for the students. We say no, July
1, only the government.
In their letter they continue:

Vanderbilt opposes the elimination of the FFEL program. We
encourage Congress to carefully study the many alternate
proposals. . . . In addition to our concerns about the
elimination of choice, competition, and the high level of
services, products and debt management we believe would come
with this switch, we are very concerned that the proposed
timeframe for this mandated conversion is unreasonable.

So Vanderbilt opposes that. So does the Baptist College of Health
Sciences, so does Maryville College, so does the Middle Tennessee
School of Anesthesia, so does Dyersburg State Community College.
I ask to have these remarks printed in the Record and an article I
wrote in the Washington Post that was published on Sunday, March 7,
about the student loan takeover.

Exhibit 1

Vanderbilt University,

September 10, 2009.
Hon. Jim Cooper,
Longworth House Office Building,
Washington, DC.
Dear Congressman Cooper: The House of Representatives will
soon consider H.R. 3221, the Student Aid and Fiscal
Responsibility Act which would fundamentally restructure the
federal student aid system and funnel the projected savings
into a variety of higher education and K-12 programs as well
as deficit reduction. While Vanderbilt supports efforts to
restructure and expand federal student aid programs, we have
serious reservations about this legislation.
As you know, one proposed change has to do with the Direct
Loan (DL) program, in which the government acts as the
lender, and the Federal Family Education Loan (FFEL) program,
in which lending institutions provide loans to students.
Vanderbilt has a long and successful history of participation
in the FFEL program which has provided our students with
superior loan products, service, and choice in their federal
loans for many years.
Earlier this year, the administration proposed eliminating
the FFEL program, requiring all institutions to participate
in DL and using the projected $87 billion in savings over 10
years from this switch to fund a mandatory Pell Grant and
expand the Perkins

[[Page S1926]]

Loan program. [Other estimates have put the ten-year savings
figure at closer to $47 billion.] H.R. 3221 seeks to
implement those proposals. Unfortunately, the legislation has
attracted a host of other education-related provisions which,
while perhaps meritorious in their own right, we believe
should not be attached to federal student aid legislation.
We applaud and strongly support a number of provisions of
H.R. 3221:
Modest increases to Pell Grants. Any increase in Pell
Grants is deeply appreciated and will benefit undergraduate
students. Although the bill does not create the mandatory
Pell Grant proposed by the administration, it calls for $40
billion of the projected savings to be invested in the Pell
Grant program, moving it toward a $6,900 maximum grant by
2019.
Converts Stafford Loan interest rates from fixed to
variable. The bill provides $3.25 billion to change the fixed
interest rates on subsidized loans to a variable rate capped
at 6.8 percent.
Simplifies the FAFSA. We support reasonable efforts
included in the bill to simplify the FAFSA for federal
student aid programs.

Eliminating the FFEL Program

Our overarching concern with H.R. 3221 is that the
legislation forces institutions, including Vanderbilt, to
switch to Direct Lending. Of additional concern is the fact
that the proposed legislation does not then direct all of the
savings from this federal mandate back into federal aid
programs. Vanderbilt opposes the elimination of the FFEL
program. We encourage Congress to carefully study the many
alternate proposals to a mandatory conversion to DL. In
addition to our concerns about the elimination of choice,
competition, and the high level of services, products and
debt management that we believe would come with this switch,
we are very concerned that the proposed timeframe for this
mandated conversion is unreasonable. Institutions will need
sufficient time to make changes to their IT systems and
update their printed and on-line recruitment materials.
Completing this by the proposed July 1, 2010 deadline is
simply not feasible. In fact, Vanderbilt has already printed
many of its recruitment materials and launched its 2010-2011
admissions and financial aid efforts. We would advise that,
if a mandated conversion to DL is implemented, the earliest
effective date be July 1, 2011.

A New Perkins Loan Program

The bill restructures the Perkins Loan program into
essentially a second DL program that is campus-based, with an
additional $5 billion. The legislation proposes a complex
institutional allocation formula based on holding past
participants, such as Vanderbilt, harmless, while
significantly expanding participation based on low tuition
and improved Pell recipient graduation rates. We believe that
a Perkins program allocation formula should be based on the
aggregate need of an institution's students relative to the
aggregate need of all students at institutions participating
in the program nationally, subject to and including the hold
harmless provisions.
While Vanderbilt supports expanding participation in the
Perkins Loan program as well as the provisions that would
hold harmless existing participants, we are troubled by
proposals to eliminate the in-school interest subsidy and
loan forgiveness programs. These features have made Perkins
Loans uniquely attractive for many of our students.
Vanderbilt also opposes proposals to require institutions to
pay the accrued interest while students are still enrolled in
school. This would impose significant costs on our financial
aid budget and could jeopardize our participation in the
program. H.R. 3221 is also not clear as to whether
institutional matching funds will be required or how that
determination would be made.

Creates Access, Completion, and Persistence Grant Programs

Included in the bill is $3 billion for the College Access
Challenge Grant program. These funds would be allocated
primarily to states and guaranty agencies with a small
portion retained for a national competition. While Vanderbilt
supports the goals of this program, and is proud of our 95
percent freshman retention and 92 percent six-year graduation
rates, we are concerned that diverting up to 75 percent of
the funding to the states could severely restrict the ability
of private institutions to compete for the funding and could
inappropriately increase state oversight of private
institutions. We also believe that any savings generated from
the switch to DL should remain in the existing federal
student aid programs.
In addition to these, there are several other provisions of
the legislation that are troubling to us:
Family Asset Cap. Students with family assets of more than
$150,000 would be ineligible for any need-based federal aid.
While the value of a family's house, farm, business, or
employee pension benefit plan would be excluded, we believe
this cap should be increased to at least $250,000, geographic
factors should be applied, and an option established for
financial aid administrators to be able to use their
professional judgment such that students and parents in
unique circumstances can be held harmless by this provision.
Beyond Student Aid. H.R. 3221 goes far beyond federal
student aid to include funding for other higher education
programs as well as K-12 school construction and early
childhood education. We believe that all savings generated
from the student aid programs should remain in these
programs. These initiatives, while potentially meritorious,
should be funded through avenues other than student aid
programs' savings.
H.R. 3221 truly is a mixed hag. While Vanderbilt supports
the significant new investment in the Pell Grant program, we
are concerned that allocations to other initiatives have
significantly reduced the possible level of support for the
Pell Grant program. We remain strongly opposed to the
elimination of the FFEL program. And, although it could bring
low-cost Perkins Loans to millions of new students, we are
troubled by proposals to eliminate the in-school interest
subsidy and other changes to that program.
Vanderbilt remains committed to the federal student aid
programs, which provide a foundation to our aid packages for
both undergraduate and graduate students. We look forward to
continuing to work with you to ensure that all capable and
eligible students, regardless of financial circumstances, are
able to access and complete post-secondary education. If you
have any questions or if I can provide any additional
information, please let me know.
Sincerely,
Christina D. West,
Director of Federal Relations.
____

Tennessee Association of Student Financial Aid
Administrators,
November 25, 2009.
Hon. Lamar Alexander,
U.S. Senate, Dirksen Senate Office Building, Washington, DC.
Dear Senator Alexander: On behalf of the Executive Board of
the Tennessee Association of Student Financial Aid
Administrators (TASFAA), I want to communicate to you our
collective concerns regarding the Federal Student Loan
Program (Stafford and PLUS).
TASFAA represents financial aid officers from 106
postsecondary institutions in Tennessee. The Tennessee
postsecondary institutions serve several thousand students,
many who are student loan borrowers. While our membership and
schools are located within Tennessee, we have students from
every state in the Union. We seek your support of our
requests, which are made on behalf of the students and
parents we serve. These students and parents have been well
served by not only the institutions and individual
professionals, but by the Federal Direct Lending Program
(FDSLP) through the Department of Education and by private
sector lenders within the Federal Family Education Loan
Program (FFELP) also. Importantly, our students and parents
have benefitted by the opportunity to seek out lenders who
offer loans with savings and service that aid the borrowers
throughout repayment.
TASFAA is an advocate for choice within the respective loan
programs. As President Obama stated in his address to a Joint
Session of Congress, ``Consumers do better when there is
choice and competition.'' We also want to focus on the timing
of all schools currently participating in the FFELP having to
switch to the Federal Direct Student Loan Program should the
Senate version of H.R. 3221 be enacted. Recent information
from the Department of Education showed that 1,990 of the
5,455 schools that participate in federal student loan
programs are currently participating in the Direct Loan
Program. Therefore, 3,465 colleges and universities across
the country, that serve millions of students, are not yet
participating in the FDSLP.
Many elected officials have expressed their concerns
regarding the timing of such a transition. Most Tennessee
institutions will begin awarding financial aid packages to
traditional students in early spring. In addition to the
traditional calendar, some institutions have non-traditional
students in year-round programs who borrow student loans
throughout the year in what is known as the Borrower-Based
Academic Year (BBAY). For these students, loans will be
packaged in approximately four weeks, and the precarious
status of the legislation may greatly harm these student
borrowers. The Secretary's assistant has noted it will take
3-4 months for schools to convert their programs. Due to the
issues related to the transition to a new program (shortage
of staff members, new software systems, lack of training,
financial issues at small schools, etc.), we ask that you
consider the dilemma that these students face by the timing
of such an action and at the very least, delay the
implementation of full conversion to FDSLP to July 1, 2011.
If you choose to support the Senate version of H.R. 3221
and move forward with full conversion to FDSLP but allow for
the delayed implementation date, we implore you to support S.
2796 to extend the Ensuring Continued Access to Student Loans
Act (ECASLA). ECASLA has assured that students have been able
to obtain the loan(s) necessary to ensure their educational
goals and dreams. This action will ensure that every
educational loan borrower will be able to continue to secure
the respective loan with no interrupted service.
As of the date of this letter, the Senate committee of
jurisdiction has not acted on this proposed legislation, as
well as the entire Senate or any conferees. This is of major
concern to us as the timing of the possible conversion to,
and implementation of, 100 percent FDSLP is further delayed.
The Senate had noted it would vote on H.R. 3221 by

[[Page S1927]]

October 15, 2009, but as of the date of this letter, proposed
legislation still has not reached the Senate for a vote.
With all of the above taken into consideration, the
Executive Board of TASFAA, on behalf of our entire
membership, urges you to support ``choice and competition.''
But if not, we ask you to implement a reasonable timeframe
for transition.
Sincerely,
Marian Malone Huffman,
President, TASFAA.
____

Baptist College

of Health Sciences,

Memphis, TN, November 24, 2009.
Members of Congress: I ask that you support H.R. 4103 and
S. 2796 to ensure uninterrupted FFELP funding of Federal
Student Loans for students and parents attending colleges and
universities across the country.
I have worked in the student financial aid profession since
1982, ALWAYS at FFELP schools. In my many years of
experience, I have witnessed tens of thousands of students
being well served by the FFELP system. The idea of the
Federal Direct Student Loan Programs certainly contributed to
needed improvements to FFELP, and the two programs have
served to keep each other ``on their toes.'' To shift now to
a federal monopoly in the student loan business could prove
to be a monumental mistake.
Schools have had plenty of time to choose between FFELP and
Direct Lending. It is clear that FFELP works better for some
schools and Direct Lending for other schools. And most
importantly, BOTH programs do a good job of serving needy
students attend college. Let's please keep it that way.
Sincerely,

Janet Bonney-Baker,

Financial Aid Supervisor, Baptist College
of Health Sciences.
____

Office of Financial Aid,

Dyersburg State Community College

Dyersburg, TN, November 25, 2009
As a student financial aid administrator for over thirty-
five years, I have concerns regarding students receiving
needed funds to attend post-secondary institutions in the
2010-2011 academic year. Regardless of our stance on direct
lending, we all have one common bond, and that is helping the
students we serve.
All schools are planning for the 2010-2011 academic year,
and we feel trapped. I implore you to consider extending the
Ensuring Continued Access to Student Loans Act (ECASLA) as
quickly as possible, so that the students in this country
will not suffer with the uncertainties accompanying delays in
implementation of new programs. Timing is critical for higher
education in this country.
Please consider choice as the loan option for the students
of this country. Competition and choice is a foundation of
our economy. As President Obama stated in his address to a
Joint Session of Congress, ``consumers do better when there
is choice and competition''.
The Secretary's assistant has noted that it will take 3-4
months for schools to convert their programs. Due to the
issues related to the transition to a new program (shortage
of staff members, new software systems, lack of training,
financial issues at small schools, etc.), please consider
delaying the implementation of full conversion of the Federal
Direct Student Loan Program to July 1, 2011, at the earliest
which will provide us with a reasonable timeframe for
transition, if choice is not an option for us.
Sincerely,
Sandra Rockett,
Director of Financial Aid.
____

Middle Tennessee

School of Anesthesia,

November 24, 2009.
Members of Congress: I ask you to support H.R. 4103 and S.
2796 to ensure uninterrupted FFELP funding of Federal Student
Loans for students and parents attending colleges and
universities across the country.
I am the sole worker in Financial Aid at Middle Tennessee
School of Anesthesia, (MTSA) and we like the FFELP program.
The students here at MTSA DO NOT want to use Direct Lending.
The decision to end the FFELP program takes away the right to
choose. The advent of the Federal Direct Student Loan
Programs certainly contributed to needed improvements to
FFELP, and the two programs have served to keep each other
``on their toes.'' To shift now to a federal monopoly in the
student loan business could prove to be a monumental mistake.
Having the ability to use both programs gives the Financial
Aid Industry a healthy competition.
Schools should have the ability to talk to different
lenders and choose between FFELP and Direct Lending. It is
clear that FFELP works better for some schools and Direct
Lending for other schools. And most importantly, BOTH
programs do a good job of serving needy students attending
college.
Sincerely,
M. Joanna Hayes Dickens,
Financial Aid Coordinator.
____

Rhodes College,

Financial Aid Office,

Memphis, TN, December 8, 2009.
Senator Lamar Alexander,
Dirksen Senate Office Building,
District of Columbia.
Dear Senator Alexander, I write to urge you to vote in
favor of extending the Ensuring Continued Access to Student
Loans Act, H.R. 4103 and S. 2796. As a financial aid
professional, I know firsthand the importance of these funds
in meeting students' educational expenses. I believe that
competition breeds excellence and I am in favor of keeping
both the FFEL and Direct programs in place. To eliminate FFEL
especially during this particular time in history, would be a
mistake that would cost institutions and students time and
money that we simply can't afford.
An interruption in the delivery of these funds would create
a hardship for many students and make the neediest among them
unable to attend college. This bill will ensure that
sufficient funds will be available for students in the 2010-
2011 academic year.
Please Vote YES to H.R. 4103 and S. 2796! Thank you for
your understanding and support of our students!
Most Sincerely,
Ashley Bianchi,
Acting Director of Financial Aid.
____

And Now for Students, Big Lender

(By Lamar Alexander)

While health-care reform occupies the spotlight, the Obama
administration is pushing for another Washington takeover--
this time of the student loan system. Last month, U.S.
Education Secretary Arne Duncan made the administration's
latest pitch on this page.
Here is what the administration and congressional Democrats
have told us about this latest attempt: Starting in July, all
19 million students who want government-backed loans will
line up at offices designated by the U.S. Education
Department. Gone will be the days when students and their
colleges picked the lender that best fit their needs;
instead, a federal bureaucrat will make that choice for every
student in America based on still-unclear guidelines. They
say that this will save taxpayers up to $87 billion in
subsidies that now go to ``greedy'' banks. In gleeful
anticipation, members of Congress have lined up to spend
those billions on Pell Grants and almost a dozen other
programs. Banks are punished. Students are helped. Members of
Congress look good.
Here is what they haven't told us: The Education Department
will borrow money at 2.8 percent from the Treasury, lend it
to you at 6.8 percent and spend the difference on new
programs. So you'll work longer to pay off your student loan
to help pay for someone else's education--and to help your
U.S. representative's reelection.
And there are some other things the government should tell
you: The estimated $87 billion in savings isn't real.
According to a July 2009 letter from the Congressional Budget
Office (CBO) to Sen. Judd Gregg (R-N.H.), the savings are
closer to $47 billion including administration costs, if we
use the same ``scoring'' (i.e., cost analysis) method that
Congress required the CBO to use when it scored the Troubled
Asset Relief Program last year because the method would more
accurately calculate the cost to taxpayers.
Finally, the government should disclose that getting your
student loan will become about as enjoyable as going to the
Department of Motor Vehicles.
Today, roughly 2,000 lenders offer government-backed
student loans on more than 4,000 campuses. One lender,
Edsouth, offers Tennessee students college and career
counselors, financial-aid training, and college-admissions
assistance; performs hundreds of presentations at Tennessee
schools; and works with 12,000 Tennessee students to improve
their understanding of the college-admissions and financial-
aid process.
Nonprofit lenders such as Edsouth use the revenue generated
under the student-loan system to operate and provide these
valuable benefits--but of course, these services cost money.
If--under this latest Washington takeover--Edsouth and other
nonprofit lenders are prevented from making the number of
loans they make today, they will no longer be able to provide
these services, depriving students of real choices in
lending.
The student loan ``Banker of the Year'' will be the only
student loan banker left calling the shots; the education
secretary in Washington. Imagine trying to get all Edsouth's
services from a federal call center.
I was education secretary for President George H.W. Bush
when, in 1991, Congress offered students a choice for borrow
from a local lender or the Education Department. In 2008, 15
million students voted with their feet and chose
nongovernment lenders--and only 4 million students chose to
get their loans from Washington.
Congress has reduced subsidies paid to lenders twice in the
past four years, investing the savings in Pell Grants and
other programs. But if there really is $47 billion in savings
to be found, Congress should return it to students as lower
interest rates, not trick students by overcharging them so
Washington can create more government programs.
Seven-eighths of students who applied for federal aid using
the Free Application for Federal Student Aid (FAFSA) had an
average loan debt of $24,651. Assuming a standard 10-year
repayment at 6.8 percent, those students would pay roughly
$9,400 in interest. If we really want to have students money,
why not just reduce the interest rate by 1.5 percentage
points, to 5.3 percent, saving students $2,240 in interest?
If this Washington takeover happens, I propose that all 19
million-plus student loans made by the government carry this
warning label:
``Beware: Your federal government is overcharging you so
your representative can

[[Page S1928]]

take credit for starting new government programs. Enjoy the
extra hours you work to pay off your student loan.''

The ACTING PRESIDENT pro tempore. The Senator from New Hampshire is
recognized.
Mr. GREGG. I am recognized, correct?
The ACTING PRESIDENT pro tempore. That is correct.
Mr. GREGG. I ask unanimous consent at this time to withdraw the
amendment of the Senator from--on behalf of the Senator from Tennessee,
I ask to withdraw his amendment.
The ACTING PRESIDENT pro tempore. Is there objection?
Without objection, the amendment is withdrawn.
Mr. BAUCUS. Mr. President, reserving the right to object.
The ACTING PRESIDENT pro tempore. The Senator from Montana.
Mr. BAUCUS. Mr. President, I regret, I object.
The ACTING PRESIDENT pro tempore. Objection is heard.
The Senator from Tennessee is recognized.
Mr. ALEXANDER. Mr. President, I withdraw my motion.
The ACTING PRESIDENT pro tempore. The motion is withdrawn.
The Senator from New Hampshire is recognized.
Mr. GREGG. Mr. President, at this time I yield such time as he may
take off the bill to Senator Alexander to discuss his amendment, which
he is not offering at this time, while retaining the right to the
floor.
The ACTING PRESIDENT pro tempore. The Senator from Tennessee.
Is there objection?
Mr. BAUCUS. Mr. President, reserving the right to object, what is the
parliamentary situation at the moment?
The ACTING PRESIDENT pro tempore. There is a Grassley amendment
pending.
Mr. BAUCUS. Mr. President, who has the floor?
The ACTING PRESIDENT pro tempore. The Senator from New Hampshire has
yielded time off the bill.
Mr. GREGG. Without losing my right to the floor.
The ACTING PRESIDENT pro tempore. The Senator from Tennessee has been
recognized.
The Senator from New Hampshire cannot reserve his right to the floor.

Mr. BAUCUS. May I ask who has the floor?
The ACTING PRESIDENT pro tempore. The Senator from Tennessee has the
floor.
Mr. ALEXANDER. Mr. President, would you let me know when 10 more
minutes has expired, please?
I have a little history with the student loan program. I see the
distinguished Senator from Utah is here. When he was the ranking
Republican on the Senate Health and Education Committee 20 years ago, I
was the U.S. Education Secretary. He even helped me in my confirmation
process, for which I have always been deeply grateful. But he and I
worked together during that time when the question of having a
government loan program or a direct loan program came up. It was widely
discussed. We had a Republican President then and a Democratic
Congress. We came to a compromise. The compromise was to say let's have
both. We will give students the option and help them stay on and keep
the organizations on their toes. So if you are a student at the
University of Tennessee, University of Utah, you have a choice. You can
either say I don't want to fool with all these private lenders or the
local bank or the nonprofit organizations in my State or Edsouth or
others or the State organization, I want to go straight to the
government. All institutions have that choice. That is 6,000 colleges
and universities and 19 million students. Only one-fourth of them
choose the government direct lending program.
In the United States of America where choice and competition is an
important part of our culture, that usually teaches us a lesson. That
would suggest to us that most campuses, most students, by overwhelming
majorities prefer being in the private market to lining up to go to the
government. Otherwise we would have the government grocery store, we
would have the government car company. Actually we are beginning to
sound like that in this country. We would have the government insurance
company and all banks would be government banks. Everything would be in
the government.
They used to have a system like that in the Soviet Union. Ours did a
little better over time. Generally, our motto has been if you can find
it in the Yellow Pages the government should not be doing it. What is
happening with this administration and this Congress is the reverse. If
you can find it in the Yellow Pages, the government should be doing it.
Here is the situation that developed over the last 20 years. There
are roughly 6,000 institutions of higher education in this country.
Many people say all higher education is like the University of
Tennessee or Harvard or University of California, but there are many
kinds of colleges and universities--for-profit, nonprofit, private,
public, historically Black colleges, many different kinds of
institutions. The genius of our system is that we let Federal dollars,
either through Pell grants or through loans, follow the student to the
institution of their choice. Choice and competition in our system of
higher education has given us by far the best system of higher
education in the world.
Of those 6,000 institutions, last year, 2008, 4,421 schools chose to
use the regular student loan program. That is three out of four. About
one out of four used the government loan, the direct loan program, the
one that everybody is going to be made to use now. Currently there are
just under 2,000 lenders who participate in the student loan program.
They are banks and they are nonprofit institutions such as Edsouth in
Tennessee.
Last year nearly $100 billion in student loans was made. Let's keep
in mind as the government takes this over we go from a system where we
have government-backed loans, which cost the taxpayers very little, to
government loans at the rate of $100 billion a year which means we are
going to have to run up a half trillion more in debt at a time when our
debt is ridiculously out of control. That is this weekend's newest
Washington takeover that just occurred.
There is not definitive evidence to suggest that the Federal
Government can make these loans better than lenders can make these
loans. I don't think the Department of Education has the manpower to do
it. I think that by July 1 there is going to be consternation all over
the country from families who have applied for student loans and are
applying through their Federal call center or through the Internet.
Edsouth, a nonprofit provider in Tennessee, for example, has five
regional outreach counselors who canvas Tennessee and provide career
training. They made 443 presentations to Tennessee schools to help
students understand--remember, we have 200,000 of these students in
Tennessee--to help them understand their options. They worked with
12,000 students to help them understand what they could do. They worked
with 1,000 school counselors.
The U.S. Department of Education will soon be providing all of these
services.
Senator Gregg earlier had written the Congressional Budget Office
asking how much money this Federal takeover would save. They came back
with an explanation that it is not $67 billion or $61 billion, which is
the current number being used today, but more like $47 billion. My own
suspicion, and I cannot prove it, but my own suspicion, having been a
university president, having been Secretary of Education and having
watched this program for 20 years, is that in the real world the
Federal Government is not going to make these 19 million loans more
convenient for students. It is not going to be able to do it any
cheaper. It is just going to deny people choice, run up the debt, throw
31,000 people out of jobs, and the icing on the cake, and it is a sour-
tasting icing, is that the 19 million students who have student loans
after July 1 are going to be overcharged by the Federal Government,
which will be borrowing money at 2.8 percent, loaning it at 6.8
percent, and using the money to help pay for the health care bill and
other programs.
Our friends on the other side, they will be saying--they like to
blame everything on the bankers or the lenders--well, the lenders are
charging too much money. Well, if they are charging too much money,
reduce what they get.

[[Page S1929]]

You are saying there are $61 billion in savings, much of which comes
from the fact that the Federal Government can borrow money more cheaply
than private lenders can.
But then you are saying, we are going to take the savings and we are
going to spend it. We are going to overcharge these students. I can't
believe the brazenness of this, and I believe neither will 19 million
students understand it.
So I am glad to come to the floor today and talk about my motion,
which I will be glad to introduce at the appropriate time. No Senate
bill has been introduced. Our committee has held no hearings. We have
not had a markup of this bill. This is a wondrous Washington takeover
over the weekend.
We stick into the health care bill another Washington takeover, this
time of 19 million student loans. On top of it: Congratulations, Mr.
and Mrs. Working Student, you are going to get to be overcharged on
your loan to help pay for the health care bill and other government
programs.
I hope my friends in the Senate, on both sides of the aisle, will see
the injustice of this and say: OK, you are right, Senator Alexander. If
we are going to take it over, and if we are going to create $61 billion
in savings, at least let's give the students the savings. Let's not
give it to the government. Let's not overcharge the students, on an
average $25,000 student debt, $1,700 or $1,800 over 10 years.
I think we need to have a truth-and-lending stamp that goes on every
single student loan starting July 1 that says: Warning. Your government
is overcharging you in order to help pay for other government programs.
We will let the single mom who has a job, who is going to school to
help improve her circumstances, see what she thinks about the idea of
her being overcharged to help pay for other government programs.
So my motion, when it is voted on, will do a very simple thing. It
will say to the 19 million students in the country: We are going to
reduce your interest rate on your student loan from a typical 6.8
percent to 5.3 percent. That is going to save you $1,700 or $1,800 on
an average loan over ten years. It says: We are not going to overcharge
19 million students to help pay for the health care bill.
Before I yield the floor, I see my friend from New Hampshire is
engaged in conversation. I wonder if I could address the Senator from
New Hampshire through the Chair. Before I yield the floor, I wished to
ask, through the Chair, whether that is what I should do.
Mr. GREGG. Well, I would like to ask the Senator from Tennessee a
question on the substance of his proposal.
Mr. ALEXANDER. I will be glad to take the Senator's question.
Mr. GREGG. Because I do think it is an important proposal. As I
understand it, what the Senator is saying is that they put this baggage
on the train, which is the nationalization of all student loans in this
country, the government is going to take them all over, which will be
the fourth major nationalization event this administration has
undertaken.
First, they nationalized the auto industry. Now, they are in the
process of quasi-nationalizing the health care industry. Now they are
going to nationalize the educational industry. If the House final
reform bill passes, they will essentially be nationalizing the
financial industry--or having the capacity to--because they can break
up any company, whether they are healthy or not, under the Kanjorski
amendment.
So my question is: They threw this proposal on the train,
nationalizing the student loan industry, in order to use student loan
money to finance the health care bill because this bill would have
violated the budget rules if it did not have the student loan money
basically paying for it?
Mr. ALEXANDER. Mr. President, I am afraid the Senator from New
Hampshire is exactly right. According to the Congressional Budget
Office's updated estimate, $8.7 billion of this money that is being
overcharged to students will be used to help pay for the health care
bill.
The other money, except for a small part, will be used for other
government programs. So you are right on both counts--one Washington
takeover after another. That is why I am saying, I think we ought to
hide the Yellow Pages from these fellows because if they find something
in there that is being done in the private sector, they are going to
say: Oh, we can cut out the profit, we can cut out the business; why
does not the government do it?
Then, second, I mean this is astonishing to me. These are not Wall
Street financiers going to community colleges in New Hampshire and
Tennessee, these are people with jobs who are trying to improve their
lot. Their student loan levels are already too high. We are worried
about that. So we are going to take another $1,700 or $1,800 on a
$25,000 average loan over 10 years. We are just going to say: Well, we
will overcharge you. We are going to use that in government. The answer
is, yes, to your question, Senator; $8.7 billion of the money taken
from students by overcharging them on their student loans will go to
help pay for the health care bill.
Mr. GREGG. If I can ask a further question of the Senator. If they
did not have that $8.7 billion of student loan money being used to
finance the health care bill, this reconciliation bill would fall;
would it not? Because it would not meet the budget instructions of
having $1 billion of savings.
Mr. ALEXANDER. The Senator is correct.
Mr. GREGG. The Senator had a further question about whether the floor
could be yielded. We are in the process of seeking a unanimous consent
agreement.
Mr. BAUCUS. I was going to ask the Senator from Tennessee a question.
Mr. ALEXANDER. I will be glad to have a question.
Mr. BAUCUS. Is it not true that the Congressional Budget Office
stated in a letter, dated March 20, commented on the bill in a letter
to the Speaker on page 13, where it states: The title as a whole--that
is referring to the education title--states that the title as a whole
would reduce budget deficits in both the 10-year projection period and
in subsequent years.
Is it not true that the Congressional Budget Office reached that
conclusion and so states in their letter of March 20?
Mr. ALEXANDER. Mr. President, I do not have that letter in front of
me, and I do not know what that has to do with my amendment.
What I am saying is, the Democratic majority is deliberately
overcharging 19 million students to help pay for the health care bill.
Those are the Congressional Budget Office's figures, not mine.
I would ask, through the Chair, to the Senator from New Hampshire,
whether I should at this point yield the floor.
Mr. GREGG. I appreciate the Senator from Tennessee's courtesy. At
this time, we are ready to go forward with a unanimous consent request.
Mr. ALEXANDER. I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Montana is
recognized.
Mr. BAUCUS. Mr. President, I will propose a unanimous consent.
Following that, I will state my intention on the order of votes, which
I have yet to clear with the leader's office.
I ask unanimous consent that the total time on the bill be divided
equally between the majority and minority leaders or their designees
and that the offering of amendments not add additional claims to the
time.
The ACTING PRESIDENT pro tempore. Is there objection?
Mr. GREGG. Reserving the right to object, I would simply note that
the next amendment on our side would be offered by Senator Hatch.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
Mr. GREGG. Mr. President, I would ask further unanimous consent----
Mr. BAUCUS. Mr. President, I wish to finish up that business. It is
something, I think, the Senator will appreciate.
It is my intention--I am not asking for a unanimous consent
agreement, but it is my intention that the order of amendments would
be, beginning with the Gregg amendment, Medicare; McCain, target
provisions; then the Crapo amendment on taxes; then the Enzi motion to
commit, regarding employer mandates; the Barrasso amendment regarding
premiums; and then,

[[Page S1930]]

next, the Grassley amendment regarding executive personnel should be in
the exchange.
Mr. GREGG. As I understand what the Senator is asking, is that the
voting order be in the order they were offered.
Mr. BAUCUS. That is correct. I am not asking consent. That is my
intention, but there is no unanimous consent request at this time.
Mr. President, I yield 10 minutes to the Senator from----
Mr. GREGG. May I make a point? Mr. President, I spoke
inappropriately. I believe the Senator from Tennessee will want to
submit his amendment back for the Record. He had withdrawn it. Can we
do that?
I ask unanimous consent that the pending amendment be the Senator
from Tennessee's amendment.
The ACTING PRESIDENT pro tempore. Is there objection?
Mr. BAUCUS. Reserving the right to object, I might ask if the
understanding be that the motion, as on the earlier amendments, that
this motion be set aside until a time to be determined by the leaders.
Mr. GREGG. Why don't we do that on every amendment we offer so we do
not have to do that.
Mr. BAUCUS. That would be fine.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered. The Alexander motion is pending.
Mr. BAUCUS. Mr. President, I yield 15 minutes to the Senator from
Michigan, under the motion.
The ACTING PRESIDENT pro tempore. The Senator from Michigan.
Mr. LEVIN. Mr. President, the debate which will come to a close this
week has, in one sense, been going on for a year. But in another sense,
it has been going on for a century.
In 1912, Theodore Roosevelt campaigned on the promise of a national
health insurance program. Workers, Roosevelt said, are entitled to a
basic standard of protection from injury and illness.

Wherever such standards are not met by given
establishments, by given industries, are unprovided for by a
Legislature, or are balked by unenlightened courts, the
workers are in jeopardy, the progressive employer is
penalized, and the community pays a heavy cost in lessened
efficiency and in misery.

Well, since Teddy Roosevelt said that, Presidents and Members of
Congress from both parties, seeing the same costs Theodore Roosevelt
saw in the failure to assure health care for all, have grappled with
this issue.
These attempts at reform have largely fallen short. They have
foundered for many reasons: Health care is personal and complex. The
timing was wrong or the politics were difficult. Leaders on all sides
failed to find the compromises that would have enabled them to move
forward. But the recurring theme is that time and again, reformers have
failed to overcome the enormous obstacles that those who profit from
the status quo have been able to erect. Because we have fallen short in
the past, Americans today face a health care system that costs too much
and too often delivers too little.
In our United States today, mothers and fathers wonder what else they
can cut from the family budget to afford yet another increase in their
health care premiums. Parents file for bankruptcy because their
insurance fell thousands of dollars short in providing for a child's
lifesaving treatment. Nearly two-thirds of bankruptcies in this country
involve medical costs, and more than half of those involve people who
had insurance.
Small business owners eliminate health coverage for employees because
they cannot afford another year of massive premium increases. Thousands
of Americans who woke this morning with health care insurance will go
to bed tonight without it.
Despite those tragic facts, entrenched interests have sought again to
prevent reform to consign our Nation to an unsustainable status quo
because what is good for the American people will not necessarily
profit some company.
The health insurance industry has dominated health care decisions in
this country for too long. How often have our constituents come to us
with stories of insurance companies that deny them coverage of
necessary treatment? How often have our constituents told us of
insurance companies that deny coverage because of preexisting
conditions or canceled coverage because of minor inaccuracies the
company conveniently discovered just after diagnosis of a serious and
costly illness?
It is time to end the unhealthy dominance of the health insurance
industry. So I will cast my vote again against those entrenched
interests and my vote will be for health care reform. I hope our
colleagues will do the same.
We have the opportunity to finish the task of overcoming the
entrenched opposition to do what so many Presidents and so many Members
of this body have fought for decades to accomplish.
The months of debate have been difficult. They have too often been
filled with too much heat and too little light, with exaggeration, with
half-truth, with untruth, with innuendo designed to obscure rather than
to inform.
That is no different in many ways from some previous debates on major
reforms. When Congress approved Social Security in 1935, one Republican
Senator warned that it would ``end the progress of a great country.''
When Medicare was debated in 1965, one critic charged that cooperating
with the plan would be ``complicit in evil.'' Scare tactics of the past
proved absurd, but they worked.
Now we get more scare tactics. A number of our Republican colleagues
continue to claim this is a big government takeover of health care. The
American Medical Association supports this health care plan. Surely the
American Medical Association is not a supporter of a government
takeover of health care. Then we are told this will hurt Medicare. Yet
the association that represents more seniors than any other, AARP,
endorses this health care plan.
The scare tactics are coming at it again, but there is a difference.
While scare tactics were able to derail health care reform in the past,
scare tactics are just not working this time. The American people have
expressed their disapproval of wild, inaccurate claims in many ways,
including personal conversations with most of us.
It is true that because health care is so complex, because changes
must be phased in and transition periods are often necessary, many of
the benefits of this bill will not take effect for some time. But
improvements in health care for millions of Americans will take place
almost immediately.
After President Obama signed this bill into law, small businesses
immediately got a tax cut to help defray the cost of providing
insurance to their employees. Within 3 months of the signing yesterday,
the bill will allow people with preexisting conditions to access a
special fund to help cover the gap until insurance exchanges, where
they can obtain coverage, become operational. And retiree health plans
will qualify for a reinsurance program to help lower cost. In October,
the Federal Government will begin helping States set up agencies to
help consumers choose new health plans or to challenge unfair decisions
by their current insurance plan. Eventually, those agencies will help
consumers enroll in insurance exchanges that will help millions of
people find dependable coverage that meets minimum quality standards at
a price they are more likely to afford. Within 6 months of the
President's signature yesterday, insurance reforms will begin to take
hold. New health plans will be required to let women see an OB/GYN
without seeking insurance company approval. They will be prohibited
from denying coverage to children based on preexisting conditions and
required to allow children to remain on their parents' policies until
age 26. Insurance companies will have to provide preventive care
without copays or deductibles, and they will be barred from setting
lifetime coverage limits. Those historic improvements in our health
care system will take place within the first 6 months after enactment
of this legislation.
More sweeping changes will come with full implementation of this
bill's provisions. We will protect Americans of all ages from denial of
coverage based on preexisting conditions, from annual limits on
treatment, from exorbitant out-of-pocket costs, and from confusing and
opaque language that disguises the cost or the scope of coverage. We
will even require insurers to give customers a rebate if those insurers
don't spend enough revenue on patient care. We will fill the Medicare

[[Page S1931]]

doughnut hole that hurts many seniors.
At its heart, this bill and its improvements in this reconciliation
effort aim to tackle the central problems of our health care system--
rising costs and the insecurity many Americans rightly feel about the
lack of dependability of their insurance.
The cost of health care already exceeds the ability of many American
families to pay, will price more and more families out of the system if
it continues to rise, and will present enormous problems for the
Federal budget if not contained. We can and we will make the health
insurance system work for those who already have coverage by holding
down those unsustainable increases in premiums. In ways large and
small, we attempt to tame this beast that threatens to swallow family
budgets and our Federal budget.
How are we going to do this?
I ask the Chair how many minutes I have remaining.
The ACTING PRESIDENT pro tempore. The Senator has 5\1/2\ minutes
remaining.
Mr. LEVIN. I thank the Chair.
Mr. President, even though health care experts believe these measures
are going to help lower costs for families and the government, the CBO
is not even taking into account the savings which will come into
existence by ending wasteful subsidies to insurance companies using
Medicare Advantage, by requiring Medicare Advantage to spend at least
85 percent of revenue on benefits, and by other kinds of savings. Some
of those savings cannot be figured out precisely by the Congressional
Budget Office. So they are prudent. They don't even take those savings
into account. But what they do, obviously, take into account and do
count are savings which will lead to $140 billion for the Federal
budget in the first 10 years and $1 trillion over the next decade.
Those savings are real savings. Those are savings which they can figure
out and cost.
We are going to subject investment income of the Nation's wealthiest
families with incomes over $250,000 to the Medicare tax. We are going
to impose a moderate Medicare tax increase on those who have that kind
of earned income, over $\1/4\ million.
This bill cracks down on artificial financial structures. I commend
the Finance Committee, Senator Baucus and his colleagues. They are
cracking down on artificial financial structures with no economic
substance whose only purpose is to allow their users to avoid taxes.
The Finance Committee has struggled with that issue for years. They
have been trying to do this for years. They have succeeded. We pick up
an awful lot of revenue that is owed to Uncle Sam by ending this kind
of loophole which has allowed wealthy individuals to avoid paying taxes
through the use of artificial financial structures that have no
economic substance, whose only purpose is to avoid paying income taxes.
We will take an enormous step with the passage of this reconciliation
bill, joined with the bill the President signed yesterday. Leaders of
our country--from Franklin Roosevelt to Harry Truman, Richard Nixon to
Ted Kennedy--have fought so hard for these kinds of reforms. We are
finally going to provide health insurance to millions of Americans who
do not now have it, and we are going to protect those workers who Teddy
Roosevelt warned nearly 100 years ago were in jeopardy unless every
American had health insurance.
Opponents of reform are vocal. They are strident. We are going to
hear amendment after amendment being offered in an attempt to derail
this effort. I hope our colleagues will answer history's call and make
the real and lasting changes these bills provide, which will improve
the lives of our citizens in ways we have been struggling to do in this
Senate for decades and long before many of us got here.
To those who continue to oppose reform, let me ask some questions.
Isn't it long overdue to end discrimination based on preexisting
conditions? The American people believe we should. So do I. Isn't it
long overdue to end the insurance industry practice of rescissions, the
denial of coverage to those who paid for it? The American people
believe we should, and so do I. Should we not do something about the
thousands of Americans who are forced into bankruptcy because of health
expenses even though they have insurance they thought would protect
them? The American people believe we should, and so do I. Should we not
take strong steps to rein in enormous, ever-growing health care
expenses, expenses that threaten to put health care out of reach for
more and more Americans and to bankrupt our Nation? The American people
believe we should. So do I. And should we not clear the way for 32
million Americans who do not now have health insurance to obtain it?
The American people believe we should, and so do I.
I hope we will join together this week and do what so many before us
have tried and been unable to do--to reform a system that leaves so
many of our fellow citizens in jeopardy. I urge approval of this bill,
this essential reconciliation bill, passed by the House as part of a
package of historic legislation to finish the task of bringing landmark
change to American health care.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Montana is
recognized.
Mr. BAUCUS. Mr. President, I ask unanimous consent that Senators
Warner, Begich, Burris, Tom Udall, Mark Udall, Shaheen, and Merkley be
allowed to engage in a colloquy for up to 25 minutes.
The PRESIDING OFFICER (Mr. Whitehouse). Without objection, it is so
ordered.
The Senator from Virginia is recognized.
Mr. WARNER. Mr. President, as we approach the end of this long
journey, at least the end of the first step of this long journey, I and
a number of my colleagues are going to come one more time to the floor
to engage in a conversation for a few moments about what this health
care bill will mean to our constituents and to the people of the United
States. We are going to talk about some of the causes of how we got
here and some of the consequences of what would happen if we don't act.
At the end, I will add some comments about how we make sure we
implement this bill in the appropriate fashion.
Recognizing that the hour is late and colleagues have other business,
I first ask my good friend, the Senator from Illinois, Mr. Burris, if
he would like to give a brief recap of why he has been such a firm
supporter of this legislation and why he thinks this bill is so
important, not only to the people of Illinois but to the people of the
United States.
Mr. BURRIS. Mr. President, I thank Senator Warner. I compliment him
for his leadership in getting the freshmen engaged and involved in
making sure we are getting the message out to the American people.
This piece of legislation, which was signed yesterday by President
Obama, is historic. I am proud and appreciative that I had the
opportunity to play a part. As you know, my position was for a very
strong public option. But as to the issues that are in it, we deal with
cost and accountability for the insurance companies. Therefore, it is a
major piece of legislation which we want the public to understand.
We want the public to understand that for some people this law takes
effect immediately. Small businesses benefit in that they will get a
tax credit right away. These tax credits can total as much as 35
percent of total premiums. Secondly, for children there will be no
elimination for preexisting conditions. Within the next 90 days, these
provisions will kick in on behalf of children. So there are a lot of
things in this bill that will benefit all of us.
We have been trying to do this for over 97 years.
I say to my colleagues on the other side, the reconciliation bill is
important to make some corrections. The battle they are waging, not
from the standpoint of policy but certainly from the standpoint of
politics, seeking to make a failure out of this issue, is not really
fair to the American people. The misinformation that has been going out
about this legislation is not fair.
Not only are we going to see immediate benefits, but the long-term
benefits of this legislation are also helpful. Situations dealing with
preexisting conditions--in 2014, that will kick in. I remember when my
daughter was changing jobs, she needed to get insurance because she had
a headache problem. They wouldn't insure her. I had to

[[Page S1932]]

battle to get insurance for my daughter.
This is good legislation. It is history. I want the American people
to know that it is on the books, and we are going to make necessary
corrections. The people will go forward.
I thank my colleague from Virginia.
Mr. WARNER. I thank Senator Burris for his comments. I know how hard
he fought for this legislation, since day one.
This legislation is going to have wide-ranging effects for people
from all across the Nation.
I now know my colleague, the Senator from North Carolina, wishes to
speak. North Carolina and Virginia are neighbors. We both share a
number of small businesses. We have a vibrant entrepreneurial flavor in
Virginia and North Carolina. I know Senator Hagan has been concerned
not only on the overall aspects of health care but particularly how
this health care bill is going to affect small business in her State.
I wish to now ask Senator Hagan to tell us how this bill will affect
people in North Carolina.
Mrs. HAGAN. I thank Senator Warner. I too appreciate the time for us
to come down here and talk about the need for health care reform. The
bill that was signed into law yesterday is getting us on that track.
The new and historic law, combined with the bill we are now
considering in the Senate, is going to reform our health care system to
reduce costs and improve patient care for those families in North
Carolina and in Virginia and families across America.
In 1996, the average premium in North Carolina for a family of four
was $6,000. Today it is $12,000. It is projected, in 2016, to be
24,000. People cannot afford that. That is why we need to have change.
After decades of working to fix a broken health care system, this law
controls exploding costs, increases access to health care, and reduces
our long-term deficit, which I know we are very concerned about, by as
much as $1.2 trillion over the next 20 years.
But in addition to containing costs, health care reform will improve
access and quality of health care for millions of Americans. Right now,
in North Carolina, we have 1.7 million people without insurance. They
will now have access to a family doctor.
This bill provides immediate benefits to small businesses, middle-
class families, and seniors in North Carolina. The small business
owners whom I talk to want to provide coverage for their employees, but
the costs are prohibitive.
This month, I received an e-mail from a small chiropractic practice
in eastern North Carolina that had to drop its health plan for its
employees because the rates doubled over the last 2 years. But starting
today, 112,000 North Carolinian small businesses will be eligible for
tax credits to provide health care to their employees.
Within the next 6 months, hard-working, middle-class families will be
able to add their children up to the age of 26 on their health care
plans. This will benefit about 870,000 young adults in my State.
This year, insurance companies will no longer be able to deny
coverage to a child for a preexisting condition, such as asthma or
diabetes. And it means insurance companies will no longer be able to
drop your coverage because you get sick or because you file too many
claims.
In North Carolina, 1.4 million seniors will receive preventive
services with no additional costs, and 250,000 seniors will have their
drug costs in the doughnut hole immediately reduced and eventually
eliminated.
I am proud of these immediate benefits and our efforts to reform the
health care system over the long term. The health care reform effort
would not have been possible without the work of tenacious Capitol Hill
staffers. I personally want to thank two incredible health care
staffers on my team, Michelle Adams and Tracy Zvenyach, who worked
countless hours for reform in our country.
Mr. WARNER. I thank Senator Hagan. I appreciate her leadership on
this issue. Again, I also appreciate her recognition of not only the
Members who have been struggling with the bill for almost a year, but
the staff members who help us put together the facts, put together the
case studies, who help us crunch the numbers, as we try to make sure we
get this right.
I now want to call on my friend, the Senator from Alaska. One of the
things the freshmen have always said, as we have come to the floor over
these months--as we have pointed out--is that the price of doing
nothing is extraordinarily high to our economy, to our families, to our
businesses, and that the status quo is not sustainable.
I know this has been a theme Senator Begich has echoed repeatedly on
the floor. As we come to the closing hours of this debate, if you could
share with us one more time why you think the status quo is
unacceptable. What is the price of doing nothing? How would that affect
the people and businesses in the great State of Alaska?
Senator Begich.
Mr. BEGICH. I thank the Senator. Thank you again for your leadership,
and especially as the freshmen group worked on the cost containment
piece of this legislation. That was an important part we will see for
many years to come.
Over the next few days we are focusing on making a good bill a little
bit better. Yesterday, the President signed the landmark legislation
moving health care reform into law. So over the next few days, again,
we are going to work on making that bill a little bit better. You are
going to see clearly the differences. You are going to see our side of
the equation has worked hard on this legislation. Those who voted for
health care reform are on the side of American families, not on the
side of the insurance industry. We are on the side of seniors who will
see lower prescription drug costs--because reform is going to work in
that direction--not on the side of big drug companies. We are on the
side of American small business--not business as usual.
I was truly proud to vote for and help pass that legislation last
December. But as mentioned already this morning, there are many
benefits that occur right now, this year. This year, for example, there
is help for small businesses. As you just heard, immediately, firms
with fewer than 10 workers get a tax credit worth 35 percent of what
they will spend now on health insurance. It will eventually ramp up to
a 50-percent tax credit, and firms with up to 25 workers will get a
partial credit. For small businesses--truly the backbone of the Alaska
business community and this country's business community--that is an
immediate benefit.
Coverage for preexisting conditions: Within 3 months, people with
preexisting conditions and no insurance will get help. A $5 billion
fund is being set up to provide them with affordable coverage.
Coverage for dependent children: Within 6 months, parents will be
able to extend their policies to cover their dependent children up to
the age of 26.
Some of these points you have already heard, as I said, this morning,
but it is important to repeat them because I think in the noise over
the last year and a half a lot of it got lost.
Another--a very important one--free preventive care: Within 6 months,
all insurance plans must provide free checkups. This includes seniors
on Medicare. And there is much, much more when you look at this
legislation.
For my own State, the bill addresses many specific concerns I have
heard in Alaska. It includes several of my amendments, including a
panel to improve Federal health care in Alaska, increased loan
forgiveness for thousands of new primary care providers, and added
funding for community hospitals.
We also, as a team of freshmen, wrote a cost containment amendment
that cuts prices for consumers, increases value and innovation in the
health care system and, as mentioned earlier--let's not forget--it is a
deficit reducer: in the first 10 years, $143 billion, and in the next
10 years, $1.3 trillion in deficit reduction.
This bill is paid for--paid for. These are many of the improvements.
Again, these improvements will save lives; add 32 million people, those
uninsured--making sure they have coverage--save seniors on prescription
drug costs by closing the doughnut hole; save families, by providing
tax relief to help them afford health care; and crack down on waste and
fraud.
It has been an enormous time in this last year and a half working on
this. But I also want to say, the next 3 days

[[Page S1933]]

will also be tedious and confusing to the public because what you will
see on the other side is every imaginable amendment we would love to
see--many of them we probably would love to vote for. I am not voting
for any of them because the whole tactic is to delay the delivery, to
ensure that people who want a family doctor will not get one, to
protect the insurance companies instead of what we are trying to do to
make sure people get a fair shake from their companies. So you are
going to see that over the next 3 days.
I think what is important for us is to remind Americans--Alaskans in
my State--why this bill is important. It helps small business,
families, seniors. It does it now. It is important. It is important for
us to get it done. But do not be fooled by the next 3 days on what goes
on this floor.
We have passed health care reform. All we are doing now is making a
good bill better.
I thank the Senator from Virginia.
Mr. WARNER. I thank the Senator. Thank you for your comments. Thank
you for your leadership, particularly on a series of freshmen
amendments that dealt with cost containment. And if time exists after
my colleagues speak, I am going to go back to that issue.
But I now want to ask my good friend from Oregon a question. No one
has come to this body with more passion about making sure working
families get a fair break, not only in health care but in the world of
financial reform and issues that cut across the spectrum. I know one of
the issues Senator Merkley has worked on tirelessly throughout this
whole conversation is how to make sure the Oregon families get that
fair break, get that fair shot, how to make sure health care is
affordable.
I would like you to share with our colleagues and those Americans who
are at home watching what this health care bill does to help those
middle-class Americans, middle-class Oregonians to make sure they get
that fair shot, fair break in health care reform.
Senator Merkley.
Mr. MERKLEY. I thank the Senator so much. It is a pleasure to come
here with my colleagues on the floor.
I know when all of my colleagues go home, they hear stories from
their constituents about our broken health care system. That certainly
is what I hear. I hear it in my townhalls. I hear it on the street, as
people stop me and share their story. And I certainly hear it in my
mail.
I have in my hand a few of the stories citizens in Oregon have sent
to me. To give you a sense of the type of frustration we are hearing,
Don writes:

Last year my premium went up 65 percent even though I've
made no significant claims against my policy.

Or we can turn to Jane, who says:

. . . we are subject to being turned down for health
insurance [because] I have a chronic illness. . . .

Or we can turn to Adrienne, who observes:

The medical debt was crushing, and we were forced to file
for bankruptcy.

Or we can turn to Amanda, who says:

My daughter cut her finger. I took her to emergency, the
hospital is a network provider. The ER Physician said she
needed surgery. Okay, what do I know, they are the experts.
It turns out that the Surgeon is not a network provider. She
bills [me] over $9,000.00. . . .
. . . I have little hope. Do I file [for] bankruptcy?

Or we can turn to Art, who says:

In less than 5 years, I had to change my health insurance 5
times. It was never a matter of choice; I simply had to take
whatever plan my employer decided to offer.

Or Dagne, who observes: When I started to fill out my insurance form,
I had ``Questions such as `Have you ever had . . . ' ''--for instance,
I had asthma.
And he goes on to describe his challenges. And the list goes on and
on and on. That is why we are in this health care dialog. Because we
need to fix our health care system that is broken for working
Americans.
The bill we have passed and the President has signed has three
terrific provisions. It creates State-based markets for health care
policies, where consumers can shop for the best policy. These markets
will increase choice and competition. Second, the bill ends insurance
company practices that victimize our working families--practices such
as turning people down for preexisting conditions or dumping them off
of their policies when they are injured or when they have a disease.
And, third, it invests in our provider workforce to counter the rapid
retirement of baby boomers. Out in Oregon, we are going to lose 20
percent of our primary care physicians in the next 5 years, while many
of us, as baby boomers ourselves, are going to need more health care.
So those things are huge challenges. This bill takes a stride that is
very significant, and this week we will work to pass--with an up-or-
down vote--a bill that will make further improvements to the bill the
President signed yesterday.
I am pleased to join my colleagues in this fight to repair a broken
health care system that is not working for our working citizens.
Thank you.
Mr. WARNER. I thank Senator Merkley. Thank you for sharing those
stories from real folks who are dealing with the current broken health
care system. There are enormous stress, challenges, and burdens that
our current system places on those families. I think we are taking a
giant step forward. The President already has by signing into law the
bill yesterday. We will continue that step with passing this
reconciliation bill later this week.
I now wish to call on another one of my colleagues, Senator Tom Udall
of New Mexico. Senator Udall has, again, along with all the other
freshmen colleagues, been a leader in this fight. He has particularly
taken on the issue of prevention and the fact that we have a health
care system in this country that is more a sick care system than it is
a wellness and prevention system. I want to hear from Senator Udall
about how the bill is going to affect the good folks of New Mexico.
Senator Udall.
Mr. UDALL of New Mexico. Mr. President, I thank Senator Warner for
leading us and pulling us together in this freshman effort. It has been
a pleasure to work with all of my fellow freshman Senators on the floor
again and to join them right now. Last fall, we gathered right here in
this Chamber to fight for health care reform. As a group, we helped
lead the charge to make quality, affordable health care accessible to
all Americans. Yesterday, the change we have been fighting for became a
reality. With President Obama's signature, health care reform is now
the law of the land.
This moment has been a long time coming. Teddy Roosevelt first called
for health care reform nearly a century ago. His banner was taken up by
a long and distinguished list of men and women who advocated for
change. For too many years, New Mexicans, like Americans across the
country, have struggled to find or afford health insurance. They have
struggled to hang on to policies that get more and more expensive and
more and more restrictive every day. With this reform, all of that
begins to change.
No longer will insurance companies be able to discriminate based on
preexisting conditions. No longer will they be able to dramatically
increase rates without public scrutiny. No longer will 32 million
Americans worry every day about what would happen to their families if
they get sick or are in an accident. I am proud to have fought for and
voted in favor of this historic legislation.
This reform will benefit all Americans, including our country's First
Americans, the 1.9 million American Indian and Alaska Natives who have
spent too many years suffering because the federal government hasn't
lived up to its promise to them.
With this reform, we begin meeting our obligations to Native
Americans by reforming the Indian health care system and permanently
reauthorizing the Indian Health Care Improvement Act. This law, which
provides a framework under which health care programs for Native
Americans are delivered, hasn't been reauthorized in more than 10
years. As a result, American Indian and Alaska Natives are three times
as likely as whites to be uninsured, and almost half of low-income
American Indians and Alaska Natives lack health coverage.
With this reform, no longer will Native Americans be forced to suffer
needlessly. No longer will they have to go without treatment for
chronic conditions like diabetes and heart disease.

[[Page S1934]]

No longer will they have to put off basic care like colonoscopies or
cholesterol screenings.
I say again, today is a new day for health care in America. I am
proud to have fought for, and voted in favor of, this historic
legislation.
Yesterday, we began taking back control of our own health care.
Today, the journey continues. I pledge to continue fighting every day
to ensure New Mexican families and small businesses have the security
and stability that comes with access to quality, affordable health
care.
The reason I have fought so hard for reform is simple. For my
constituents, the status quo is not an option. So it is the people of
New Mexico I wish to talk about today. They are the reason I stand up
every day and fight for comprehensive reform.
People such as Katheryn Whitesides--Katheryn lives in Clayton, NM. We
met last year when she attended one of my health care townhalls.
Katheryn worked hard all her life. She had affordable insurance through
her employer. But since she retired, Katheryn's health insurance
premiums have risen dramatically from $110 a month when she was
working, to more than $800 a month today. Katheryn's insurer recently
denied a claim for a treatment she received. Now, on top of
skyrocketing monthly premiums, she also owes about $4,000 in medical
bills. That is more money than she receives from 5 months of pension
payments.
As Katheryn herself said:

It's unsustainable for me. And I know I'm not the only one.
I'm just looking for some relief--not just for me, but for
all those people coming behind me.

To folks such as Katheryn, I say: Relief is coming. This reform will
make health insurance more affordable by placing caps on out-of-pocket
medical expenses. It will make it more affordable by providing premium
assistance through tax credits for low- and moderate-income families.
I am fighting for New Mexicans such as Katheryn, and I am also
fighting for New Mexico's small business and for entrepreneurs such as
Arvind Raichur. Arvind has owned a small business in Albuquerque for
more than a decade. As the boss, he has made it a priority to provide
his employees with good benefits. For years, he paid 100 percent of his
employees' health care premiums, but he is not sure how much longer he
will be able to do that and stay afloat. You see, for the past few
years, Arvind's insurer has increased his company's health care
premiums by between 30 and 40 percent every year, and there is nothing
Arvind can do about it.
As Arvind said:

We've got no bargaining power. We've got no leverage. I'm
insuring maybe a dozen people at my company here. It's very
hard. The insurance companies give you a 30 or 40
percent increase and that's what you get. . . . It's too big
a bite.

To small business owners such as Arvind and their employees, I say:
Relief is coming.
This reform will help small businesses by making it more affordable
for them to offer coverage for their employees. We do this by providing
tax credits for up to 50 percent of premiums and by creating small
business health exchanges to build a larger employee pool.
In New Mexico, the vast majority of our insured are employed, but
they and their employers can't afford coverage. These new tax credits
will help our small businesses provide insurance for their employees at
a cost they can afford.
For hardworking New Mexicans like Katheryn and for small business
owners like Arvind, health care reform can't come fast enough. Katheryn
and Arvind can't afford the health care status quo. Katheryn and Arvind
are the reason I stand here today. To my friends on both sides of the
aisle I say: Let's get this done.
I am proud to be part of this body as we cast our final votes in
favor of this landmark reform. With this final vote, we will finish
this leg of the race. I look forward to building on this solid
foundation in the coming months and years.
I yield the floor.
Mr. WARNER. I thank Senator Udall. I know our time is running out;
just a final comment I wish to make.
As many of my colleagues know, I had the honor of serving as Governor
of Virginia before becoming a Senator. I think one of the differences
between an executive and a legislator is, as a former executive I
realize that passing the bill is just the first step. What happens is
going to be in the implementation afterwards.
The appeal I would make, particularly to my colleagues on the other
side, is, I agree with some of their points that we don't go far enough
on cost containment, but there are a lot of things in this bill where
we grant the Secretary the ability to start experimental programs--on
cost containment, on bundling of payments. How this bill is implemented
is going to be where the rubber hits the road. I, for one, believe
there is more we can do around this issue of cost containment, and I
hope in the coming weeks and months, rather than being for repeal, they
would join with us in finding that common ground to make this
legislation even better.
I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I wish to let Senators know that we intend
to alternate blocks of time, roughly a half hour on each side. So I ask
unanimous consent that the next half hour be under the control of the
Republicans and the half hour thereafter be under the control of the
majority.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The Senator from Florida.

Amendment No. 3586

Mr. LeMIEUX. Mr. President, I ask unanimous consent to temporarily
set aside the pending motions and amendments so that I may offer an
amendment which is at the desk.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The clerk will report the amendment.
The legislative clerk read as follows:

The Senator from Florida [Mr. LeMieux] proposes an
amendment numbered 3586.

Mr. LeMIEUX. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To enroll Members of Congress in the Medicaid program)

At the end of subtitle C of title I, add the following:

SEC. 1207. MEMBERS OF CONGRESS REQUIRED TO HAVE COVERAGE
UNDER MEDICAID INSTEAD OF THROUGH FEHBP.

(a) In General.--Notwithstanding chapter 89 of title 5,
United States Code, title XIX of the Social Security Act, or
any provision of this Act, effective on the date of enactment
of this Act--
(1) each Member of Congress shall be eligible for medical
assistance under the Medicaid plan of the State in which the
Member resides; and
(2) any employer contribution under chapter 89 of title 5
of such Code on behalf of the Member may be paid only to the
State agency responsible for administering the Medicaid plan
in which the Member enrolls and not to the offeror of a plan
offered through the Federal employees health benefit program
under such chapter.
(b) Payments by Federal Government.--The Secretary of
Health and Human Services, in consultation with the Director
of the Office of Personnel Management, shall establish
procedures under which the employer contributions that would
otherwise be made on behalf of a Member of Congress if the
Member were enrolled in a plan offered through the Federal
employees health benefit program may be made directly to the
State agencies described in subsection (a).
(c) Ineligible for FEHBP.--Effective on the date of
enactment of this Act, no Member of Congress shall be
eligible to obtain health insurance coverage under the
program chapter 89 of title 5, United States Code.
(d) Definition.--In this section, the term ``Member of
Congress'' means any member of the House of Representatives
or the Senate.

Mr. LeMIEUX. Mr. President, I rise in support of the amendment I am
offering today.
I wish to thank my colleague from Virginia who asked us to think
about the practical aspects of this health care reform. I just listened
to my freshman colleagues on the Democratic side talk about all of the
good things, in their opinion, this bill is going to do. There is one
thing I didn't hear them speak about. I didn't hear them speak about
the fact that half of the new people who are going to be covered by
health care in this country--some 16 million of the 30-some million who

[[Page S1935]]

have the opportunity for health care under this law--are going into
Medicaid.
The practical impact my friend from Virginia asked us to think about
is that our States right now are finding themselves in bankruptcy,
realistically, because of the obligations of Medicaid. Our States,
unlike the Federal Government, have to balance their budgets. Medicaid
is a program that the States pay some 50 percent of, and they can't
make it work. We are finding out in Florida right now that this
program--this new law--will cost Florida $1 billion in the next 10
years. Because they balance their budget and because they can't print
money, that means the dollars will go away from teachers, away from
students, and away from police.
The point I wish to make today and the amendment I am offering is
this: Several times, as I have been on the floor and heard from my
Democratic colleagues, they have made this point: Why shouldn't the
American people have the same health care that we in the Congress
enjoy? Why shouldn't they, as do all Federal employees, be able to pick
from a comprehensive and rich plan of benefits in order to take care of
their health and the health of their families?
That is a good point, but what is going to happen to these 16 million
new Americans? They are going to go on Medicaid. That is not the plan
we have. That is not the rich benefits the Members of Congress enjoy.
Medicaid--health care for the poor, which will now have some 50 million
Americans in it after these 16 million join it--is a program in crisis.
It is a program that is failing.
Let me give my colleagues some real examples. Right now we know
patients on Medicaid can't find doctors who will treat them. We know in
California, for example, 49 percent of family physicians do not
participate in Medicaid.
I entered this document into the Record last week. On March 17 the
Seattle Times reported that Walgreens will no longer take new Medicaid
patients in the city of Seattle. On March 15, the New York Times
reported about Mrs. Vliet. She is in Flint, MI. She has cancer. For 2
years she has been receiving treatment, but now her doctor is dropping
her from Medicaid. He says:

But after a while you realize that we're really losing
money on seeing those patients, not even breaking even. We
are starting to lose more and more money, month after month.

All across America, health care providers are dumping Medicaid, and
we are about to add 16 million new people. So I wish to take a page
from my friends on the other side because they say the American people
should have the same rich benefits we have.
What I am proposing today with this amendment is that 535 Members of
Congress should have the same benefits as these 16 million new people
and these 50 million Americans. Under this amendment, the Members of
Congress will go into Medicaid. If it is good enough for 50 million
Americans, it should be good enough for us.
So I have offered amendment No. 3586. It will require that the
benefits that are paid for health care by the Federal Government for
the 535 Members of Congress go to the State Medicaid agencies, and then
we can all enjoy this program that 50 million people in America are
struggling with. If it is good enough for 50 million Americans, it is
good enough for Members of Congress.
I wish to call upon my distinguished colleague from Arizona whom I
know wishes to speak on this issue as well.
Mr. McCAIN. Mr. President, I ask unanimous consent to engage in a
colloquy with the Senator from Oklahoma, the Senator from Florida, and
myself.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCAIN. Mr. President, I strongly support the amendment. Let me
also just for a moment point out where we are.
Where are we now that all the champagne has been drunk and all the
celebration has gone on; the inside-the-beltway excitement has subsided
along with the adoring media? Here we are: We have a budget deficit
that is still $1.4 trillion. We still have 9.7 percent unemployment.
Beginning right away we have $\1/2\ trillion worth of Medicare cuts
that will take place over the next 10 years--$\1/2\ trillion beginning
right away, $\1/2\ trillion worth of tax increases over the next 10
years.
Beginning in 4 years, $2.5 trillion in new health care entitlements
spending begin. The plan still puts government in control. It still
mandates that every American must purchase a government designed and
approved health policy. It still mandates that employers have to
provide health insurance or pay a fee, and 330,000 Medicare Advantage
members in my State are going to be exposed to drastic cuts.
Fortunately, we took out one of the sweetheart deals so that now, at
least the 800,000 who were carved out before in Florida will be subject
to the same cuts. No one, no one, no one believes--the so-called doc
fix--that the 21-percent cut in physicians payments for treatment of
Medicare patients is going to happen.
You can put lipstick on a pig, but this is still a pig. I noticed the
Senator from Illinois came to the floor this morning and said how great
this is and how there is going to be real reductions in the deficit as
a result of this legislation. I wonder what his response has been to
one of the biggest corporations in the State of Illinois, Caterpillar,
who sent him a letter saying:

In our fragile economy, we can ill afford increases that
place us at a disadvantage versus global competitors that are
not similarly burdened.

They state:

Elements of the legislation would drive up Caterpillar's
health care costs by more than 20 percent, over $100 million.

The Senator from Illinois is sponsoring legislation that increases
costs for one of the largest manufacturers and exporters in America
that is going to increase their cost by $100 million. I wonder when he
is going to go out and visit headquarters out there in Peoria. I hope
it is soon.
The fact is, there are things in this legislation that are wrong, and
there are things that are left out of this legislation that are wrong,
including $100 billion a year that could be saved by medical
malpractice reform. Is there anything in those 2,073 pages that have
anything to do with medical malpractice reform? That is the dirty
little secret. The dirty little secret in this body is that trial
lawyers control the agenda, certainly as far as this legislation is
concerned.
The State of Texas has reduced costs, has reduced premiums, and has
increased the number of people who have been able to--lawsuit filings
are down from defensive medicine increases for annual costs by 10
percent. Physician recruitment is up. The largest malpractice insurance
company in the State has sliced its premiums by 35 percent, saving
doctors some $217 million over 4 years in the State of Texas. And I
would like to ask my friend from Oklahoma why in the world we would not
enact medical malpractice reform if we are truly interested in reducing
the cost of health care in America.

The Senator from Oklahoma and our other doctor in the Senate, Senator
Barrasso from Wyoming, can testify because of their experience of the
requirement to practice defensive medicine, which could be as much as
$100 billion a year. So here we are, looking at dramatic increases in
cost, and the President is going around the country saying that
insurance premiums will go down. Individual premiums will go up between
10 and 13 percent. You know, facts are stubborn things.
So I would ask my friend from Oklahoma if he might talk a little bit
about not only what is in this bill but what is not in this bill, and
medical malpractice reform is certainly something that anyone would
logically assume would be part of any real reform if you are interested
in reducing cost.
If you are interested in increasing government bureaucracy, I hear
this bill could mean the employment or hiring of some 16,500 new IRS
agents. We are trying to track down the facts behind that. So we are
now embarked on one of the greatest expansions of government in the
history of this country.
Mr. COBURN. I thank the Senator for his question. If you look at
Thomson Reuters and several others who have studied the health care
field, the estimate for defensive medicine costs is $250 billion a
year. It is not just that we order tests that protect us from frivolous
lawsuits, but those tests have consequences. Some of those tests
actually hurt patients or expose them to radiation or, in fact, limit
our ability

[[Page S1936]]

to do what is best for the patient because we are more interested in
protecting ourselves.
Mr. McCAIN. May I ask the opinion of the Senator from Oklahoma as to
why he thinks there is no address of medical malpractice reform
whatsoever in this legislation that has the slightest impact on
reducing health care costs?
Mr. COBURN. I think there are two reasons. One is because there is
large support of those who wrote this legislation by those who benefit
from suing doctors. That is pretty straightforward. And the doctor's
only defense is to order tests which they need but which the patient
doesn't necessarily need. The second is because they couldn't get--or
wouldn't put it in the bill because they knew it would pass and the
American people would agree with it. You know, it is beyond me.
But let me go to the point of this current amendment. I have
delivered somewhere over 4,000 babies, and 2,000 of those were Medicaid
babies. Over half the babies I have delivered in my life I have cared
for through Medicaid. The State of Oklahoma just cut, in February or
March, Medicaid reimbursements 3 percent. They are going to cut it
another 8 percent. Forty percent of the primary care doctors don't see
Medicaid patients because the price that is paid for the coverage
doesn't cover the cost, let alone any margin. It doesn't cover the cost
of nurses, the rent, the malpractice, and everything else.
The second point is, of the specialists who are available, 65 percent
of the specialists in this country won't see Medicaid patients. So when
I am taking care of Medicaid patients, I have trouble finding somebody
better than me in a specialized area to care for my patients.
What is the other thing we know about Medicaid? Even if you normalize
for social factors, their outcomes are worse. The cost in terms of the
number of procedures, the failure of therapeutics--all are worse.
So why is this a good idea? It is not just a political stunt. If
Members of Congress are enrolled in Medicaid, the first thing that is
going to happen is Medicaid and reimbursements are going to go up so
that the availability of the finest and the best and the brightest in
this country is available to Members of Congress. So it is not just a
stunt to say we put our membership in Medicaid; it is a very important
ulterior motive to improve Medicaid.
Think about it. If you are one of the 16 million people who are going
to get health care under Medicaid, supposedly, in this bill--and I
doubt that seriously, simply because we are going to see a marked
decrease of 50 or 60 percent of doctors who won't see them--think about
what is going to happen: You are not going to be able to find a doctor.
You may have coverage, but you won't be able to get anybody to care for
you. Is that coverage? Is that care? Is that prevention? Is that
management of chronic disease? No. None of that will happen.
So the whole idea of placing us in a leadership position into
Medicaid is so that we will lead and fix it and make it what it should
be. There is only one health care system worse in America than
Medicaid, and that is the Indian Health Service. That is the only one
that is worse. Everything else outside of those two programs is better.
So why would we consign 16 million Americans to a health care program
that is failing today? So the way to fix that is to put us into it. And
I guarantee you, the self-interests of the Members of Congress will fix
Medicaid and make it what it should be.
With that, I yield back to the original author of the amendment.
Mr. LeMIEUX. I thank my friend and colleague from Oklahoma.
How could anyone in this body not vote for this amendment? Why should
we have better health care than the 16 million people whom we are going
to put into Medicaid, and now will be 50 million Americans? Why should
we have it better? Why should we have a gold-plated premium health care
plan?
Look, I have a family of five. We are going to have a baby any day--
could be today--so it will be a family of six. I pay $400 a month on
the government program--$5,000 a year. Could I get that in the
marketplace? Of course I couldn't. There is a doctor here in the
Capitol, a whole staff of them, anytime I want to see a doctor. I get
fantastic health care as a Member of Congress.
Why shouldn't we have the same health care we are subjecting 15
million new Americans to and 50 million Americans in total? As my
friend from Oklahoma says, certainly won't that make the point to us
that this health care system is failing? What will happen when a Member
of Congress tries to find a doctor and can't find a doctor who will
take him? What is going to happen when he tries to find a specialist
and no specialist will take him? You don't hear our friends on the
other side talking about the fact that half of the people getting
coverage under this legislation are going into a failing system. That
is not one of their talking points, but it is the truth. So I challenge
my friends who say that they should walk among the least of us to vote
for this amendment.
I want to turn again to my colleague from Arizona. He and I have
expressed our distress about this bill for lots of reasons, but a
specific reason is that we both represent States with lots of seniors.
We have this Medicare Advantage Program that is going to get $200
billion cut out of it. That will really affect our two States. So I
wonder--and I would ask my colleague, the distinguished Senator from
Arizona, to speak on this issue--how is this going to affect seniors in
Arizona when we are raiding Medicare to start this new program?
Mr. McCAIN. I thank my friend from Florida. The fact is, Medicare
Advantage is a program that provides seniors with choices. That is one
of the reasons it is a major target of the other side--because it
doesn't fit in, then, with the government mandates this whole bill
embodies. So I am worried about the 11 million Americans who have the
Medicare Advantage Program.
I would like to refer my colleagues to an article--I know the Senator
from Utah is waiting, if he would just give me another minute or so
here--today in the Wall Street Journal titled ``Now, Can We Have
Health-Care Reform?'' And I want to quote from part of it, as follows:

Health insurers, and indeed Corporate America as a whole,
are like monkeys who are caught by staking a glass jar to the
ground with a shiny trinket inside. They won't let go so they
can't get their hands out of the jar. That trinket is the
ruinous and regressive $250 billion-a-year tax benefit for
employer-provided insurance.

That is the elephant in the room, my friends.

Corporate America isn't brave enough to argue against a
direct subsidy to its employment costs, no matter how
perverse its impact in insulating consumers from the true
cost of their health care choices. Insurers are not brave
enough to say: Give us a tax code that lets us go back to
being insurers rather than a tax laundromat for the middle
class's health care spending.
Almost any bill would have been worth having that
fundamentally fixed this tax distortion, regardless of its
other elements.
We say this because any bill, including the one signed by
the President yesterday, will be revisited many times in the
future. Millions of pages of rules will be written by
regulators before we see how it really works. Congress itself
will return in predictable ways: It will reverse the proposed
Medicare cuts that created ObamaCare's illusion of fiscal
probity. It will tighten the mandate that requires insurers
to cover the sick at favorable prices. It will not tighten
the requirement that the young and healthy buy insurance at
prices that subsidize the old and unhealthy.
More and more tax money will have to be found to keep the
jalopy on the road. More and more administrative controls on
medicine will attempt vainly to keep the jalopy from
bankrupting the Nation.
Under the law just signed, employers have even more
incentive than they did yesterday to lavish excessive health
insurance on their high-end employees.

Mr. President, I ask unanimous consent to have printed in the Record
this entire Wall Street Journal article.
There being no objection, the material was ordered to be printed in
the Record, as follows:

[From the Wall Street Journal, Mar. 24, 2010]

Now, Can We Have Health-Care Reform?

(By Holman W. Jenkins, Jr.)

A certain kind of person--we get emails from them all the
time--understands exactly nothing about the health-care
debate, but thinks they know who the villain is: the
insurance industry.
Barack Obama is not one of them. In the desperate hours he
played to public ignorance. But from the beginning, the
industry was his ally because he set out to solve its

[[Page S1937]]

biggest problem--which is not the same as America's biggest
problem.
We'll let Angela Braly, CEO of insurer WellPoint, take the
story from here. She was recently hauled before Congress to
justify her company's proposed 39% rate hike in California.
She explained the source was two-fold: rising medical costs
and healthier customers dropping their coverage, forcing the
sick to pick up the tab.
Now this sounds like two problems, but for WellPoint and
other insurers it's really only one problem. Once everyone is
required by government mandate to buy insurance, the
industry's survival is no longer threatened: It can just pass
its skyrocketing costs along to customers. Once customers can
no longer refuse to buy the industry's product, the problem
of costs won't be fixed, but it no longer is the insurance
industry's problem.
There, in that one sentence, we give you the failure of
ObamaCare, the failure of the congressional health-care
debate, the failure of health-care politics in this country.
Health insurers, and indeed Corporate America as a whole,
are like monkeys who are caught by staking a glass jar to the
ground with a shiny trinket inside. They won't let go so they
can't get their hands out of the jar. That trinket is the
ruinous and regressive $250 billion-a-year tax benefit for
employer-provided insurance.
Corporate America isn't brave enough to argue against a
direct subsidy to its employment costs, no matter how
perverse its impact in insulating consumers from the true
cost of their health care choices. Insurers are not brave
enough to say: Give us a tax code that lets us go back to
being insurers rather than a tax laundromat for the middle
class's health-care spending.
Almost any bill would have been worth having that
fundamentally fixed this tax distortion, regardless of its
other elements.
We say this because any bill, including the one signed by
the president yesterday, will be revisited many times in the
future. Millions of pages of rules will be written by
regulators before we see how it really works. Congress itself
will return in predictable ways: It will reverse the proposed
Medicare cuts that created ObamaCare's illusion of fiscal
probity. It will tighten the mandate that requires insurers
to cover the sick at favorable prices. It will not tighten
the requirement that the young and healthy buy insurance at
prices that subsidize the old and unhealthy.
More and more tax money will have to be found to keep the
jalopy on the road. More and more administrative controls on
medicine will attempt vainly to keep the jalopy from
bankrupting the nation.
Under the law just signed, employers have even more
incentive than they did yesterday to lavish excessive health
insurance on their high-end employees. They have less
incentive to cover low-end workers, or even hire them.
For the young, healthy or anyone not stumbling into a giant
tax handout, buying insurance at the inflated prices
available in the marketplace would be an even crazier
financial decision today than it was yesterday--because now
you can wait and buy it when you're sick.
For insurers, the check is in the mail: So watered down is
the individual mandate that it must accelerate the industry's
death spiral if not for the massive subsidies the government
now has obliged itself to provide to keep the industry afloat
and allow insurers to continue scalping their 15% off the top
for serving as gatekeeper to a tax loophole.
When all is said and done, with unerring accuracy,
ObamaCare has ended up doubling down on the system's existing
perversities. The one thing it doesn't do (though it would be
perfectly consistent with the Democratic goal of universal
access) is incentivize a health-care marketplace based on
competition in price and quality.
A world-class hospital in India does heart surgery the
equal of any heart surgery in America, but does so at one-
tenth the cost (and increasingly attracts a world-wide
clientele). The reason is not what you think: low-paid
doctors and nurses. The reason is that competition works in
medicine as it does in everything else when the patient cares
about getting value for money. This is the great low-hanging
fruit of health-care reform. It continues to hang.

Mr. McCAIN. Mr. President, I thank my friend from Utah for his
indulgence.
The other side is going around the country right now telling the
American people things that simply are not correct, including the fact
that these budget projections we know are patently false, not because
CBO gave us false numbers but because the assumptions were wrong. One
of the biggest assumptions--and we will be talking about this more--is
the so-called doc fix. Is there anyone who believes we are going to
have a 21-percent cut in Medicare physician payments this fall?
I would ask my friend, the Senator from Utah, who is very familiar
with this issue--I know he has an amendment, but this is one of the
reasons Americans are so angry. They know they are not going to cut
doctors' payments from Medicare by 21 percent, and that is a
fundamental part of the assessments as to the cost by CBO. It is a sham
perpetrated on the American people.
So I would say to my friend from Florida and my friend from Utah, we
will be back on the floor probably this fall sometime or early next
year, and we will be talking about the fact that this doc fix--the
doctor payments provision of health care for Medicare enrollees--was
not cut 21 percent, as the other side is telling the American people
that it will be. It is not fair to the American people, I would say to
my friend from Utah.
Mr. HATCH. I agree with my friend from Arizona, no question.

Motion to Commit

Mr. HATCH. Mr. President, I ask unanimous consent to set aside the
pending motion to offer a motion to commit.
The PRESIDING OFFICER. Without objection, the clerk will report.
The legislative clerk read as follows:

The Senator from Utah [Mr. Hatch] moves to commit the bill
H.R. 4872 to the Committee on Finance with instructions to
report the same back to the Senate within 1 day with changes
to strike all cuts to the Medicare Advantage program and add
an offset if the Department of Health and Human Services'
actuary certifies that 1,000,000 or more Medicare Advantage
beneficiaries, American seniors, and disabled individuals,
will lose their current Medicare Advantage coverage or plan
benefits.

Mr. HATCH. Mr. President, before I discuss my motion to commit to
protect the Medicare Advantage Program for more than 10 million
seniors, I would like to take a few moments to discuss the broader
issue of health care reform.
To be honest, we have never seen anything like the issues facing our
country right now. We are at a pivotal point as a Nation. The line
between private businesses and public government has never been so
blurred. Government effectively owns several of our Nation's financial
institutions, insurance companies, and auto manufacturers. CEOs have
been fired by government bureaucrats, and Washington is now in the
business of running our health care system more than ever before.
Our fiscal outlook is bleaker than ever. According to the recent 10-
year outlook by the Congressional Budget Office, the CBO, the current
administration's policies would add $8.5 trillion to our already record
national debt. The report also confirmed that we would be facing a
record deficit of $1.5 trillion this year, along with a dire prediction
of our deficits only getting worse after 2015 and beyond.
Let me put this in perspective. Our deficit this year is the largest
yearly deficit since 1945. It is 10 percent of our entire economy. Our
national debt is on a path to double in the next 5 years and triple in
the next 10 years. According to CBO, our national debt will explode to
$20.3 trillion by 2020 or 90 percent of our GDP. We are literally
drowning the future of this Nation and the future of our kids and
grandkids in a sea of red ink.
I deliver these remarks with a heavy heart because what could have
been a strong bipartisan bill reflecting our collective and genuine
desire for responsible health care reform turned out to be an extremely
partisan exercise resulting in one of the largest big-government
spending bills being signed into law yesterday. We are jamming through
another 153-page addition of new taxes and spending.

Recent polls show that a majority of Americans remain concerned and
skeptical about all the promises of reduced deficits and lower costs
under this legislation. Why? Because they know there is no such thing
as a free lunch, especially when Washington is the one inviting you
over.
According to the administration's own Actuary at the Centers for
Medicare and Medicaid Services, CMS, the health care bill signed by
President Obama yesterday will actually raise our total health care
spending by $222 billion over the next 10 years. That does not even
include the doc fix the distinguished Senator from Arizona was talking
about, which is as much as $371 billion more.
But the most cynical joke played by Washington on the American people
in this entire exercise has been the promise of this $2.5 trillion tax-
and-spend bill actually reducing our deficit. Nobody believes that.
The biggest bait and switch on the American people about the bill's
impact on the deficit is a simple math

[[Page S1938]]

trick. If something is too expensive to do for a full 10-year period,
just do it for 5 or 6 years. Most of the major spending provisions of
the bill do not go into effect until 2014 or later--coincidentally
after the 2012 Presidential elections. So what we are seeing is not a
full 10-year score but rather a 6-year score. According to the Senate
Budget Committee, the full 10-year score of the Senate bill would
approach $2.5 trillion. We are already spending $2.4 trillion.
More importantly, let me also clarify what the Congressional Budget
Office has said on the nearly $500 billion in Medicare cuts which my
friends on the other side argue will magically not only extend Medicare
solvency but also pay for a large part of this bill. This is like
telling American families that they can spend the same magical dollar
to not only pay their mortgage but also their credit cards. It is
nonsensical. Here is what the experts at CBO said:

The key point is that the savings to Medicare trust fund .
. . would be received by government only once, so they cannot
be set aside to pay for future Medicare spending and, at
the same time, pay for current spending on other parts of
the legislation or on other programs.

By the way, did I mention that at a time when major government
programs like Medicare and Medicaid are already on a path to fiscal
insolvency, it is interesting to note that more than half of the newly
covered lives, 16 million out of the 32 million, are simply being
pushed into the Medicaid Program. And if anyone thinks that States,
that are facing more than $200 billion in deficits, will not be left
holding the bag in the future, then I have a bridge to sell to you.
I have said all along that this is not a fight between Republicans
and Democrats, but a fight between the Democrats and a majority of
Americans who did not want this bill. In townhall after townhall and
poll after poll and election after election, Americans begged
Washington to listen to their voices. But Washington ignored them and
used every means necessary--from backroom deals to procedural
trickery--to get this bill passed.
We need to remember the real implications of these policies--not
simply in terms of political legacies and ideological holy grails--but
in terms of its impact on the future of our children and grandchildren.
We need to ensure that they have the same opportunities to prosper that
we have all been blessed with.
I would now like to speak for a few minutes about a motion to
commit that I will be offering. My motion to commit states that if the
Actuary of the Department of Health and Human Services certifies that 1
million Medicare Advantage beneficiaries lose their coverage or
benefits, the cuts to the Medicare Advantage program will not go into
effect. It is that simple.

It is important to point out that the bill the President signed into
law yesterday would slash $120 billion from the Medicare Advantage
program. This reconciliation bill would cut the program by an
additional $66 billion for a grand total of $202 billion.
Before the health care reform bill was signed into law, CBO projected
that Medicare Advantage enrollment would have increased from 10.9
million in 2010 to 13.9 million in 2019. Now, Medicare Advantage
enrollment will be 4.8 million less in 2019 due to the passage of the
new health bill or almost 2 million less than today.
CBO also projected that rebates for additional benefits and reduced
cost- sharing offered through Medicare Advantage would be reduced by 50
percent from $135 per member per month to $67 per member per month in
2019. These lost benefits include lower premiums, lower copayments, and
lower deductibles. It will also impact everything from hearing aids to
dental and vision benefits. Most importantly, it would violate
President Obama's own pledge ``if you like what you have, you may keep
it.''
Medicare Advantage works. Every Medicare beneficiary has access to a
Medicare Advantage plan. Almost 90 percent of Medicare beneficiaries
participating in the program are satisfied with their health coverage.
It is time for us to stand up for more than 10 million seniors and
ensure that this program is not used as a piggy-bank to finance
Washington's big government plans.
I appreciate my colleagues allowing me to go maybe a minute longer
than I should have, but I urge my colleagues to support my motion to
commit this bill.
The PRESIDING OFFICER. Who yields time? The Senator from Montana.
Mr. BAUCUS. Mr. President, have Republicans used up their time?
The PRESIDING OFFICER. The Republicans have 1 minute remaining.
Mr. BAUCUS. I don't mean to be picky, but I assume they will yield
back that minute.
Mr. HATCH. I will yield back the minute.
Mr. BAUCUS. I will yield 15 minutes to the Senator from Maryland.
The PRESIDING OFFICER. The Senator from Maryland.
Ms. MIKULSKI. Mr. President, this is indeed a great day because we
are passing real health care reform for American families, for American
workers, for American small business, for seniors, and our communities.
Health care reform will save lives. No longer will dreams and lives be
endangered because people lost their health care insurance when they
got sick, lost a job or had an accident.
I listened to the other side which says they listen to the people.
You heard the old saying, ``Men are from Mars, women are from Venus.''
I think that party is from Mars and we are from planet Earth. I think
they have been out in orbit. The planet Earth that I am on tells me to
pass health insurance reform.
One of the reasons I am voting for this bill, the main reason I am
voting for this bill, is the stories I heard from my constituents in
Maryland--roundtables, townhalls, hearings, lots of letters, phone
calls, e-mails. They told me about the situation in their lives, where
they were terrified that one big health care incident could lead them
into bankruptcy. They were terrified that if they had changed a job to
one in our new high-tech communities that would have offered great
opportunity for them--they didn't take it because they were not going
to have health insurance.
When I listen to people, I think about the lady in Cumberland who
works full time, but her employer does not provide health insurance and
she is terrified that she is one sickness away from a catastrophic
situation, or from Karen, in Kensington, whose father had to quit work
because he had Crohn's disease. He was making payments on his
insurance. He was two payments short, and they canceled his insurance.
It took him 6 months to try to get it back. He lost his coverage, and
he was only 59 years old when he passed away.
Then there were the breast cancer survivors, the wonderful women and
the men they love who are out there raising money for the cure. But
even in a prosperous community such as Annapolis, a woman told me how
she lost her job and with it her family's health insurance, and when
her insurance ran out, she was terrified she would lose her cancer
treatment.
Walking around the diners--and I love diners. I see myself as a diner
Democrat. In every diner it is usually multigenerational people. What
do they tell me? Barb, don't forget the old people. Senator Barb, no
matter what, keep Medicare stable. If you are 50 years old, you are
terrified your parents can lose their Medicare and it is going to fall
on you. The sandwiches they are eating are eaten by the sandwich
generation, worried about the oldtimers' health care, worried about
keeping their own, and then trying to figure out how they were going to
pay for college. Medicare has multigenerational implications.
This is why in this bill I am so proud of the fact that we are going
to stabilize Medicare for another 10 years and do very important
reforms in Medicare.
I am also pleased to respond to the people who said no matter what,
make health care available and affordable. For every parent who has
ever worried about covering a child with a chronic illness, whether
autism or cerebral palsy or juvenile diabetes, they will always be able
to get health insurance. The small business owner, such as my own
father who once had a grocery store or my grandmother who had the best
bakery shop, worried about how they were going to provide individual

[[Page S1939]]

health care for themselves--this generation will not have to worry
about that.
This bill is an exceptional one. We save Medicare, expand its
solvency for another nearly a decade. We end the punitive practices of
insurance companies. We expand uniform access, and we pay for it with
an emphasis on wellness and quality, saying goodbye to quantity
medicine and emphasizing quality medicine; goodbye to volume medicine
and getting value for our dollar.
For our seniors, one of the most important things we will do is close
that doughnut hole. The doughnut hole has been hard to swallow ever
since this bill was passed. We are going to provide a $250 rebate for
seniors who hit the gap in the prescription drug benefit and also offer
a better discount on prescription drugs.
I am also very excited and honored because of the role I played in
making sure we ended the punitive practices of insurance companies
toward women. For too long, in too many ways, they treated simply being
a woman as a preexisting condition. First of all, they charged us 30
percent to 40 percent more just simply to be able to get insurance.
Then they would have the punitive practices of denying us health
insurance for a preexisting condition. In eight States, domestic
violence was viewed as a preexisting condition. You talk about being
abused--you were abused by your husband, then you were abused by your
insurance company. We are not going to be battered anymore by these
companies. We ended that in this bill.
Then there was the hearing that shocked and chilled me, a hearing on
gender discrimination in insurance. A woman told a compelling story,
Peggy from Colorado, that after she had a C-section and a premature
baby, the costs were high. She lost her health insurance and when she
went to apply they told her in order to get health insurance, because
she had a premature baby, because she had a C-section, they would not
give her health insurance unless she was sterilized.
I couldn't believe it. That is what fascist countries do. That is
what authoritarian regimes do. It was not the Taliban in Afghanistan,
it was an insurance company in Colorado. We took up that fight and
ended those abusive practices in this bill. Never again will a woman be
able to be denied health insurance because of any preexisting
condition. We ended gender discrimination in charging women more.
But as the debate went forward, they wanted to take the mammograms
away from us and they didn't want to put mammogram and preventive
services for women in the bill. They said it costs too much money.
I didn't want to hear that. I asked the women to suit up and come to
the floor and we offered an amendment. The good men of the Senate also
joined us. Many remember we wore pink that day. Today we are in the
pink as well. We offered our amendment to ensure preventive services
for women so that if your doctor says you need a mammogram, you are
going to get one. If you need screening for cervical cancer or a Pap
smear, you are going to get one and you are not going to have to pay a
copay and a deductible. But like the old song ``Bread and Roses,'' we
fight not only for women, but we fight for men too. Because for us it
is not gender, it is about the agenda, and the biggest agenda is to
make sure we provide health care to as many Americans as we can in the
most affordable way, with value, quality, and prevention as their
underpinnings.
We were able to make significant changes in this bill. But
affordability is an issue. I believe we dealt with that by emphasizing
quality. At Senator Kennedy's request, I led the quality task force.
Because of proven ways that we are going to be able to offer in these
initiatives, we are going to be able to increase the affordability of
this bill to make people healthier. We want to prevent disease and
manage chronic disease. By the emphasis on the management of chronic
disease, we are going to save lives and save money.
First of all, we are getting more value for the dollar. Yes, we will
be looking at comparative effectiveness, so when you go for a treatment
or you buy a drug, you know we are getting value for the dollar.
The other is, we are going to emphasize the reduction of medical
errors and also medical infections in hospitals by introducing quality
initiatives that reward hospitals for being able to do that. But I also
listen to the providers. I represent iconic international institutions
such as Johns Hopkins medical institution and the University of
Maryland.
I listen to my primary care doctors as well. They said: Senator Barb,
please reduce the hassle factor; too much paperwork and not enough time
to be with patients; too many contradictory rules from the insurance
companies and not enough of a clear path on what we can do to be able
to help people.
So we made sure we are going to save money by reducing the hassle
factor by simplifying administrative costs, by emphasizing medical
health information technology. We are going to promote evidence-based
medicine through this comparative effectiveness research. We are going
to also reward, following the recommendations of the Finance Committee,
the encouragement of medical homes in order to be able to manage
chronic disease.
These are the many reforms that are in this bill and that I am very
proud of. I am also, as the daughter of a small business owner, excited
about how we are going to be able to help small business be able to
provide health care to their employees. The fact that we are going to
offer tax breaks for small business and be able to have health
exchanges where they can buy those health care policies at a better
cost is indeed important.
So, again, the other party might be Mars, but I am glad my feet were
planted in planet Earth, by listening to the people I represent, by
listening to their concerns and then listening to the excellent ideas
that came from both the people themselves and, I must say, the people
who are the providers who could help us lead the way.
I am going to vote for this bill. I know there is much to reform in
it in the years ahead. But this is more than a beginning, this is a
leap into the future. It is a leap we can take with confidence that
when this bill passes with reconciliation, we will have won a major
historic advance for the American people.
Our job is about creating opportunity and opportunity to have health
care is one of the greatest benefits we can provide.
I yield the floor.
The PRESIDING OFFICER (Mr. Burris). The Senator from Montana.
Mr. BAUCUS. Mr. President, I ask unanimous consent that at the
conclusion of the half hour under the majority's control, at about
roughly 11:21, the Republicans control the next half hour and the
majority control the half hour after that, starting at about 11:51.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. BAUCUS. Mr. President, I would like to take a couple moments to
speak on two amendments, one offered by, I think, Senator Hatch, with
respect to Medicare Advantage. Off the topic, it is important to
remember that health care reform will reduce excessive overpayments to
Medicare Advantage plans, while at the same time rewarding high-
quality, efficient plans for providing care to seniors.
Medicare Advantage plans that achieve high-quality rankings under
this legislation, let's say, for regular checkups for blood pressure,
diabetes, will receive an increase in payments. That is very important
because, today, Medicare Advantage plans are paid the same amount
regardless of the quality of care they provide.
For the first time, under this legislation, payments to plans would
be based on performance. I think that is something all seniors would
prefer. That makes this Medicare Advantage plan more fair, more
reasonable. This will enable plans to participate everywhere in the
country, both urban and rural, while eliminating overpayments that
plans receive today.
According to MedPAC--MedPAC is that bipartisan commission that
advises Congress on Medicare payments--that organization says Medicare
Advantage plans are paid 13 percent more than traditional fee-for-
service plans, on average, and in some parts of the country overpayment
is as high as 20 percent. They strongly recommend that we reduce that
overpayment because it causes great inefficiencies.
I might also say that, today, because of the overpayments, all
seniors on

[[Page S1940]]

Medicare--I am talking now especially about seniors who take fee for
service--all seniors on Medicare pay for these overpayments, even if
they are not in Medicare Advantage plans. How? Well, it is basically
because every senior pays $3 more per month in Part B premiums, that
totals about $80, on average. So seniors in traditional fee for service
are paying for the overpayments for Medicare Advantage plans.
Medicare Advantage overpayments drain resources for the Medicare
trust fund. If they are overpaid, that means they are draining
excessive resources from the Medicare trust fund. In fact, the
government estimates that Medicare Advantage overpayments speed up
insolvency of the Medicare trust fund by about 18 months.
After that, there is no evidence that overpayments to Medicare
Advantage plans--do not forget these are private insurance plans--even
though they say Medicare, they are private insurance plans. There is no
evidence that overpayments to them lead to better quality for Medicare
beneficiaries.
In fact, seniors can end up spending more out-of-pocket dollars under
Medicare Advantage plans than under traditional Medicare, even if they
have certain conditions. The bill eliminates these overpayments by
decreasing the statutory rates in place today and giving quality
performance payment increases to high-ranking plans. We are paying more
than we do today to high-ranking plans.
No senior in Medicare Advantage will lose access to any of their
Medicare benefits under this proposal. We hear all these false claims
across the aisle that these cuts, which cause more efficiency, prevent
waste, prevent overpayments, are going to cut beneficiaries, Medicare
Advantage beneficiaries' payments. That is not true. It is misleading.
Plans will not be allowed to lower or drop their basic Medicare
benefits that seniors are entitled to under the Medicare Program. So
there are no cuts in basic Medicare benefits. In fact, they are
guaranteed. The reforms in this bill will ensure that the dollars for
the Medicare trust fund go toward improving the quality of care for
seniors, rather than to support the operations of private insurers. I
think that is something the vast majority of seniors would prefer. I
wish to make that clear because some of the statements made on the
other side of the aisle are quite misleading, which leads me to another
point.
Americans probably are a little confused about what is in health care
reform because they hear all kinds of claims, both sides. Well, now
health care reform has passed. The President signed the bill yesterday.
This is sort of to help, a fixer-upper around the edges a little bit.
Americans can look for themselves as to who is telling the truth. They
will want to look more closely than they have in the past because now
it is law. Now it affects people.
Some people are going to ask: Gee, how does it affect me? I better
find out. When people start to find out, they are going to learn--I say
this somewhat presumptuously, but I believe it very strongly--they are
going to find out that those who are claiming all the bad things that
are going to happen, all the bad things about this bill, are basically
not true.
They are also going to start to realize that all the good things in
this bill, that a lot of proponents have been mentioning, from the
President on down, they are pretty much true, the good things are
pretty much true. I think once people start thinking closely,
separating the wheat from the chaff, they will start to realize that
not only are the Medicare Advantage charges false, but a lot of the
other charges that some make about why the bill is so bad are also
false. Again, I say, somewhat presumptuously, the prevention
provisions, I think are very good and help seniors, are basically
accurate.
One small, final point. The Senator from Florida offered an amendment
basically requiring all Members of Congress to enroll in Medicaid. Now
I ask you, that clearly is not a serious amendment. Medicaid is a very
vital program for vulnerable Americans. It should be treated very
seriously and should not be used for political games.
I now yield the remainder of our time in this half hour to the
Senator from Rhode Island.
The PRESIDING OFFICER. The Senator from Rhode Island is recognized.
Mr. REED. First, I wish to begin by recognizing the extraordinary
leadership of majority leader Harry Reid, Chairman Baucus, Chairman
Dodd, and Chairman Harkin to get us to this point.
Commonsense and cost-effective health care reform is now the law of
the land. The question before the Senate now is whether we will make
some important improvements to that reform or whether we will respond
to the wishes of the insurance industry and others who want to preserve
a broken status quo of higher premiums and dwindling coverage for
middle-class families.
Yesterday, President Obama signed into law a health insurance reform
bill that will cut the deficit by $143 billion over the next 10 years,
ensure that health insurance companies actually provide Americans with
the coverage that they pay for, and preserve Medicare for our senior
citizens. That is no small achievement, and it would be a tragedy if
the other side of the aisle persists in its effort to defeat health
care reform by seeking to delay and up-end the package of improvements
in the bill that we are now debating.
It sometimes gets lost in the heated rhetoric of the other side, but
under the status quo, the healthy are faced with ever-increasing costs
and the ill are denied care, dropped from coverage, and prevented from
purchasing coverage. The new health insurance reforms will provide
relief for every American. Indeed, under the law just signed by
President Obama, these five reforms will take place by the fall of next
year:
No child will be denied coverage because of a preexisting condition.
Small businesses will receive a 35-percent tax credit to purchase
insurance for their employees.
Seniors on Medicare who confront the doughnut hole will receive
additional assistance.
Health insurers will be required to spend more of their premium
revenues on clinical services, with less going to administrative costs
and profits, or else they must pay a rebate to policy holders.
And our State's Community Health Centers will receive a boost in
Federal resources.
Rhode Islanders will particularly welcome this relief. Just last
week, Rhode Islanders learned that health insurance premiums in the
State will go up 10 percent this year. In the same week, they also
received news that as many as 21 percent of individuals in the State
will be without insurance sometime during this year. This is double the
rate of uninsured just 10 years ago.
In Rhode Island, these two headlines, coupled with an unemployment
rate of nearly 13 percent, have caused a perfect storm.
As the economy took jobs away from Rhode Islanders, it also took away
their health insurance. The healthy hoped not to get sick, the sick
started showing up in hospital emergency rooms, and those who still had
access to insurance stopped being able to afford it.
Hospitals in Rhode Island can no longer shoulder the burden of the
uninsured. Community health centers in Rhode Island can no longer
shoulder the burden of the uninsured. Indeed, the economy can no longer
shoulder the burden of the uninsured.
Today we are considering a bill that makes further improvements to
the health insurance reform law. Indeed, these are changes that
Americans have consistently said they want, and that is why we should
support this bill. It is also why I intend to oppose the legislative
maneuvers from the other side of the aisle. They are interested in
overturning the reform of our health care system, reforms which have
replaced the costly status quo with a system based on more competitive
markets. They are in favor of a system where the whim of insurance
companies rule. They are in favor of a health care system in which
costs continue to rise at astronomical rates each year for families and
for businesses.
It may be politically heartening for the other side to try and slow
down reform through a series of repetitive amendments, but I think
Rhode Islanders and all Americans want us to pass the bill because it
contains straightforward proposals.

[[Page S1941]]

First, this reconciliation bill, as it is known, would eliminate the
so-called Corn-Husker kickback, which would have created an entirely
inappropriate Medicaid reimbursement system exclusively for one State.
Gone too are other provisions that would have unfairly supported some
States and not others.
Second, this bill begins the process of closing the Medicare
prescription drug coverage gap, also known as the doughnut hole, which
requires seniors to pay more for their medications than they ordinarily
would. This year seniors would receive $250 when they enter the
doughnut hole and pay less for drugs they purchase once they enter this
coverage gap.
Third, at a time when so many of us are worried about government
spending, this bill does more to reduce the budget deficit so that we
can save up to $1.3 trillion in the next two decades. Those are real
savings. I find it ironic that some on the other side oppose them.
Fourth, the bill makes sure the so-called Cadillac tax, which was
intended to affect the most expensive health care plans, is reduced by
80 percent so that it hits its intended targets, not middle-class
families.
Fifth, the bill recognizes that we should do even more to help
struggling families afford health insurance, and so it provides new tax
breaks to help make coverage more affordable.
As I said, in the next few days my colleagues on the other side of
the aisle are expected to file and attempt to offer numerous amendments
to this bill. These are tactics that are purely dilatory. That is,
again, another reason I will oppose the amendments. Some of these
amendments may seem as though they are common sense, but each one is
designed for the purpose of derailing this legislation, of sending it
back to the House, of undercutting the most significant reform of
health care in the last several decades.
But there is another aspect to this legislation which is vitally
important; that is, the improvement to the student support system for
higher education. It is the dream of every parent that their child will
have a better life, and a big part of that dream is that they will have
the opportunity to go on to college or even an advanced degree. This
bill ends the student aid system that gives away billions of Federal
subsidies to private banks, including some that helped create the 2008
financial meltdown, and instead puts those taxpayer dollars directly
into the hands of students to pay for their education.
During this economic downturn, paying for college has become all the
more difficult for many families in Rhode Island and across the Nation.
Like health care, one of the top concerns of families as they sit
around their kitchen tables during these difficult times is how they
will pay for their child's education. The key to ensuring our Nation's
economic stability and progress is also providing access to education.
It is the engine that moves people forward. It is what expands our
capacity and our capabilities in a complex world.
Now we have the opportunity so that we can, in fact, provide
additional assistance through Pell grants, and we can do it by saving
money from bank subsidies and reinvesting that in Pell grants.
Approximately $42 billion will be freed up; over $35 billion will be
committed to Pell grants. It will be expanded to additional recipients,
and the maximum grant will increase to nearly $6,000. We will also
provide in Rhode Island $7.5 million for information so that families
and students can locate the best arrangements for their college
education, for their financial aid. It will also invest $2 billion in
community colleges, which have become a central part of our educational
system, particularly for those people who are transitioning into the
workforce or through the workforce.
One final point: It is particularly fitting that we are investing in
the Pell grant, named after my predecessor Senator Claiborne Pell. His
vision to give people the opportunity to higher education and then to
stand back and watch them do great things has been legitimized and
vindicated over 30 years. I don't think Senator Pell foresaw the
Internet. I don't know how much he used it even when it arrived. But he
knew if we gave people the skills and talents, they would do great
things. They have done great things.
With this legislation, they will do even more.
I yield the floor.
The PRESIDING OFFICER. The Senator from New Hampshire is recognized.
Mr. GREGG. How much time does the majority have on their half hour?
The PRESIDING OFFICER. The time of the majority has expired.
The Senator from New Hampshire.
Mr. GREGG. Mr. President, a couple comments need to be responded to
because they are so patently inconsistent with the facts that they
should be clearly rejected. It is almost as if somebody spent too much
time at the movie ``Alice in Wonderland.'' The idea that by their own
score, when you cut Medicare by $521 billion--$\1/2\ trillion cut out
of Medicare by their own score, which is inaccurate, of course, because
it doesn't count the full 10 years--if you count the full 10 years, it
is $1 trillion taken out of Medicare--the idea that seniors are not
going to be affected by that type of a cut is absurd on its face.
The claim is, we don't affect senior benefits. That is nice. That is
like telling somebody they can have a car, but there is no engine in
it. I mean, the simple fact is, when you cut the providers of seniors
by as much as this bill cuts them, clearly it is going to be harder for
a senior citizen to see a provider, a doctor, a hospital group. Or when
you reduce the spending on Medicare Advantage, which is an insurance
program that many seniors appreciate--CBO scores the reduction as being
so large that over 11 million seniors will be thrown off that system--
that affects seniors.
If they genuinely believe their language, ``we don't do anything
about Medicare; we don't do anything about seniors,'' even though the
score says they cut Medicare by $500 billion, their own score, and the
CBO has said over 11 million people will be knocked off of Medicare
Advantage--if they believe that, if they believe their language, then
they have to vote for my amendment. They have to vote for my amendment
which makes it clear that we protect Medicare.
Then there was some other comment made that somebody was going to
vote against our amendments, not because they don't make sense but
because they are dilatory. This is from a leadership on the other side
of the aisle that produced the largest piece of social engineering in
our history: 2,500 pages, $2.6 trillion of spending, $1 trillion of
cuts in Medicare when fully implemented. They produced that bill in a
closed room behind a secret door somewhere on that side of the Capitol,
never open to the public, brought it to the floor of the Senate on a
Saturday afternoon, filled up the tree, wouldn't allow any amendments,
and within 3 days forced us to vote on it on Christmas Eve. Then they
took it over to the House, where they rewrote this trailer bill, again,
in a secret room, behind a closed door, and brought that bill to the
floor and didn't allow anybody to amend that. But amendments are
dilatory.
Why have an opposition party? Maybe we should just go with the Cuban
system. That seems to be the attitude of the other side of the aisle.
The American people are an unfortunate inconvenience. The fact that
they have elected a Republican membership to this Senate and to the
House, they are an unfortunate inconvenience that should be ignored and
not allowed to participate in the process.
When they come up with ideas such as protecting the Medicare system
or such as taking out the sweetheart deals or such as suggesting that
the President and his people and the staff of the majority leader
should be under the laws we are about to pass or suggest that we should
live by the terms of the rhetoric which is, if your premiums go up, you
won't be impacted by this bill, or that says that there won't be any
taxes on people under $200,000 of income, amendments which just fulfill
the statements of the other side of the aisle on issues--they are going
to keep the bill clean, they are not going to tax people under $200,000
of incomes, people's premiums won't go up, Medicare won't be affected,
and everybody will be subject to this new law of the land, including
the President of the United States and his people and the staff of the
majority leader--when we offer amendments like that, they are dilatory.
They are an inconvenience. They

[[Page S1942]]

should not be allowed. They should not be voted on, not because they
don't make sense but get rid of them; they are the opposition.
They are the American people speaking through their elected
representatives and they ought to have a voice and they ought to be
voted on and they ought to be given a vote based on the substance of
the amendments, not on the fact that the other side of the aisle
doesn't like opposition.
It is so arrogant, this attitude which pervades Washington now that
says: The American people, we know better than you do how to live your
lives. Why do you get in our way? We in Washington know how you should
live. Just stand back. Let us make your decisions as to what you should
do with your life, especially relative to health care. We will do a
much better job. Certainly, don't countenance any opposition. Don't
countenance any dissent, and, certainly, don't hold us to our word, for
example, when we say people with incomes under $200,000 won't be taxed
or when we say premiums won't go up or when we say everybody will be
covered by the bill or when we say Medicare recipients won't be
impacted. Don't make us hold to those words by voting on amendments
because those amendments are dilatory.
The arrogance is palpable and inexcusable.
Now we will hear from the Senator from Oklahoma who has another
amendment that I am sure the other side will say is dilatory and
inappropriate, even though it makes a heck of a lot of sense to me.
I yield the floor.

Amendment No. 3556

The PRESIDING OFFICER. The Senator from Oklahoma.
Mr. COBURN. I thank the Senator from New Hampshire.
As I contemplate what is happening at 62 years of age and looking
back through my life, this is undoubtedly the greatest assault on
liberty this country has ever had. It is not direct; it is indirect.
But it is what the Senator from New Hampshire talked about: we are
going to decide for you what you get.
What the American people still don't understand is there are three
areas in this bill that in the next 5 years will put the government in
charge of everybody's health care--what you can have, what you can't
have, and who can give it to you. That is what is coming. So if you are
a caregiver or you are a patient, you might think long and hard about
the three provisions in this bill that are going to do that: a Medicare
advisory commission, the cost-effectiveness comparative effectiveness
panel, and the U.S. preventative task force panel. All of those are
going to carry the force of law, and it will not just apply to
government-run plans. If you have private insurance with your employer
today, you are going to be told what treatments you can have because
some group of bureaucracies in Washington are going to decide that.
That is what is in this bill.
The Senator from New Hampshire mentioned several claims that have
been made.
I ask unanimous consent to temporarily set aside the pending motions
and amendments so I may offer an amendment which is at the desk, No.
3556.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report.
The assistant legislative clerk read as follows:

The Senator from Oklahoma [Mr. Coburn] proposes an
amendment numbered 3556.

Mr. COBURN. I ask unanimous consent that reading of the amendment be
dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To reduce the cost of providing federally funded prescription
drugs by eliminating fraudulent payments and prohibiting coverage of
Viagra for child molesters and rapists and for drugs intended to induce
abortion)

At the end of subtitle D of title I, add the following:

SEC. 1306. REDUCING HEALTH CARE COSTS BY ELIMINATING PAYMENTS
FOR FRAUDULENT CLAIMS AND PROHIBITING COVERAGE
FOR ABORTION DRUGS AND ERECTILE DYSFUNCTION
DRUGS FOR RAPISTS AND CHILD MOLESTERS.

(a) Eliminating Fraudulent Payments for Prescription
Drugs.--The Secretary shall establish a fraud prevention
system and issue guidance to--
(1) prevent the processing of claims of prescribing
providers and dispensing pharmacies debarred from Federal
contracts or excluded from the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or
the Medicaid program under title XIX of such Act (42 U.S.C.
1396 et seq.);
(2) ensure that drug utilization reviews and restricted
recipient program requirements adequately identify and
prevent doctor shopping and other abuses of controlled
substances;
(3) develop a claims processing system to identify
duplicate enrollments and deaths of Medicaid beneficiaries
and prevent the approval of fraudulent claims; and
(4) develop a claims processing systems to identify deaths
of Medicaid providers and prevent the approval of fraudulent
claims filed using the identity of such providers.
(b) Prohibiting Coverage of Certain Prescription Drugs.--
(1) In general.--Health programs administered by the
Federal Government and American Health Benefit Exchanges (as
described in section 1311 of the Patient Protection and
Affordable Care Act) shall not provide coverage or
reimbursement for--
(A) prescription drugs to treat erectile dysfunction for
individuals convicted of child molestation, rape, or other
forms of sexual assault; or
(B) drugs prescribed with the intent of inducing an
abortion for reasons other than as described in paragraph
(2).
(2) Exceptions.--The limitation under paragraph (1)(B)
shall not apply to an abortion--
(A) in the case where a woman suffers from a physical
disorder, physical injury, or physical illness that would, as
certified by a physician, place the woman in danger of death
unless an abortion is performed, including a life-endangering
physical condition caused by or arising from the pregnancy
itself; or
(B) if the pregnancy is the result of an act of forcible
rape or incest.

Mr. COBURN. This is a constructive amendment that saves millions and
millions of dollars in Medicaid. The fraud in Medicaid prescriptions is
out of this world. It can be fixed. This amendment will prohibit
prescriptions for recreational drugs for rapists and child molesters.
Nobody can disagree with that. It is not in the bill. It is the current
state. But if this bill goes through without this amendment, your tax
dollars are going to be paying for Viagra for child molesters. That is
what is going to happen. There is an Executive order that this will
override. The bill overrides the Executive order. So there is no
prohibition in the bill for this at this time.
A Government Accountability Office audit of Medicaid found 65,000
instances of improper prescriptions costing $65 million over the last 2
years, including thousands of prescriptions written for dead patients
by people prescribing and posing as doctors. The audit focused on 10
types of frequently abused prescription drugs in just 5 States, which
means this audit, which is just over 5 States, multiply by at least 10,
and you get $650 million worth of fraud in prescriptions in Medicaid
alone. We are not going to address that.

Sixty-five doctors or pharmacists were banned from Medicaid for
writing or filling prescriptions or illegally selling drugs--but just
in those five States.
About 1,800 prescriptions were written for dead patients and 1,200
prescriptions were ``written'' by dead doctors--just in those five
States.
This amendment would direct the Centers for Medicare and Medicaid
Services to enact the GAO recommendations to prevent and eliminate
these fraudulent prescriptions. Specifically, it would direct CMS to
establish a fraud prevention system for the Medicaid Program and issue
guidance for States to prevent the processing of claims of all
prescribing providers and dispensing pharmacies debarred from Federal
contracts or excluded from the Medicare and Medicaid programs; ensure
that drug utilization review and restricted recipient program
requirements adequately identify and prevent doctor ``shopping'' and
other abuses of controlled substances; develop a claims processing
system to identify both duplicate enrollments and deaths of Medicaid
beneficiaries and prevent the approval of fraudulent claims.
For years, the Federal Government had required States to provide
prescriptions for Viagra and other impotence drugs to Medicaid
patients, including to convicted sex offenders, child molesters, and
rapists. States had provided the coverage based on a 1998 letter from
the Clinton administration. As a result of that, an Executive order was
issued in 2005, which this bill, if

[[Page S1943]]

unamended, will reverse. Mr. President, 800 convicted sex offenders in
14 States received Medicaid-funded prescription drugs for erectile
dysfunction. That is according to a 2005 survey.
The predators' victims have been as young as 2 years old. So we have
convicted sex offenders, rapists, and child molesters who were taking
Federal tax dollars and buying a drug so they can act again.
In Florida, 218 cases; New York, 198 cases; Texas, 191 cases, and it
goes down the list.
This amendment would prohibit the new health care exchanges from
providing coverage of ED drugs to convicted child molesters and
convicted rapists. It is pretty simple.
The claims that are made on this bill are outlandish. As somebody who
has practiced medicine for 27 years, 50 percent of my patients were
Medicaid patients. What you are going to do if you do not fix some of
the things in this bill is destroy the best doctor-patient
relationships in the world. That is what you are going to do.
You are going to put 16 million people into a failing Medicaid system
that the States cannot afford. Almost every State is cutting Medicaid
reimbursement. At this time, only 40 percent of the doctors in the
specialties will see Medicaid patients. It is going to go to 20
percent. So we are going to put 16 million people in a system, and then
they are not going to be able to find a doctor. Because of the costs,
in my own State, we are going to have an 11-percent net reduction in
Medicaid reimbursements, which is only 75 percent of Medicare.
What do you think is going to happen in all the States in the country
when the Medicaid reimbursement goes down and we add 16 million new
people to Medicaid? You are going to call it care. You are going to rub
your shoulder, rub that medal on your shoulder, and say: Oh, we fixed
health care. You are going to promise them they are going to have care,
but they are not going to have care. They are going to have a card, but
they will have no care. We are going to have Indian Health Service-type
care in Medicaid because nobody is going to be there to care for them.
The claims under this bill keep me sleepless at night--not because of
Washington but because of those 10,000 Medicaid patients I have taken
care of through my career for whom I know you are going to destroy what
care is left for them. You can claim otherwise, but the facts are going
to prove you wrong. We are seeing it in every State in the country
right now--the cuts to Medicaid reimbursements.
So at least you ought to help save $650 million a year by getting rid
of fraudulent prescriptions, eliminating prescriptions for convicted
child molesters for erectile dysfunction, and recreational uses with
drugs such as Viagra. The American people do not want to pay for that.
To vote against this amendment, to not fix something that is very
obvious, is criminal--it is not just not right, it is an active aid to
help those who would hurt our children.
I yield to the minority whip.
Mr. KYL. Thank you, Mr. President.
The PRESIDING OFFICER. The Senator from Arizona is recognized.
Mr. KYL. Mr. President, I would say, we are fortunate to have a real
doctor, a physician, Dr. Tom Coburn of Oklahoma, as one of our
colleagues in the Senate to talk about the real impact of legislation
like this as he sees it when he treats his patients. I think his words
deserve a lot of attention.
I just want to briefly address this morning a couple of the claims my
Democratic colleagues are making about this new legislation, claims
that are simply false.
The first one: There is a big tax cut. One of my colleagues said this
is the biggest tax cut we have ever had. There is no tax cut for
taxpayers in this bill. What they are touting as a tax cut is, rather,
a direct payment to insurance companies. I find it very odd that is
called a tax cut. When I think of a tax cut, I think of money remaining
in the pockets of taxpayers so they do not have to pay taxes they have
been paying in the past. That is not what is in this bill.
What the bill does is to provide a subsidy to insurance companies to
dispense government-mandated insurance. It is not a tax cut for
taxpayers. Instead, most of the so-called tax relief goes directly to
the insurance companies. It never touches--you never touch the money--
it never touches an American family's pocket.
These premium subsidies are delivered straight from the U.S. Treasury
to help insurance companies, as I said, to purchase this government-
mandated, government-approved insurance. They are not extra dollars in
people's pockets, as the chairman of the Finance Committee argued. They
are, rather, advanceable, refundable tax credits, which is code for a
new tax entitlement. In fact, that is exactly the way it is recorded in
the Federal budget. It is recorded as a spending program, the reason
being that the people receiving these so-called refundable credits paid
very little if any taxes. These are folks who do not pay taxes, so they
get what is called a refundable tax credit. But even then the money
goes directly to the insurance company, not to them. I always thought
you had to pay taxes to get a tax cut, but not in the rubric of this
legislation.
According to the Joint Committee on Taxation, only about 8 percent of
all taxpayers making under $200,000 a year would actually benefit from
this government subsidy for health insurance. The remaining 92 percent
would receive no tax benefit under the bill.
I have to say, when we are talking about tax cuts, we have to at
least put in a little word about the tax increases in the bill because
that is where the bill focuses, on taxes. It taxes many of those who
have health insurance and taxes people if they do not have health
insurance.
The taxes in the bill hit families. They hit seniors and the
chronically ill, small businesses, those who have flexible spending
accounts, and those who use medical devices. All of those things create
a tax people pay. The vast majority of the people who pay these taxes
are not high earners. As the Congressional Budget Office has said,
whenever there is a tax on some other entity that delivers health
services, that tax flows directly through to the taxpayers in virtually
the same amount of money.
In fact, in order to collect all of these taxes, and especially the
tax that is imposed on people if they do not buy this insurance, the
Internal Revenue Service estimates it is going to have to have between
$5 billion and $10 billion more just in order to collect the taxes. It
has been estimated this would require 16,500 new IRS agents. Welcome to
your friendly new health care bill.
The second aspect my colleagues have been talking a lot about in the
last 48 hours: The elimination of the problem of preexisting conditions
in acquiring health insurance. The implication is that Republicans have
not supported help for people who have preexisting conditions. That is
not true. We have made that point clear. We made that point clear in
the meeting we had with the President at Blair House. The argument is
about the best way to do it.
As you will see in just a moment, it turns out this bill has not done
it very well. Republicans have suggested there are a lot of different
ways to get to this problem--State reforms, risk pools, more
competition, some subsidization. All of these things can help us with
this problem. But for all of the Democrats' central planning in this
bill, it looks as though the problems are already arising as a result
of their specific provision to deal with this problem.
According to a brand new Associated Press story of March 24,
President Obama's claims about preexisting coverage for children are
not what they seem. The article notes that ``the letter of the law''--
which Democrats took upon themselves to write behind closed doors--
``provided a less-than-complete guarantee that kids with health
problems would not be shut out of coverage.''
In your rush to do these things--behind closed doors, without proper
vetting, always voting no on any attempts to correct it--you end up
with problems like this, and they are going to have to somehow go back
and try to fix this. If this blunder is discovered on the first day
this law takes effect, how many more errors will be discovered in the
next days and weeks, as people pour over the 2,733 pages of this new
health care law, and the 150 pages of the reconciliation bill that is
on the floor right now?

[[Page S1944]]

If you cannot draft a bill properly to protect children with
preexisting conditions--which is a centerpiece of the bill's so-called
immediate deliverables--then how are you going to be able to
successfully make one-sixth of the economy work through this new
government-operated system?
Finally, I have talked about two things our Democratic friends are
crowing about, neither one of which, it turns out, I think are worth
crowing about. How about the things they are not talking about, the
things Americans are very concerned about?
Democrats love to talk about people who are allegedly helped by the
legislation. How about those who are hurt by the bill? How about
talking about seniors whose care is going to be jeopardized as a result
of this bill? Seniors in my State of Arizona are very worried about the
Medicare cuts. There are over $\1/2\ trillion in Medicare cuts in this
bill.
Well, our Democratic friends do not like to talk about that. But it
is a reality. It is in the bill. The reconciliation bill slashes more
than $\1/2\ trillion from Medicare and contains a whopping $202 billion
reduction in Medicare Advantage. That is more than in the bill the
Senate passed last December. But you do not hear about that. Medicare
Advantage beneficiaries in my State like the health care they have
right now, and it is simply not true if they like their health care
they get to keep it. It is false. This bill takes health care benefits
away from seniors who are on Medicare Advantage. That is the truth. It
may be an inconvenient truth for our colleagues who like to stress what
they think is good about the bill but conveniently ignore things that
are going to hurt their constituents and certainly going to hurt my
constituents.
My senior citizens in Arizona do not want the government taking away
their health care, and they are very concerned as a result. A
constituent from Tucson--I will just close with this--wrote me a very
short, a very direct letter, but it summarizes the point a lot of
people feel.

I am a senior citizen, age 83. If I lose my Medicare
Advantage coverage, I'll also lose my primary care physician
of 18 years because he does not accept Medicare Direct.
Senator Kyl, do not let them take away my Medicare Advantage.

Well, all of us know physicians who are no longer taking new Medicare
patients. They cannot afford to because we do not pay them enough. Mayo
Clinic in Arizona has already said it is not going to accept any more
Medicare patients at several of its facilities in the Phoenix
metropolitan area.
This health care bill is asking a lot of the American people, a lot
in terms of tax collection, and a lot in terms of future debt that our
children and grandchildren are going to have to pay.
But just one group that ought to be very concerned--and is--are our
senior citizens who face nearly $\1/2\ trillion in Medicare cuts. Taxes
and premiums are going to be increased on all Americans. Small
businesses will be hit with a litany of onerous new taxes and mandates
and regulations. Probably worst of all from my perspective, just as
these costs inevitably escalate, as time goes on, just as in the
European countries that have had to deal with these same kind of health
care issues, this legislation will ultimately lead to the rationing of
health care. That is the cruelest result of all.

I ask unanimous consent to have printed in the Record at this point
an op-ed piece by Mr. Bob Robb who writes for the Arizona Republic. It
is dated March 24. The last two sentences of this op-ed I think
summarize the point I made very well. He says:

But it is impossible to treat health care as a public good
without rate regulation and rationing. And those are the
inevitable next steps down the health care road the Democrats
have taken the country.

There being no objection, the material was ordered to be printed in
the Record, as follows:

[From the Arizona Republic, Mar. 24, 2010]

(By Robert Robb)

Democrats tend to discount the influence of economic
incentives on human behavior. They had better hope they are
right because the incentives in the health-care bill point
toward an explosion in costs.
The health-care bill is built upon a fundamental tradeoff.
Health-insurance companies will be treated as public
utilities, having to take all customers irrespective of
health status with sharp limitations on pricing and
underwriting. To pay for this increase in costs, everyone
will be required to purchase health insurance.
This is an attempt to force the young and healthy to
subsidize the health care of the acutely or chronically sick
through the premium mechanism. But, as finally passed, the
incentives and timing are badly misaligned.
The basic problem is that the penalty for not purchasing
insurance is substantially less than the cost of the
insurance. Even with the generous subsidies the bill
provides, young singles making more than $25,000 a year will
be money ahead paying the penalty rather than buying
insurance.
Doing so would be risk-free for them. If necessary, they
can purchase insurance after they get sick and know that they
need it. The implementation timetable for the bill
accentuates the misaligned incentives.
Insurance companies are saddled with additional costs right
away.
They will have to accept children with pre-existing
conditions and carry children on their parents' policies up
to age 26. They can't impose lifetime benefit limits. Any new
policies have to cover preventive services without co-pays or
deductibles. But the individual mandate, the source of new
revenue to cover the additional costs, doesn't kick in until
2014.
Moreover, the penalties start very low, only $95 in 2014,
while the requirement to accept all comers irrespective of
pre-existing conditions applies fully that year. So, the
additional costs are added full bore, while the additional
revenue is phased in slowly.
This misalignment of incentives in the individual market is
compounded by a similar misalignment in the group market.
The penalty for employers (with more than 50 employees) not
providing health insurance is $2,000 per employee. Employers
pay on average two to four times that to provide health
insurance.
Employers do it now to compete for employees, since the
current individual market isn't an attractive alternative.
But, under the bill, the federal government is setting up and
heavily subsidizing an individual market with generous
benefits.
So, the incentive will be for employers to drop health-
insurance coverage, pay the fine and allow their employees to
go shopping in the subsidized exchanges.
The Congressional Budget Office estimates that 8 million to
9 million Americans will lose employer-provided health
insurance. I think that's a gross underestimate.
Moving people into the individual market could be a good
thing for cost control, if individual health insurance
operated like other individual insurance products, where
people pick up the cost of small stuff and insure against big
stuff. But the individual market mandated by the bill
requires first-dollar coverage and sharply limits deductibles
and co-pays.
So, the bill gives incentives to move people into an
individual market with even less cost-control incentives than
the existing system, where at least employers worry about the
final tab. It also gives many people an incentive not to
participate in the new system until they are actually sick.
If incentives matter, there are likely to be sharp
insurance-rate increases and insurance-company bankruptcies.
Contrary to the rhetoric on the right, it is possible to
treat health care as a public good without being a socialist
country. And it is possible to treat health care as a public
good without having it delivered through government agencies.
But it is impossible to treat health care as a public good
without rate regulation and rationing. And those are the
inevitable next steps down the health-care road the Democrats
have taken the country.

Mr. KYL. Thank you, Mr. President. I yield the floor.
The PRESIDING OFFICER. The Senator from Texas.

Amendment No. 3608

Mrs. HUTCHISON. Mr. President, I ask unanimous consent to temporarily
set aside the pending motions and amendments so that I may offer an
amendment which is at the desk.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The clerk will report.
The assistant legislative clerk read as follows:

The Senator from Texas [Mrs. Hutchison], for herself, Mr.
Enzi, Mr. Coburn, Mr. Burr, and Mr. Brown of Massachusetts,
proposes an amendment numbered 3608.

Mrs. HUTCHISON. I ask unanimous consent that the reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To protect the right of States to opt out of a Federal health
care takeover)

At the end of section 1002, insert the following:
(c) Right of States to Opt Out of Federal Health Care
Takeover.--Section 1321(d) of the Patient Protection and
Affordable Care Act is amended--
(1) by striking ``Nothing'' and inserting:
``(1) In general.--Except as provided in paragraph (2),
nothing''; and
(2) by adding at the end the following:
``(2) Exception for opt out of health care reform.--The
provisions of, and the

[[Page S1945]]

amendments made by, this Act shall not preempt any State law
enacted after the date of enactment of this Act that exempts
the State from such provisions or amendments, including, but
not limited to, provisions and amendments relating to the
individual mandate, the employer mandate, taxes on
prescription drugs, taxes on medical devices, taxes on high
value health plans, Medicare cuts, and the unfunded expansion
of Medicaid.''.

Mrs. HUTCHISON. Mr. President, the amendment I offer today is to
allow States to opt out of this health care bill. If ever there was an
encroachment on the tenth amendment, this bill is it.
We are hearing from State leaders all across the country asking
Congress to abandon this bill. It is an unconstitutional preemption of
State innovation, State prerogative, and States rights they are
guaranteed in the Constitution by the tenth amendment. Thirteen States
have now filed suit against this legislation because the leaders in
those States know the detrimental impact this broad, one-size-fits-all
solution will have on their unique situations. States are the most well
equipped to design and approve governmental programs to address the
needs of their citizens. My amendment would restore the tenth amendment
rights reserved for the States by allowing State legislatures to pass
legislation that would allow them to opt out of this bill and the
Federal takeover of their health care system with its mandates, many of
which are unfunded.
Let's walk through the harmful provisions in this bill from which the
States could opt out.
Taxes, the job-killing taxes. The bill imposes 10 years of taxes,
about $\1/2\ trillion, on individuals and businesses as well as
pharmaceutical companies, insurance companies, and medical device
manufacturers. Some of these taxes will start almost immediately. More
than $100 billion in taxes on prescription drug companies, medical
device manufacturers, and insurance companies will begin to take effect
before the actual supposed benefits of this bill would come into play.
Studies show these taxes will be passed on to consumers. There is no
doubt about it. Of course they are going to be passed on to consumers.
They are going to be collected for years before there are any supposed
benefits. Then there are the taxes on those who can't afford insurance:
the higher of $695 per individual or 2.5 percent of household income.
Employers will be hit with new taxes. The penalty could be as high as
$2,000 or $3,000 per employee.
What is this going to do to the small businesses of our country,
which create 70 percent of the jobs? At a time when families are
struggling, at a time when our businesses are struggling, at a time
when our economy is at an all-time low--not all-time low, but almost
all-time low; certainly bad--businesses aren't hiring. Why aren't they
hiring? They aren't because they have a fear of the future. They don't
know what to expect going forward. They are not going to start hiring
people until there is a comfort level that the economy has stabilized
and that we are in a real recovery mode. Yet, when people feel that way
and when small businesses feel that way, what is the biggest deterrent
to them being able to say, OK, things are getting better and I can hire
new people? More taxes and more mandates and more burdens. That is what
is going to keep them from taking that leap to hire more people. So it
is like a revolving situation we are not going to get out of as long as
we are continuing to put on more taxes, more expenses, and more
mandates.
We know premiums are going to go up. Premiums are already going up.
Our purpose in this bill should be to bring premiums down by lowering
the cost of health care, not by increasing the cost. That is so
counterintuitive. It could only be thought of in Washington, DC.
Cuts to Medicare. The Senate bill includes over $\1/2\ trillion in
cuts to Medicare. About $135 billion of those are in cuts to hospitals.
Mr. President, in conclusion, the Medicare Program is unsustainable.
The Chief Actuary of Medicare has said that as much as 20 percent of
Medicare's providers will either go out of business or will stop seeing
Medicare beneficiaries.

Millions of seniors, including those who have chosen Medicare
Advantage, will lose the coverage they now enjoy. Medicare is being
used as a piggy bank and it needs every penny that has been deposited.
We cannot pay for reform on the backs of our seniors. Cuts to
hospitals will threaten access to care for seniors in our States.
Third, this bill imposes on States an unfunded mandate to expand the
Medicaid Program. Putting millions of individuals in to Medicaid is a
fast way to quickly reduce the number of uninsured.
Yet by doing so, the Federal Government is sending a very large check
to the States, $20 billion to be exact, with a note that says ``We
decide--you pay.''
At a time when so many States are struggling to balance their
budgets, pay their teachers, improve transportation, maintain services,
this bill imposes more costs.
How much more are we going to ask of our States?
States are in the best position to determine what is right for their
citizens. Yet this bill will take away their right to innovate and
determine fiscally responsible and effective ways to offer affordable
health insurance coverage.
In big government style, this bill manipulates that idea into a one-
size-fits all solution for every single State.
Plus, states should have the option of implementing tort reform as we
have done in Texas. Yet under this bill States are actually punished
for implementing tort reform. Tort reform is essential to bring down
the cost of health care. This bill stiffles the ability to achieve this
commonsense option.
Why not level the playing field for taxpayers by offering tax
incentives to encourage the purchase of health insurance at the State
level. Let citizens in each State decide which health insurance plan
best fits their needs--a decision that should be free from interference
by the Federal Government.
Senator DeMint and I have a bill which would offer a voucher of
$2,000 to individuals and $5,000 to families so they can purchase
health insurance that is portable and not tied to their employer.
These are the right steps to achieving reform and these steps empower
the States rather than violate their rights and impose a heavy handed
Federal approach to reform.
I urge my colleagues to support this amendment which is cosponsored
by Senators Enzi, Coburn, Burr and Brown of Massachusetts.
The bottom line is I hope my colleagues will vote to support the
States rights so that we will be able to address high unemployment as
well as high uninsured rates in a way that will lower the costs and
give more options.
I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I now wish to yield to the Senator from
New York.
I have already said we are going to divide the time in half-hour
segments back and forth.
I yield 10 minutes to the Senator from New York, Mr. Schumer.
The PRESIDING OFFICER. The Senator from New York.
Mr. SCHUMER. Mr. President, I thank the chairman of the Finance
Committee, on which I am proud to serve, for yielding time, as well as
for the great work he has done. I wish to commend Senators Dodd and
Harkin for the great work they have done in the HELP Committee and all
the members of the HELP Committee, as well as the Finance Committee
and, of course, Majority Leader Reid, who has been as solid as a rock
and steadfast in his own quiet way. He is more responsible for this
bill passing than just about anybody else. So I thank our leadership
for that.
I rise today to talk about this historic accomplishment of health
care reform. I congratulate all of my colleagues for their hard work
and dedication. I congratulate the President. He, too, was like a rock.
He never budged. The day after the Massachusetts election, when so many
others were saying we can't get this done and to trim back, he was
steadfast. I saw him and his steadfastness. His internal gyroscope got
us over the goal line.
I wish to address where the future is in this bill in terms of
average Americans. We all know the American people are still trying to
digest the health care legislation we have just passed. That is
understandable. It is a large and complex piece of legislation and, of
course, there has been a tremendous

[[Page S1946]]

amount of misinformation out there about what it does and what it does
not do. To tell the average American that this is truly historic
legislation doesn't get to them. They want to know how it is going to
affect them.
I fervently believe that the more the American people learn about
this bill, the more they will like it. I believe this for two reasons.
First: People very quickly come to see that the myths and lies that
some have put forward about this bill will not come true, because they
are not in reality, and now we are in reality--we are in health care
reality--because the first part of the bill has passed, the major part,
and we will pass the second.
Second: There are so many good things in this bill that people like
and need. As people learn the truth as to what those things are, many
of which will improve their lives--some immediately and some in a few
years--I am confident they will not only like health care reform but
embrace it. When the crime bill was passed in 1994, at first the same
thing happened. There was a parade of horribles. But over the years, we
saw that it reduced crime and made America a better place, and it
became a very popular piece of legislation. I believe the same thing
will occur with this health care bill.
So today I wish to take the rest of my time to describe to average
Americans how this bill will affect them. The No. 1 group, the largest
group of average Americans, is those who are covered by their employer
plan. First, you will keep your coverage. For people who have been
scared into thinking they might lose their health coverage or have the
government telling them what to do or what treatments they could or
could not receive, they are going to discover there is very little
change for them. I had a firefighter employed by the city of New York
on Long Island last week say to me: Don't pass the bill. I will lose my
benefits. That firefighter will see his benefits will stay as good and
as strong as they are now. In fact, it will get better for those folks
who are already covered, because premiums to their employer won't go up
and up and up, and their employer will not continue to ask them, as
they have now, to pay so much more and to get so much less back.
We cannot claim premiums won't go up at all, but we know they will go
up much less. The likelihood of the employer calling a person, the
average person, a worker in their company and saying: Jim, Mary, you
are a great worker. I love you. I want you to stay in my company, but I
am eliminating your health care benefits or I am greatly cutting them
back, will be greatly reduced over the years as this bill becomes law
and works its way.
Beneficiaries, those on private health care, won't pay higher
Medicare taxes. Their benefits will not change. Their choice of doctors
will not change. They will be much better off, and they will learn
that.
Second: To small business owners who are trying to do the right thing
and provide health insurance coverage to their workers and now find
that costs are increasing, which makes it more and more difficult every
year to keep those employees on health care, they are going to find
this year that there is a generous tax credit to make it more
affordable to provide coverage for their employees. The average small
businessperson is going to like this bill because the average small
business owner wants their employees to have good health care coverage,
but they can't do it alone. Now they are going to get some help.
What about to the small business owner who aches because he or she
can't supply insurance because the employee has a preexisting condition
or just because it is too expensive? They are going to find they will
now be able to provide insurance for those folks.
What about all of those families with kids who are now in college and
they worry, once the kid gets out of college, they are not going to
have health care? They are going to find that they are covered up until
their 26th birthday on their parents' plan. They have to be. That is
going to start this year. What a relief to millions of American
families and millions of American students. I know this personally. My
daughter is graduating from law school. When the bill passed at 1 a.m.,
she called me. She was watching when the House bill passed and said:
Dad, I have been worried what I am going to do about health insurance
next year. She is out in the job market. Now I don't have to worry.
That phone call will be repeated by hundreds of thousands and millions
of students to their parents in the next while. So it is great for
them.
What about retirees who are not yet eligible for Medicare, the person
who fears that because they don't have their job or they are retiring
at age 60 or 62, 61, what are they going to do? This bill will provide
more assistance to bring down premiums. It will provide more choices to
these retirees who right now have either no health insurance or a
policy that is so expensive they can't afford it.
What about average Americans who worry because say they have early
stages of diabetes and their health care doesn't cover prevention?
Average American families--and I see the Senator from Iowa is here, who
has been a leader in the fight for prevention--will now get prevention
in their benefits. For the average American who has recently gotten
sick or who might in the future, they don't have to worry that their
insurance company will take away their benefits. They will not be able
to do that the way they do now. We won't have to hear stories anymore
of health insurers looking for any excuse to cut sick people off from
their insurance.
What about those tens of millions on Medicare who, again, have been
scared and worried that Medicare will change? Yes, Medicare will
change. It will get stronger and still preserve the exact same benefit
to every person on Medicare.
Before this bill was signed into law, Medicare was going to go broke
in 7 years. It has been given an extra decade. That should be a huge
load off the shoulders of people who worry about Medicare.
In addition, the doughnut hole will be closed, so all those Medicare
recipients on prescription drugs will get relief--more relief.
For the average senior citizen, as they learn about this bill, they
are going to like this bill. They are going to say this was a great
thing. It kept Medicare as is, surviving much longer than previously
predicted. If we had done nothing and Medicare was about to go broke,
guess who would have paid the price. Those senior citizens on it.
What about young women looking for health insurance? Health reform
means she will not be charged a premium 150 percent more than a young
man's. Health reform ends that gender discrimination.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. SCHUMER. Mr. President, in conclusion, I will just say this: In
November, this bill will be a positive--a strong positive for those who
supported it. Those who were in favor of it will benefit. Those who
opposed it will come to regret their opposition as America learns about
what is in and what is not in this bill. It is not just a triumph for
history; it is a triumph for the average American.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I yield to the chairman of the HELP
Committee--I yield to another distinguished chairman, this one not of
the HELP Committee but the Energy Committee, Senator Bingaman.
The PRESIDING OFFICER. The Senator from New Mexico is recognized.
Mr. BINGAMAN. Mr. President, I thank my friend and chairman of the
Finance Committee, Senator Baucus. I congratulate him on his leadership
on this issue for many months.
I rise in strong support of the reconciliation bill that is before
us. It is a historic time for our Nation. I am very glad that after
decades of effort, national health reform has become law and that we
are considering this set of changes to the law through this
reconciliation bill.
There is considerable confusion about what health reform, in fact,
will accomplish. It is not surprising that there is confusion when one
considers all of the nefarious charges that have been made and claims
of nefarious provisions within the legislation. I am glad to see that
most Americans, according to polling, believe the actual provisions
that are described to them that are contained in the bill are
meritorious and deserve support.
Simply stated, the law has four main goals. It reforms health
insurance markets to ensure Americans have access

[[Page S1947]]

to affordable care that meets their needs. Second, the bill improves
the efficiency and quality of health care and does it in a way that
helps contain rapidly rising costs. Third, the bill improves access to
primary care and preventive services. Fourth, the bill significantly
reduces the Federal deficit over the coming decades.
I think we need to focus on what the effect of the legislation will
be on particular individuals and families in our States.
I look at our circumstance in New Mexico, which I am proud to
represent. Let me pick out a few examples.
First, there are families there who are very happy with their current
coverage. For these folks, reform ensures they can keep that coverage.
They do not have to purchase any new coverage offered through health
insurance exchanges. The reform will help protect their coverage and
introduces important policies to put downward pressure on the cost of
premiums, requirements that the coverage continue to be meaningful, and
significant improvements in the overall quality of and their access to
health care.
Small business owners or the people who work for small businesses--a
third of the people in my home State fall into that category. For those
who do offer coverage, we know that without reform, they have
difficulty affording and keeping meaningful and affordable coverage for
their employees. Premiums are rising quickly. These costs threaten the
financial stability of these small businesses.
CBO tells us that for small businesses, the impact of reform will be
very significant. First, the businesses would have the option to come
to the new health insurance exchanges and would have a guaranteed
source of meaningful coverage for themselves and their employees. In
addition, these small businesses may qualify for tax credits for up to
50 percent of the cost of coverage. For businesses receiving tax
credits, their employees' premiums would decrease by 8 to 11 percent
compared to their costs under current law. Small businesses and their
employees do well.
What about individuals purchasing coverage in the individual market?
This is particularly important in my home State, for over half of the
workers in my State are not offered employer-sponsored coverage. We
have the highest percentage of workers without coverage of any State in
the Union.
Like small businesses, individuals today have great difficulty in
navigating insurance policies, securing affordable and meaningful
coverage. This reform will provide these individuals with the options
to come to new health insurance exchanges and have a guaranteed source
of meaningful coverage for themselves and their families. The
Congressional Budget Office predicts that the subsidies enrollees would
pay would reduce the premiums they otherwise would have to pay by 50 to
60 percent.
Among higher income enrollees in the individual market who would not
receive new subsidies--only about one-fifth of new enrollees--average
premiums would increase by 10 to 13 percent.
This is consistent with estimates of the impact in my home State of
New Mexico, where average families may see a decrease in premiums of as
much as 60 percent as compared to the premiums they would pay without
reform. In addition, about two-thirds of New Mexicans could potentially
qualify for subsidies or Medicaid.
This reconciliation bill also contains important provisions to help
Americans obtain a quality education. The higher education provisions
of this bill will help put college within reach for more Americans. By
eliminating subsidies to private student lenders, the bill supports
large Pell grant increases for low-income college students, grants to
States to help low-income students enter and succeed in college, and
major new investments in minority-serving colleges and universities.
And it does this without raising taxes; in fact, the CBO estimates that
these student loan reforms will reduce the deficit by over $10 billion
over 10 years.
In challenging economic times, we can no longer afford to subsidize
private lenders at the expense of college students and their families.
In my home State of New Mexico, this bill will provide almost $240
million in new Pell grant funding and an estimated $95 million for
Hispanic-serving institutions and tribal colleges over the next 10
years. In supporting economically disadvantaged college students
through this bill, we help them to achieve the American dream. We also
strengthen our economy by ensuring that we continue to have the
smartest, most competitive workforce in the world.
It is clear that the legislation before us and the new health reform
law signed by President Obama yesterday are important steps forward for
our country. Once we get beyond the rhetoric and discuss the specific
reforms in this legislation--it becomes clear that this bill is vital
to our Nation. It protects the aspects of our health care system that
are working well while fixing those things that are broken including
outlawing the nefarious games that health insurance companies play. It
improves health care quality and it reduces costs; reforms the student
loan system and expands important programs to help all America's
children access a higher education--and it does all this while
substantially reducing the Federal deficit.
I hope we can join our colleagues in the House and move swiftly to
pass this reconciliation bill.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. BINGAMAN. Mr. President, I will conclude by complimenting my
other committee chair who is on the Senate floor, Senator Harkin, who
has worked tirelessly to get this legislation through the HELP
Committee. He deserves great credit for his leadership on this bill, as
does Senator Baucus.
The PRESIDING OFFICER. The Senator from Montana is recognized.
Mr. BAUCUS. Mr. President, that is a good introduction to the next
speaker, the distinguished chairman of the HELP Committee, Senator
Harkin.
The PRESIDING OFFICER. The Senator from Iowa is recognized.
Mr. HARKIN. Mr. President, I thank my friend from New Mexico for his
kind words, and I thank him for the great work he did on getting us to
this point.
I have a limited amount of time. I want to respond to the motion to
commit made by the Senator from Tennessee yesterday that would reduce
our investment in Pell grants and replace them with lower student
interest rates.
We all want lower student interest rates. I am, quite frankly,
surprised. I do not remember my colleague from Tennessee or other
colleagues on that side of the aisle raising much cane around here when
the private bankers and Sallie Mae were charging students over 20
percent interest. I did not hear a peep out of the other side.
We have capped all of those interest rates now, and we are changing
this program to a direct loan program to get the middlemen out. By
cutting out the middlemen, by cutting out the huge subsidies to the
bankers, we are able to save over $61 billion over the next 10 years,
which we are using, again, to put into the Pell Grant Program to help
our students.
I said yesterday, and I repeat, think about the present status quo
with this indirect guaranteed student loan program. Think about how
bizarre it really is. The Federal Government pays fees to private banks
to make entirely risk-free loans using taxpayer dollars. The loans,
which are already guaranteed by the Federal Government, are then sold
back to the Federal Government. The banks then pocket tens of billions
of dollars, taxpayers' dollars, in fees and easy profits at absolutely
no risk to them whatsoever. This has been going on for far too long.
What this bill does is it ends that. It takes all those savings that
otherwise would go to Sallie Mae and to the bankers and puts them into
Pell grants.
While I would agree that our students have too much debt--way too
much debt; 73 percent of 4-year college graduates in my State of Iowa
graduated with debt that averaged over $28,000. The national average is
$23,200 for a student graduating from college. My Iowa students have
the second highest debt loads in the Nation. We are taking charge of
that.
Three years ago, in the College Cost Reduction and Access Act of
2007, we created the Income-Based Repayment program. What that bill
said is that a borrower's payment would be capped at 15 percent of
their net income after adjustments are made for living expenses

[[Page S1948]]

and provided total loan forgiveness after 25 years. We targeted that
assistance to people who had the most difficult time repaying their
loan.
More can be done. Here is what we did in this bill. Starting in 2014,
a new borrower's monthly payment will be capped at 10 percent of their
net income. They will be eligible for total loan forgiveness after 20
years. This is going to make college much more affordable for students
even after they graduate.
If my friend from Tennessee wants to look at ways of reducing
interest rates, I am all for it. Some of the biggest users of credit
cards are kids in college, and look what they are being charged under
credit cards--well over 20 percent, 30 percent sometimes on their
credit cards. And they need that for immediate needs. If you are a
parent with a kid in college, you know what I am talking about.
If you really want to help students, how about capping the interest
rates they can charge on credit cards. I advocated that 20 years ago.
We cap it at 12, 15 percent. They cannot charge any more than that. But
I do not hear my friend from the other side talking about that. That
would do more to help our students than just about anything else.
Three years ago when we cut the interest rates on student loans, we
were criticized by the Republicans for not doing enough to increase
Pell grants. Now we are being criticized for doing too much on Pell
grants and not enough on interest rates for students. We see what this
is. It is just another attempt to try to kill this reconciliation bill.
That is all it is. Of course I am for lower interest rates. Who
wouldn't be? Of course we are all for making the interest rates lower.
When this reconciliation bill is through, I intend to come to the floor
on some bill that probably will be coming up--maybe a financial bill or
something like that--and I will be proposing at that time that we have
lower interest rates. I ask my friend from Tennessee to join us in that
effort at that time. But now is not the time and this is not the bill
on which to do this.
We have to get our reconciliation bill through. Every amendment being
offered by the Republicans is no more than an attempt to stop and kill
this reconciliation bill, and we cannot allow that to happen.
We are going to have an education bill this year. We are going to
have an elementary and secondary education bill I hope sometime this
year. Higher Education Act changes are in this reconciliation bill. We
are going to make sure the students have the money to go to college and
Pell grants for the lowest income students. And, yes, we have capped
interest rates at 6.8 percent. Could they be lower? I invite my friend,
when we have another bill up that addresses this, let's see if we can
get lower interest rates. I would be glad to work on that issue at that
time. But right now, let's put the savings, the $61 billion that we are
saving--let's do what this bill does: put it into better Pell grants so
the kids can get into college in the first place.
We also put $2.5 billion into something we have neglected for far too
long; that is, our Historically Black Colleges and Universities and
other Minority-serving Institutions. So a big chunk of that money goes
in there so they can also get a good education.

So this bill was carefully crafted. We put the money in there in the
Pell grants. Let's keep them there and let's address the issue of the
interest rates later on. I invite my Republican friends to join with us
in doing that, especially on credit cards when that issue comes up down
the pike.
Again, I urge my colleagues, when the vote comes up, to defeat the
Alexander motion to commit and to keep the money in there for Pell
grants.
I yield floor.
The PRESIDING OFFICER. The Senator from Montana is recognized.
Mr. BAUCUS. Mr. President, I wish to say a few words about how much
this underlying legislation helps small business. We hear a lot of
claims to the contrary, and I wish to set the record straight.
Essentially, small business people in America today spend about 18
percent more than the large businesses for the same health care
coverage. Why is that? Because of high broker fees--small businesses
have to buy insurance through brokers--because administrative costs are
higher for them compared to big businesses, and adverse selection hurts
them much more than big business. There are a lot of reasons why small
businesses pay 18 percent more for health care than big business.
This legislation contains $37 billion in small business tax credits--
$37 billion in small business tax credits--most of which go into effect
this year, not later but this year, tax credits for a businessperson
who wants to offer health insurance for his or her employees. Add to
that insurance reforms, which are very much going to help small
business. What are they? Preventing insurance companies from
discriminating against small employees based on preexisting conditions,
preventing discrimination on the basis of older or sicker employees,
discrimination based on the size of the plan or discrimination against
those whose employees work in dangerous industries.
All these insurance reforms are going to help small business. I might
say the Congressional Budget Office also estimates the Senate bill will
lower premium costs by nearly 7 percent for small businesses--lower
premium costs, not increase them, as has been suggested, but lower
premium costs for small business.
The bill also provides for State-based exchanges. That is going to
help small business because that will require more competition among
insurance companies. That will help give better rates and better
quality insurance to small businesses.
I might say this as well. The legislation exempts small businesses--
that is a business with 50 or fewer employees--from the requirement
that employers that do not sponsor health care insurance pay a fee for
their employees receiving premium tax credits. That is an exemption for
small businesses with fewer than 50 employees from paying any penalty
if they do not provide insurance.
So I wished to make it very clear that this bill very much helps
small business--and I repeat--with $37 billion in small business tax
credits, along with the other reasons I gave.
Mr. Chairman, how much time remains?
The PRESIDING OFFICER. There is 1\1/2\ minutes remaining.
Mr. BAUCUS. Mr. President, I don't know if Senator McCaskill is in
the Chamber. I doubt she wants to take 1\1/2\ minutes. If not, I will
yield back the 1\1/2\ minutes.
I understand Senator McCaskill is here now and wishes to speak, so I
will try to find a way to squeeze in as much time as I can.
You are on.
The PRESIDING OFFICER. The Senator from Missouri is recognized, and
she has 1 minute.
Mrs. McCASKILL. Mr. President, I am confused about why the hearing we
had scheduled this afternoon cannot go forward. The subject matter of
this hearing is oversight of the contract that is engaged in police
training in Afghanistan in the Subcommittee on Contracting Oversight.
This is a hearing that is getting to the heart of the matter; that we
have a real problem with the mission part in Afghanistan on police
training because of problems with these contracts--problems with
oversight at the State Department.
We have now canceled the hearing because we have been told we can't
have it. The witness from the State Department has been canceled, the
witness from the Defense Department has been canceled, and the
inspectors general who were coming to testify about a GAO report that
just came out last week that was damning in its criticism in the
oversight of these contracts.
The PRESIDING OFFICER. The Senator's time has expired.
Mrs. McCASKILL. I don't get it.
The PRESIDING OFFICER. The Senator from Montana is recognized.
Mr. BAUCUS. Mr. President, is there an order providing for the next
half hour?
The PRESIDING OFFICER. There is not.
Mr. BAUCUS. I ask unanimous consent that the Republican side control
the next half hour and that the majority control the half hour
following that.
The PRESIDING OFFICER. Is there objection?
Mr. GREGG. Reserving the right to object, that would be a half hour
off, so

[[Page S1949]]

we should have the half hour after that because you got the first half
hour.
Mr. BAUCUS. We won't worry about that yet.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mr. GREGG. Mr. President, the Senator from Maine is about to take the
floor.
The PRESIDING OFFICER. The Senator from Maine is recognized.
Ms. SNOWE. Mr. President, I wish to thank the Senator from New
Hampshire very much for his leadership and for consideration of the
time today.
As consideration of health care reform draws to a close in the Senate
with the pending reconciliation bill, I cannot help but arrive at this
moment with a sense of profound disappointment in considering what
might have been, rather than what has actually occurred with respect to
one of the foremost domestic matters of our time.
As I stated as a member of the Senate Finance Committee at the
conclusion of our markup of health reform legislation last October,
this is one of the most complex set of issues ever placed before us. At
the same time, I have said the reality that crafting the right approach
is arduous in no way obviates our responsibility to make it happen,
given the enormous implications of reordering more than $33 trillion in
health care expenditures over the next 10 years, representing one-sixth
of our economy and affecting every American.
Well, if there is one thing I have learned, it is that the only way
to allay people's fears is by systematically working through the
concerns, the issues, and the policy alternatives from all sides. When
we hear proponents portraying the passage of health care reform as the
equivalent of landmark legislation of the past, what they fail to note
is, those efforts were all bipartisan. Regrettably, part of the history
we made this week is that, for the first time, a truly watershed bill
became law purely along partisan lines.
As I mentioned on the floor last November, it is almost impossible to
imagine how transformational legislation over the last nearly 100
years, such as Social Security, Medicare, and civil rights could have
been as strongly woven into the fabric of our Nation had they forsaken
bipartisanship.
We could have extended that bipartisan legacy. The majority had 60
votes for health care reform, so they had a choice. They could have
worked collaboratively to develop a more balanced, effective, and
credible approach that--even if it ultimately failed to attract many
Republican votes--could have resulted in legislation more widely
embraced by the American people because, in the final analysis, no one
party or person has a monopoly on good ideas.

That is precisely the reality that originally brought six of us
together in the Senate Finance Committee in the so-called Gang of 6, to
the credit of Chairman Baucus, who convened a meeting last summer,
along with Ranking Member Grassley, and that the chairman and ranking
member referenced earlier in the debate on the floor. I commend them
for what was the only bipartisan effort in any committee of the House
and Senate. Certainly, that has been true and indicative of their
collaborative, cooperative relationship. As the chairman pointed out,
we met 31 times, week after week, for over 4 months, to debate policy
and not politics because we were attempting to reach bipartisan
consensus on reform legislation.
While we ultimately did not reach an agreement, given our discussions
were ended prematurely by an artificially imposed deadline, our efforts
did, in many ways, form the foundation for the subsequent Finance
Committee legislation that, while far from perfect, produced bipartisan
reforms, including banning the egregious practices by the insurance
companies that have been discussed so often. We tried to navigate the
ideologies on both ends of the political spectrum.
At the same time, as I stated at the conclusion of the Finance
Committee markup, the issue of affordability remained one of my
paramount concerns. I further expressed that we could not create vast,
new bureaucracies and governmental intrusions. Finally, I said my vote
to report the bill out of the committee was to continue to work to
improve the legislation and, therefore, it would be imperative moving
forward that the majority in the Senate give deference to the scope and
the complexity of this issue, earn broader support, and resist the
impulse to retreat into partisanship.
Yet regrettably, since the Finance Committee vote on October 13, the
wheels essentially came off. The process went behind closed doors, with
only one party represented. Long gone was the transparency of the
Finance Committee debate, and what came to the Senate floor was a
2,400-page bill--900 pages longer than the Finance Committee bill--that
we were forced to complete by Christmas Day, after a mere 21 days on
the floor. In looking at a relative equivalence in terms of benchmark
legislation, the Senate debated the Civil Rights Act of 1964 for 57
days. In the FAA bill that we just considered--that we just voted on
this past Monday--we disposed of 45 amendments. That is 17 more than we
addressed in the amendment process on health care reform legislation in
December. What exactly were people afraid of?
Think what we could have been celebrating today if we would have had
the open amendment process we had been promised or even if we had had,
as I urged, that bipartisan summit last October instead of just last
month. If it was a good idea now, it would have been a good idea then.
Imagine if everyone had the opportunity to sit down with the actual
legislative language and work through all the issues, determining what
works and what doesn't work. We could have crafted a better product.
But now we will never know. We could have, instead, developed something
practical, rolled out in phases--something all the more critical, given
we are already in treacherous economic and fiscal waters.
It is not as though we lacked the time. After all, the major
provisions of this initiative do not even take effect until 2014. In
fact, CBO has said that with the majority of the reform measures not
scheduled to commence until then--4 years from now, by year 2013--there
will still be 50 million uninsured Americans, exactly the same number
as today.
There are those who will argue that the Senate-passed legislation was
basically the same bill that emerged from the Finance Committee. But
the facts tell a story of a different bill that, far from improving
upon the finance measure, as I had indicated would be critical, instead
went precisely in the opposite direction from what Americans wanted--
with greater bureaucracy, more taxes, and ill-conceived measures that
will cost our Nation jobs rather than help to create them.
Look at this chart, with respect to the employer mandate, to cite
some examples. Something of critical importance to me, as ranking
member of the Senate Small Business Committee, the Finance Committee
proposal contained no employer mandate per se, forcing firms to offer
health insurance. Rather, it specified that if a firm chose not to
offer insurance and any of its workers received subsidized coverage in
the exchange, the firm would pay a penalty equal to the lesser of an
average credit amount that the employee received in the exchange or a
flat $400 fee for all its workers.
While I would have preferred a zero penalty, the Senate-passed bill
actually got worse, as you can see with this chart. First, penalties
nearly doubled from those in the Finance Committee package to $750 per
employee. Then it greatly expanded the instances in which penalties
would be applied, requiring employers with more than 50 full-time
employees who don't at least offer coverage and have even one full-time
employee receiving a subsidy through the exchange to pay $750 for each
of its full-time workers.
Under the reconciliation package that is pending before the Senate,
firms with more than 50 workers would have to pay $2,000 per employee
with just the first 30 employees exempted. That is a 167-percent
increase over the $750 in the bill that was just signed into law. So we
have gone from $400 to $750 and now to $2,000.
If that is not enough, part-time workers and seasonal workers will
now be counted in determining whether the mandate will apply. That will
be devastating. It will be devastating to

[[Page S1950]]

small firms, middle-sized firms, restaurants, retailers, and seasonal
industries, such as those in my State of Maine, that will be subject to
this mandate, which now produces $52 billion in revenue, up from the
$27 billion in the bill that just became law.
Exactly how is this going to help our Nation's greatest job
generators--our small businesses--that we are depending on to lead us
out of this downturn?
Now let's look at the Medicare taxes, the second chart. The finance
bill did not contain any form of Medicare taxes. We did not increase
Medicare taxes. The Senate bill that just now became law, signed by the
President yesterday, included $87 billion in Medicare taxes. That
disproportionately affects small businesses because they apply to the
income those businesses would normally reinvest.
Plain and simple, this .9 percentage point increase in Medicare
payroll taxes is a job killer as it essentially takes away 1 additional
percentage point of capital from the very small business owners we are
depending on to create jobs, who are more than likely to employ between
20 and 250 employees, all at a moment when we should be looking for
ways to help bring capital into small businesses.
If that were not bad enough, here we have reconciliation that is
pending before the Senate that compounds the mistake with a 3.8-percent
Medicare tax that is unprecedented because it is imposing a payroll tax
on investment income. When combined with a capital gains tax increase
the majority is planning for the end of this year, this 3.8 percent tax
will raise the capital gains tax rate to an astonishing 23.8 percent,
which is a 67-percent increase in taxes on investment during these
precarious times.
Taken together, it is a grand total of $210 billion in Medicare
taxes. So we went from the Finance Committee at zero to the Senate-
passed bill that became law yesterday at $87 billion, and now in the
bill pending before the Senate, we have a grand total of $210 billion
in Medicare taxes.
It is a hidden tax, by the way. It is not indexed for inflation, so
it will be similar to the alternative minimum tax that is going to
continue to ensnare more and more people in this tax. It is a major tax
increase on individuals, small businesses, on capital, at a time when
we desperately need that capital to be reinvested to create more jobs.
Again, we have gone from zero to $210 billion in new taxes in
Medicare. Do we seriously believe this is the time we should be
instituting these breathtaking and job-killing increases, not to
mention the unprecedented shift because not one dollar gets reinvested
in Medicare--not one dollar--not to mention it does not address the
physician problem with a 21-percent reduction in provider reimbursement
that we have to extend this week for another month because it is a
month-to-month problem. We need a 10-year fix. That will be over $200
billion but, rather, we are taxing it for other purposes rather than
into Medicare. But unfortunately, that's what becomes of a broken
process.
Look at what two of the largest organizations representing small
business in America stated upon passage of the finance bill. The
National Federation of Independent Business said at the time the
finance bill passed on October 13:

NFIB appreciates the many provisions in this package that
reflect small businesses' needs, which are rooted in
approaches that aim to lower costs, increasing coverage
options, and provide real competition in the private
marketplace.

Fast forward to the Senate-passed bill in December that now became
law as a result of the President signing it yesterday. Now what does
NFIB, the National Federation of Independent Business, have to say?

The impact from these new taxes, a rich benefit package
that is more costly than what they can afford today . . .
[and] a hard employer mandate--

The one I referred to earlier--

equals disaster for small businesses.

On March 21, they said:

We couldn't have been clearer how damaging this bill will
be to America's small businesses and the economic recovery of
this country.

Particularly in these precarious economic times, shouldn't that make
us all deeply concerned?
Now consider what the National Small Business Association released
this weekend. I have that on a chart as well.

We have continued to work positively for needed changes . .
. but it is now clear that most of these recommendations have
not been accepted. . . .We understand that it is impossible
to create a significant reform such as this one without some
objections from nearly every constituency. But our objections
to this bill go beyond those reasonable expectations.
Congress can do better.

To which I add, I could not agree more. They say they oppose the
health care reform bill with regret but they base it on all the
significant issues that have been incorporated in this legislation that
will be damaging to small businesses. I could not agree more.
Furthermore, I am deeply troubled by the manner in which the Medicare
tax increases in this bill are to be utilized--$210 billion. According
to CBO, and this is their exact words:

To describe the full amount of the [Medicare] trust fund
savings as both improving the government's ability to pay
future Medicare benefits and financing new spending outside
of Medicare would essentially double count a large share of
those savings and thus overstate the improvement in the
government's fiscal position.

So, No. 1, talking about the fact of the reduction of deficit, it is
not going to improve that; and No. 2, whether or not it can be plowed
back into Medicare, obviously it is not going to affect Medicare's
insolvency issue because it is going to go to other purposes and is not
intended for the Medicare trust fund. How are we going to strengthen
Medicare when these new tax dollars are being diverted from their
original intended purpose of actually paying for Medicare benefits?
Another major difference in the legislation we passed in the Senate
Finance Committee on October 13 and in the pending reconciliation bill,
is the so-called CLASS Act. While proponents point to estimates that
this provision would raise $72 billion over the first 10 years, that
savings only occurs as a result of a fiscal shell game of using funds
promised to pay beneficiaries later to lower the deficit today. As CBO
says, ``The program would pay out far less in benefits than it would
receive in premiums over the 10-year budget window,'' raising $70
billion in premiums that will fund benefits outside the window, and as
a result, CBO further concluded that ``in the decade following 2029,
the CLASS program will begin to increase the deficit.'' Again, this is
exactly the wrong direction for America.

Perhaps most disturbingly, we don't even have answers from CBO to
many of the most fundamental questions in the minds of Americans, the
minds of small businesses--what will be the true impact? Those were
questions I posed to CBO on December 3 to which I still don't have the
answers. What provisions in the legislation would justify and
facilitate premium increases, and to what extent would other provisions
limit their outcome? What would go up and what would go down? We need
to know what is going to drive up premium costs and what is going to
lower premium costs. Indeed, the headline on Tuesday in my home State
newspaper the Portland Press Herald was ``Mainers Wait and Wonder: How
Will Reform Affect Us?''
That is why I also requested from CBO specific state-by-state
analysis of reform's effects on premiums, because while we do have from
CBO a national average for premiums, what they would be for minimum
credible coverage under the new law, the reality is that cost will vary
widely from State to State. That is why I proposed and I asked CBO what
the impact would be of opening up the legislation to extend the ``young
invincibles'' plan, that catastrophic coverage for young people, to all
Americans and extend those subsidies to that coverage as well so
everyone at least has one affordable option to purchase health
insurance. Why? Because the Federal Government is requiring for the
first time that individuals purchase health insurance--that is, first,
individual mandates; second, it sets new standards in the plan and the
exchanges that could drive up premium costs for certain individuals and
small businesses. So shouldn't we have the certainty that affordable
choices are available? Yet we do not even have substantiation whether
provisions of this reform will make health care costs higher or lower.
In fact,

[[Page S1951]]

there is actually a presumption in the legislation that costs may well
go up.
I find it telling that the excise tax on high-cost insurance in this
reconciliation contains a fail-safe provision, referred to as a health
cost adjustment percentage, that automatically raises the threshold to
higher numbers. That was described in the House Democratic summary of
reconciliation. They put it this way:

CBO is wrong in its forecast of the premium inflation rate
between now and 2018.

Maine is a high-cost State, regrettably, because it is not a
competitive market. We have high-cost plans, along with 16 other
States. But given that the bill already provides for thresholds as high
as $13,900 for individuals and $36,450 excluding vision and dental
benefits before triggering the excise tax, those thresholds are
significantly higher than those that were passed in the Senate-passed
bill yesterday. Now they will be raised even higher under the pending
reconciliation.
The question is, Why exactly would we still require a medical
inflation adjusted for 2018, 8 years from now, that raises those
thresholds even higher? What does that say about the performance
confidence in reining in medical costs as a result of this legislation
that was signed into law and the pending reconciliation? It says they
simply do not know. The fail-safe automatic increase in the threshold
clearly assumes this legislation still may not address runaway costs.
The PRESIDING OFFICER (Mrs. Hagan). The time of the Senator has
expired.
Ms. SNOWE. I ask unanimous consent for 1 additional minute.
The PRESIDING OFFICER. Without objection, it is so ordered.
Ms. SNOWE. Madam President, these are the thresholds. Eight years
from now--the legislation suggests that because of inflation for
medical costs that outpaces inflation two to three times, they are
saying that 8 years from now, we will not have controlled medical costs
even with the passage of this legislation having taken effect as a
result of yesterday. It is precisely because of this uncertainty that I
will be offering amendments to address these very issues.
Somehow, the high worth of legislating, of deliberating, of ironing
out our differences has been cast aside in favor of either/or
propositions when we could have instead risen to the monumental
challenge with the best possible solution to strengthen America's
health care today and for generations to come. I profoundly regret that
this process has provided far too few opportunities to forge
legislation that would stand not just the test of our time but for all
time. We could have done better and we should have done better.
I yield the floor, and I ask unanimous consent to have printed in the
Record the NSBA statement of March 19, 2010; the NFIB statement of
November 19, 2009; and the Portland Press Herald article of March 23,
2010.
There being no objection, the material was ordered to be printed in
the Record, as follows:

[From the National Small Business Association, Mar. 19, 2010]

NSBA Opposes Health Care Reform Bill, With Regret

Despite the extraordinary need of small businesses for
health care reform, the National Small Business Association
cannot support the reform bill currently pending before
Congress. This bill will place significant new pressures on
small businesses to both offer and pay for employee health
insurance, starting in the earliest stages of reform.
However, the provider-level reforms that could contain costs
and enable small businesses to afford this commitment will
not be fully effective for many years--if at all. We
justifiably expect that small companies caught between these
twin pressures will see their ability to grow, prosper, and
create jobs greatly diminished.
As long-time advocates of fundamental reform of the health
care system, we had high hopes for a reform measure that
could be more broadly embraced and that we could support.
Indeed, the current bill has many positive features that NSBA
supports: repair of the dysfunctional individual and small
group insurance markets; focus on individual needs and
responsibilities, rather than all-encompassing employer
mandates; and a start on transforming the delivery system
incentives that have driven health care costs to
unsustainable levels.
The shortcomings, though, also are significant.
Small business health premiums will continue to increase
sharply, as even the Congressional Budget Office has
determined.
The legislation does nothing to encourage cost-conscious
consumer behavior, aside from the unnecessarily blunt
``Cadillac tax,'' which will not begin to have an effect
until at least 2018, and which is insufficiently transparent
and imposes unintended administrative burdens on small
businesses.
The previously mentioned delivery system reforms are
positive, but are too back-loaded, giving powerful vested
interests years to water them down or remove them entirely.
Even if implemented, they are not likely to have a
significant effect on costs for a decade or more. Malpractice
reform, absent from the current legislation, would make these
reforms much more effective.
Though currently excluding most small companies, the large
increases in ``free-rider fees'' are troubling. If there was
once a distinction between an employer mandate and a free-
rider provision, it seems to have been lost.
The very large tax increases on both earned and unearned
income could have a significant effect on many small business
owners and their ability to reinvest in their companies'
growth. These increases are in addition to the
administration's current budget proposal which calls for
significant income tax increases on the same individuals.
Together, these taxes will create a steep increase in
marginal tax rates on the very entrepreneurs we need to be
investing and creating jobs.
NSBA has stood apart from many other business groups during
deliberations on health care reform, preferring to be a
nonpartisan, thoughtful, and member-driven organization. We
have continued to work positively for needed changes to the
legislation, but it is now clear that most of those
recommendations have not been accepted and that the bill is
in its final form. We understand that it is impossible to
create a significant reform such as this without some
objections from nearly every constituency. But our objections
to this bill go beyond those reasonable expectations.
Congress can do better. A sense of urgency on cost
containment is the place to start.
____

NFIB Statement: Senate Health Bill

Washington, DC, Nov. 19, 2009.--Susan Eckerly, senior vice
president of the National Federation of Independent Business,
the nation's leading small business association, issued the
following statement in reaction to the Patient Protection and
Affordable Care Act:
``Small business can't support a proposal that does not
address their No. 1 problem: the unsustainable cost of
healthcare. With unemployment at a 26-year high and small
business owners struggling to simply keep their doors open,
this kind of reform is not what we need to encourage small
businesses to thrive.
``We oppose the Patient Protection and Affordable Care Act
due to the amount of new taxes, the creation of new mandates,
and the establishment of new entitlement programs. There is
no doubt all these burdens will be paid for on the backs of
small business. It's clear to us that, at the end of the day,
the costs to small business more than outweigh the benefits
they may have realized.
``Small businesses have been clear about their needs in
health reform; they have been working for solutions for more
than two decades. They have a unique place in this debate
because of the exceptional challenges they face. They
experience the most volatile premium increases, are the most
cost-shifted market, see the most tax increases and have the
least competitive marketplace. For all these reasons, they
especially need reform, but these reforms can't add to their
cost of doing business. The impact from these new taxes, a
rich benefit package that is more costly than what they can
afford today, a new government entitlement program, and a
hard employer mandate equals disaster for small business.
``We are disappointed that, after so many months of
discussion, small business could be left with the status quo
or something even worse. Unless extreme measures are taken to
reverse the course Congress is on, small business will have
no choice but to hope for another chance at real reform down
the road.
``Congress is running out of opportunities to prove to
small business that they are serious about helping our
nation's job creators. We are hopeful that a robust
bipartisan debate will produce a bill that small businesses
see as a solution and not another government burden.''
____

[From the Portland Press Herald, Mar. 23, 2010]

Mainers Wait and Wonder: How Will Reform Affect Us?

(By John Richardson)

Terri Grover of Portland watched from her home Sunday night
as Congress finally passed health-care reform legislation.
She didn't realize that her 22-year-old daughter, a senior
at Bates College, was glued to the television, too.
``My daughter called from college last night at 10:45 and
said, `They passed it, they passed it! Does that mean I'm
going to get insurance?' '' Grover said.
Grover is pretty sure the answer to that question is
``yes.''
The legislation, which still needs to be signed by
President Obama and then amended by the U.S. Senate, says
dependents will be eligible to stay on their parents'
policies until they turn 26.
However, Grover is still nervous about all of the details
in the complex reform package, some of which have yet to be
finalized.

[[Page S1952]]

Some Mainers, including Grover, said Monday that they're
excited about the legislation.
Others said they fear that the added costs and regulation
will just make matters worse.
All agreed, however, that there is much uncertainty and
confusion about how it will ultimately affect their health
care costs, their jobs and their businesses.
``We all want to know,'' Barbara Thorso of South Portland
said Monday afternoon between bingo games at the city's
community center.
Thorso, 87, is president of the Three Score Plus Club,
which hosts the weekly gathering.
``We're the general public. This bill is going to cover
us,'' Thorso said. ``I would like to have an understanding of
what's in the package. I don't have a clue.''
The 10-year, $938 billion bill will eventually extend
coverage to 32 million uninsured Americans, prohibit
insurance companies from denying coverage to sick people, and
create insurance marketplaces, called ``exchanges,'' intended
to make coverage more affordable.
Other changes will be more immediate, such as subsidies to
help senior citizens pay for drugs and the requirement to let
dependent children remain on their parents' health insurance
plans until age 26.
``It's really too soon to know how all of this is going to
unfold. Some of the provisions of the bill don't go into
effect until 2014, and some after that,'' said Katherine
Pelletreau, director of the Maine Association of Health
Plans, an association of health insurance companies.
``In truth, I'm trying to understand it, to dissect it so
we can know what the impacts and (employers')
responsibilities are, and that's going to take some time,''
said Dana Connors, president of the Maine State Chamber of
Commerce.
``The big question is . . . does it reduce costs or does it
add costs?''
Parker Williams of South Portland believes that the
legislation will hurt businesses and cost jobs. ``Where are
they going to get the money to pay for it?'' said Williams.
``It will take 10 years before it will start to save money.''
Anne LaForgia of South Portland said she has more faith in
President Obama.
``Most of the people our age are very concerned,'' said
LaForgia, who is 84. ``I'm really hopeful . . . I don't think
it will hurt (seniors covered through Medicare). I'm more
worried about the younger people.''
Toni Fizell and Sharon Haskell, both of South Portland,
could be directly affected by the legislation. Fizell, who is
59, has no health insurance.
Haskell, who is 63, expects that she will be uninsured,
too, after her rate goes up in June.
Both are more nervous about the bill than optimistic.
``It's scary to listen to (the debate),'' Fizell said.
``Everybody has to have insurance. . . . How are they going
to enforce that?''
The bill will eventually require people to buy insurance or
pay fees, and it includes subsidies to help people who can't
afford it.
Haskell, who lost her job and her employer insurance last
year, said she doesn't expect any help from the legislation
before she turns 65 and is eligible for Medicare. ``I'm just
going to look for something part time and pray that I stay
healthy,'' she said.
Grover, who celebrated on the phone with her daughter, is
confident that the legislation will be an improvement,
despite all the details.
``Young people will be able to search for the right career
for them rather than search for any job that will give them
health insurance,'' she said. ``I wish the whole thing went
into effect faster.''

The PRESIDING OFFICER. The Senator from North Carolina.
Mr. BURR. Madam President, how much time remains?
The PRESIDING OFFICER. Nine minutes.
Mr. BURR. Will the Chair please notify me when I am down to 1.
I will also offer an amendment tonight, and the purpose is very
clear: it is to protect the health care of our Nation's servicemembers,
veterans, and their widows, orphans, and dependents. The problem is,
since the debate on health care reform began, our veterans and their
families have asked for just one thing: Protect our health care
benefit. The President even promised. He said that ``one thing that
reform will not change is veterans health care. No one is going to take
away your benefits--that is the plain and simple truth.''
Unfortunately, the Patients Protection and Affordable Care Act does
not explicitly protect the health care of our Nation's servicemembers,
veterans, their widows, orphans, or dependents. Let me explain why.
Under this health care bill, it requires a minimal essential coverage
of any health care plan. The requirements for that health care do not
clearly include TRICARE, which is the Active-Duty family members of our
troops; the VA's spina bifida program for children under our Agent
Orange veterans under chapter 18 of title 38; and CHAMPVA, a program
run out of the Veterans Administration for spouses and dependent
children of veterans who died or are profoundly disabled as a result of
military service; and possibly VA's vocational rehabilitation program.
As a result, these beneficiaries could be forced to pay additional
insurance or to pay punitive fees because the threshold of coverage
does not meet the threshold defined in this bill.
Apparently, the authors were so preoccupied with the sweetheart deals
and backroom negotiations that they forgot to uphold their promises,
they forgot about the policy part of this health care bill.
Both the House and Senate have acknowledged the oversight I am here
to correct. As soon as the issue was identified, the House rushed
through on Saturday to pass a bill to put a technical correction on the
Department of Defense piece. The bill passed with overwhelming
support--403 to 0. The problem is, the only piece that the DOD
technical corrections piece fixes is, in fact, TRICARE.
It does not fix spina bifida for the children of Agent Orange
survivors. It does not fix CHAMPVA, which is the program for spouses,
dependent children of veterans who are profoundly disabled as a result
of military service.
Now, identical legislation was introduced in the Senate, and some
claim, well, we just need to pass that. Well, you need to pass that if,
in fact, you do not want to extend CHAMPVA and spina bifida.
I have to commend that Secretaries Shinseki and Gates have tried to
alleviate the concerns. I certainly appreciate their reassurances.
However, the greatest assurance you can provide is to be unambiguous
about the issue. We owe it to our Nation's veterans, to their families,
to leave uncertainty outside and to spell it out in the legislation
that these items meet the threshold. Therefore those families, those
servicemembers, are not obligated in the future for additional
penalties and/or fees to participate.
It is time we started to listen to the American people, especially
when it relates to our Nation's veterans and their families. My
amendment maintains the integrity of the health care system of VA and
DOD. It ensures that the authority of the Secretary of the Department
of Defense and the Secretary of Veterans' Administration would not be
challenged or obstructed by any provision in the Patient Protection and
Affordability Care Act.
My amendment will ensure that nothing in the Democrats' health care
bill should be construed as affecting benefits provided under TRICARE
or any VA health care program.
Finally, my amendment ensures that the minimal essential coverage--
key words, ``minimum essential coverage''--under this Democratic health
care bill includes TRICARE and all health care provided by the VA.
I think it is important to remind my colleagues that over the weekend
the veterans service organizations have expressed their deep concern,
and more than one VSO, Veterans of Foreign Wars, said this:

Bill language is important, and that's why the VFW remains
adamant to expeditiously fixing the new law. All of DOD's
programs should have been in the original bill, as well as
all of Title 38, not just one part of one chapter. This is
not playing politics, this is protecting the hard earned
health care coverage our veterans, servicemembers, and their
families deserve.

Some might come to the Senate floor later and say, well, this is not
the appropriate place to fix it. The reconciliation bill has been
billed as ``the bill to fix everything'' that is wrong in the original
health care bill. That is how it was sold to House Members: Vote for
the Senate bill, and we will fix all of those things that you find as
problems in the reconciliation bill.
We have before us the reconciliation bill, and some will argue that
fixing it for our Nation's veterans, their spouses, their family
members, that this is not the appropriate place to do it. I agree. We
should have gotten it right the first time. We should not have to have
a fix-it bill. But when we do not bring sunlight to it, when we exclude
people who are focused on policy, this is what we get. We get a bill
that does not fulfill the promise the President made.
Let me just state again exactly what they were. The President said:

One thing that reform won't change is veterans health care.

[[Page S1953]]

He went on to say:

No one is going to take away your benefits, that is plain
and simple truth.

Well, if it is plain and simple truth, then this body has no choice
tonight but to take my amendment, to pass my amendment, to incorporate
it in the health care fix bill, the reconciliation bill, and to make
sure that when we finish our business, whether that is tomorrow or the
next day, that, in fact, it is very clear in the health care bill who
is covered. It is not just TRICARE for Life, it is TRICARE; it is spina
bifida for the children of Agent Orange exposure; it is the CHAMPVA
program, which covers spouses, children, and the severely disabled of
those killed in action.
My hope is that all of my colleagues will see the wisdom in
supporting this bill, that they will not look for another avenue to do
it in, that they will put it in the fix bill, and they will not leave
it up to Secretaries to give us the assurance when we have set up so
many outside panels to interpret for the American people what their
coverage is going to be in the future.
I think sometimes we can forget the complicated maze this bill
creates, where we will actually have nonproviders determining whether
your coverage is sufficient that you constructed or that your employer
provided for you or that you went out as an independent and bought, and
if it does not meet the standard of minimum essential coverage, then
you could open----
The PRESIDING OFFICER. The Senator has 1 minute remaining.

Mr. BURR. I thank the Chair.
Then you could be exposed to a fine because a government bureaucrat
has determined that the coverage, the health care coverage you bought,
that you were given, is not sufficient enough to meet the minimal
essential coverage this bill crafted.
Well, very simply, there are veterans around the country who know
they have been left out--their spouses, their family members, their
kids with disease. Tonight we can assure them they are included by, in
the health care fix bill, actually fixing that one piece and making
sure that we extend the coverage the President promised and that we owe
to these veterans and their families.
When I introduce that bill, I hope all 100 Senators support it like
the House has. I thank the Chair.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, I think the half hour has now turned to
our side.
The PRESIDING OFFICER. That is correct.
Mr. BAUCUS. I yield to the Senator from Michigan for a request.
The PRESIDING OFFICER. The Senator from Michigan

Request for Committees to Meet

Mr. LEVIN. Madam President, I make this request as chairman of the
Senate Armed Services Committee. I would note that this unanimous
consent request is supported by my ranking member, Senator McCain.
We have three commanders scheduled to testify this afternoon. They
have been scheduled for a long time. They have come a long distance.
One of them has come from Korea; one of them has come from Hawaii. I
would therefore ask unanimous consent that the previously scheduled,
currently scheduled hearing of the Committee on Armed Services, be
allowed to proceed and that we be authorized to meet during the session
of the Senate on Wednesday, March 24, 2010, at 2:30 in open and closed
session to receive testimony from ADM Robert Willard, U.S. Navy,
Commander U.S. Pacific Command; from GEN Kevin P. Chilton, U.S. Air
Force, Commander of the U.S. Strategic Command; and from GEN Walter
Sharp, U.S. Army, Commander U.S. Forces Korea, in review of the defense
authorization request for fiscal year 2011, and the future years
defense programs.
Senator McCain supports this request. I understand it is not likely
there will be any votes on the floor until 5:30 this afternoon.
The PRESIDING OFFICER. Is there objection?
Mr. BURR. As a member of the committee, and I side myself with the
chair and the ranking member that I have no personal objection to
continuing. There is objection on our side of the aisle. Therefore, I
would have to object.
The PRESIDING OFFICER. Objection is heard.
The Senator from Montana.
Mr. BAUCUS. Madam President, I yield to the distinguished senior
Senator from California, Mrs. Feinstein, 10 minutes.
The PRESIDING OFFICER. The Senator from California.
Mrs. FEINSTEIN. I thank the distinguished manager of the bill for his
work on this which has been prodigious, long, and, I hope, not too
exhausting.
I want to speak rather personally about health care reform, why I
support the bill that has been signed by the President, why I support
the reconciliation bill, and why I will oppose any amendment no matter
how good that amendment may appear to be.
I am a doctor's daughter, and I am a former doctor's wife. So I have
lived most of my life in a medical family. I have had very good health
care. My father, who was chief of surgery at the University of
California Medical Center, never operated on anyone he did not make a
house call on. He was well respected by his students and a great
surgeon.
My husband who died was a neurosurgeon, and his practice was spent in
stereotactic surgery with respect to people who had abnormal movements
and could not control their movements. So I came to believe that we had
the best medical system in the United States of America.
It was only in the last few years that I began to see how much
medicine had changed in America. We walked into a doctor's office, and
it was not like one secretary in my father's office; it was a bank of
files and pressure and lines waiting to be seen. I realized that there
were so many people who did not have good health care, who worried
about losing their health care, and, in fact, were losing their health
care; that this kind of reform suddenly was open to me.
Then I looked at some statistics because I thought, America is
spending all of this money, spending nearly 15 percent of our GDP on
health care, we must be getting substantial bang for the buck. And here
is what I found instead.
According to the World Health Organization, the top health care
systems in the world begin with France, No. 1, Italy, and it goes on.
The United States is ranked 37.
So let's go on. Infant mortality: I think infant mortality is a good
criteria of care because we know with good medical care we save babies.
I thought surely America is going to be No. 1 in terms of infant
mortality. No, we are No. 22. It is, in fact, Japan at the top with 3
deaths per 1,000 births.
So let's look a little further. Avoidable mortality rate: This is
deaths that you can avoid with good medical care. Well, we have great
medical institutions. You would expect that we would rank very high.
Again, France is No. 1, and the United States is not 2, 3, 4 or 5 but
No. 15. And the source of that is the Commonwealth Fund.
Well, I then began to think more deeply about it and to realize that
we have all of these people in this country growing who are uncovered.
In fact, in California, my State, a State of nearly 40 million people,
in the last 2 years, each year the uninsured have gained 1 million
people. So over the past 2 years, California has lost insurance for 2
million people, bringing the total of people up to 8 million who have
no insurance whatsoever.
Then you see companies, when the people get sick with HIV, with full-
blown AIDS, will just simply cancel their policies and throw them out.
Then you learn that there is such a thing as a preexisting condition.
We all come with certain preexisting conditions, or probably at one
time in our life we will have one.
We find there are companies that will not grant insurance if you have
a preexisting condition. In my 17 years in the Senate, 18 years in the
Senate, we have had numerous people write and say: I have been denied
this treatment, or, I have been denied that treatment. Would you please
try and help me? And we do. Sometimes we win, and we get a procedure
for them that they had been denied by their insurance company. So it is
so important to know what this bill will do; that it will essentially
cover 32 million or 95 percent of the people of this country with some
form of insurance.

[[Page S1954]]

When the exchanges are functioning, they will have real choice if
they wish it. Their insurance will not be taken away from them. Right
away, this year, yesterday, those of us who were at the White House
heard the President say that immediate gains will take place. For
example, $5 billion for a high-risk pool, helping to provide coverage
for those who are uninsured because they have been denied coverage by
one of the big medical insurance companies.
Also, children with preexisting conditions can no longer be
discriminated against. So the family with the juvenile diabetic who
cannot get insurance because the child is a juvenile diabetic will be
able to get that insurance.
That is important. We have learned that the notorious doughnut hole
which takes place when you spend a certain amount on your
pharmaceuticals--there is a hole in the middle at which point there is
no help, and each person in that situation would receive $250 to help
them through that time.
A child can remain on a parent's policy until the age of 26. These
are some of the things that happen right away.
Now, I know people do not like this plan, some of them. But the
question comes: Do we keep doing what we are doing, spending more and
more of our gross domestic product and not improving our overall
performance, not improving our infant mortality, not improving our
longevity, the way good practical medicine should?
I wish to talk about one thing that isn't in any bill about which I
am very worried. A while ago, I introduced legislation for a medical
insurance rate authority. We have about nine very large for-profit
medical insurance companies in the United States. As a product of an
earlier action, they are the only industry, other than major league
baseball, that has an antitrust exemption. What they have been doing is
merging and acquiring companies so that they can control markets. In
Los Angeles, for example, today two of these companies control 51
percent of all of the premiums. Once you have this market share and
control, you can raise premiums with abandon. Earlier this year, a
company, a subsidiary of WellPoint, sent out notices to 800,000
Californians and said: We are raising your premiums. Premiums went up
39 percent for those not in a group policy but who held individual
policies. Can you imagine getting a notice that your insurance has gone
up 40 percent? To add insult to injury, they then said: We may come
back in the middle of the year and ask for another.
That company came in. I asked the CEO what her salary was. Nine
million a year. And you realize that these companies also have a
substantial percentage that they spend on rent of your premium dollar,
on the salaries of their executives in the millions of your premium
dollar, on transportation, on conventions. Generally this can go to 20
to 30 percent of the premium dollar. We begin to bring it down to 15
percent of the premium dollar.
What is missing and what the President put in the reconciliation bill
was my legislation to give the Secretary of Health the ability to see
that medical insurance premiums are reasonable and would establish a
rate authority of people who have expertise in the arena that she could
consult with in levying this authority. That is not in the bill.
The PRESIDING OFFICER. The Senator has used 10 minutes.
Mrs. FEINSTEIN. If I might conclude.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mrs. FEINSTEIN. These rate increases go into place May 1. So it is
vital that we take some action before May 1, or all throughout the
United States there are going to be substantial premium increases.
I yield the floor.
Mr. BAUCUS. Madam President, I yield 10 minutes to the Senator from
Virginia, Mr. Webb.
The PRESIDING OFFICER. The Senator from Virginia.
Mr. WEBB. Madam President, being an eternal optimist, I rise to
express my hope that once the process of voting over the next 2 days is
completed, we can find a way to move forward with our colleagues across
the aisle to fix other provisions in this legislation and make it truly
the kind of bill they say they wish to see as well. I will support this
reconciliation bill. At the same time, as my colleagues on this side of
the aisle know well, I worked very hard to narrow and improve this
legislation as it was passed last December, including voting, as I
recall, eight different times with my Republican colleagues, which
didn't make my chairman very happy, on a few occasions to make changes
in the bill. In the end I voted in favor of this legislation despite
serious misgivings with portions of it, because it does represent a
true step forward in terms of quality, accessibility, and affordability
of health care for most Americans.
The important point for us to remember today and tomorrow, as we go
through the process, is that the bill is now law. The question before
us now is how best to implement that law so that the benefits can be
put into place and the many detriments I was worried about can be
addressed. There are a number of strong points in this bill. Many of my
colleagues have laid them out. As we know, insurance companies will be
prohibited from denying health care coverage to children with
preexisting conditions. Young adults will be able to stay on their
parents' insurance plans until they are 26. Uninsured Americans with
preexisting conditions will have access to affordable insurance
options. Insurance companies won't be able to drop people from coverage
when they get sick, and they will be banned from implementing lifetime
caps on coverage. Seniors who hit the Medicare Part D doughnut hole gap
in coverage will get a $250 check to help with the cost of
prescriptions and the doughnut hole will be completely closed by 2020.
Access to insurance over the next couple years will be expanded to 95
percent of Americans. It will implement reforms designed to slow
skyrocketing health care costs. Working families will not have to worry
about losing health insurance or facing bankruptcy because of a job
loss or because of illness. Insurance companies will be required to
spend the majority of their money on patient care.
The law will also provide tax credits to help make health insurance
available for individuals, expand access to Medicaid, create a
regulated marketplace where people can shop for the health insurance
plan that best meets their needs, and will prohibit insurance companies
from refusing to sell or renew policies due to an individual's health
status. These are just some of the positive points of the law.
In fairness--and I understand and appreciate some of the frustration
on the other side--there are serious problems in this bill. I don't
like the dramatic cuts in Medicare this law proposes. In fact, I voted
against them. I share the concerns by my Democratic colleague,
Congressman Rick Boucher of southwest Virginia, regarding the potential
negative impact these cuts could have on rural areas, particularly the
population of southwest Virginia. This legislation proposes to cut
approximately $450 billion from Medicare spending over the next 10
years at a time when Medicare is already mired in debt and, as we know,
a bow wave of baby boomers is going to start hitting the Medicare
system immediately. Medicare Advantage, which provides better benefits
than traditional Medicare, is a valuable tool in rural and underserved
areas, and that may decrease. This law does little to address the
historic disparity in Medicare funding between urban and rural areas.
I am also concerned about the cost and spending projections of this
legislation. There is a great deal of debate going on right now about
the real cost of this bill. Former CBO Director Douglas Holtz-Eakin
estimated, in an article in the New York Times recently, that the bill
may increase the Federal deficit by $562 billion over 10 years because
of some of these areas I discussed. The official score maintains that
the bill would lower the deficit by $143 billion over that same period,
but it includes a number of unlikely assumptions, Medicare being one of
them. The system for reimbursing Medicare doctors, called the
sustainable growth rate, is widely agreed to be broken, but we have not
tried to fix it. That is a $250 billion ticket. Many, including myself,
believe the Community Living Assistance Services and Supports Act, the
CLASS Act, is structurally unsound. I voted against that as we were
considering the bill.

[[Page S1955]]

In addition, as my colleague Congressman Glenn Nye from the Norfolk-
Virginia Beach area pointed out, there is a great deal of concern among
families and small businesses regarding the impact of this bill.
Again, the point is, the bill is now law. The question is how to make
the law a better law. The process that got us here has been ugly. It
has diminished the trust and respect some citizens hold for our own
government. We need to restore that trust through a genuine and
transparent effort on both sides of the aisle to fix the problems in
the law. We also need to start working together again across the aisle,
on this and other issues that confront us, in a bipartisan sense and a
sense of shared responsibility about the many problems facing the
country. We are now preparing to begin a series of votes through the
reconciliation process that ultimately, quite frankly, is going to mean
little or nothing in terms of the outcome of this legislation. They are
not going to seriously address the problems in it. I understand the
concerns on the other side. I respect them. These votes in many cases
are politically necessary for the other side. But I call on my
Republican friends to begin to work with some of us over here on this
side to address the inequities that we are concerned about, to
implement cost controls, to work together for the good of the country
once this next couple of days is done.
I yield the floor.
The PRESIDING OFFICER. The Senator from Connecticut.
Mr. LIEBERMAN. Madam President, I gather I have at least 7 minutes
assigned to me.
The PRESIDING OFFICER. Ten minutes remains.
Mr. LIEBERMAN. I ask that the Chair inform me if I am not finished
when there is 1 minute remaining on my time.
The PRESIDING OFFICER. The Chair will so inform.
Mr. LIEBERMAN. Madam President, a good friend once wisely said to me
that it is only a very short road that has no turns. The road that
health care reform has traveled to get to the Senate has been very long
and has had many turns. Its path to us might well be described as
tortuous, with all that word has come to mean. As I said when I
explained in December why I was voting for the Senate health care
reform bill, any piece of legislation this big, this complicated, and
this transformational is unlikely to be perfectly pleasing to anyone.
That is true for me. In the end, each of us has to ask ourselves, do
the positives in this legislation outweigh the negatives? Does what
pleases us in it outweigh what worries us? Let me begin with the
measure before us now.
The reconciliation act that is before us preserves most but not all
of the health care reform the Senate adopted and I voted for in
December. I concluded then and repeat now that together these measures
achieve real change in the three big areas in which our health care
system needs to be changed: reforming health care delivery to put a
brake on the skyrocketing costs of care for individuals, families,
businesses, and our government; better regulating health insurance
companies to protect consumers, including those with preexisting
conditions; and helping millions of middle-income Americans who cannot
afford health insurance now to buy it.
For me it is particularly noteworthy that the Senate bill, plus the
reconciliation act, achieves all that progress without a government
takeover of health care or health insurance. That would have been a
very costly deficit-exploding mistake and would have fundamentally and
adversely altered the traditional American balance of power between the
public and private sectors that has worked so well over our history to
create economic growth and opportunity and to build the American middle
class. That is why I opposed the so-called public option so strenuously
and why I am so grateful it is not in the reconciliation act the House
has sent us. Those are the big and good things I appreciate in this
health care reform package.
What worries me about it? First, the size of this proposal concerns
me, particularly at this time of national fiscal indebtedness and
economic stress. I wish we had chosen to achieve health care reform
step by step, beginning with delivery reforms that would lower health
costs and then moving on to expand middle-class access to affordable
health insurance and then more aggressively regulating health insurance
companies. But there was never enough bipartisan support for such step-
by-step reform. I know because I tried to find it. So now, along with
each of my colleagues, I must vote on the proposal before us, not on
one I wish we had before us.

My biggest concerns about this proposal are its prospective fiscal
consequences. I worry that the savings this bill achieves in Medicare
and the revenue it raises from new Medicare taxes to help pay for
health care reform will soon be urgently needed to save Medicare itself
from running out of money it needs to pay the bills for seniors' health
care. Most of all, I worry that the bottom line consequences of this
health care reform will be to increase our already ominous national
debt.
I am, of course, greatly encouraged by the conclusion of the
independent, nonpartisan Congressional Budget Office that this health
care reform legislation will not only not increase the debt but
actually decrease it by more than a trillion dollars over the next two
decades, and that its savings in Medicare will not only pay for part of
health care reform but actually extend the solvency of the Medicare
Hospital Trust Fund.
According to the Chief Actuary at the Centers for Medicare and
Medicaid Services, the solvency of the trust fund will be extended by
10 years as a result of the Senate health care reform bill that is now
law.
However, for those good and significant things to happen, future
Congresses will have to be very disciplined and keep the promises that
are made in this legislation to reform health care delivery to cut
costs. Most of those reforms will over time be opposed by providers and
beneficiaries. The record of Congress in resisting such pressure to
stick with the costly status quo is not encouraging.
So in the end, I have weighed the pluses and minuses, and I have
decided to vote for this health care reform package, choosing its real
change over the broken status quo, raising my hopes above my fears, and
adding, if I may, a personal prayer that future Congresses and
Presidents do not weaken the reforms in this bill that will stop the
constant increases in health care and health insurance costs and help
reduce our national debt.
That will happen best if we can achieve the bipartisanship in
overseeing the implementation of this historic health care reform
legislation that we, unfortunately, were not able to achieve in its
passage.
I thank the Chair.
I thank the distinguished chairman of the Finance Committee for his
extraordinary effort that produced this admirable result.
I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, first, I thank the Senator from
Connecticut for his very thoughtful endorsement of this legislation. He
is one of the more thoughtful Members of this Chamber, and I want to
very much compliment him on his process and his conclusion.
Mr. LIEBERMAN. I thank the Senator.
Mr. BAUCUS. Madam President, I do not think I have much time
remaining--3 minutes. Thank you very much.
The Senator from Maine raised the issue of Medicare solvency. I want
to remind my colleagues that health care reform extends the solvency of
the Medicare trust fund. Whether it is 9 years or 10 years, I am not
sure exactly, but the Medicare trust fund is extended for at least that
period of time, which I am sure gives great comfort to seniors and near
seniors. Health care reform is exactly what the doctor ordered for
Medicare's long-term health.
The Senator also mentioned a letter from an outside group raising
concerns with health care reform. Let me add for the record three of
the many letters of endorsement that health care reform has received.
The first is from the American Medical Association. I will read one
sentence:

After careful review and consideration, the Board of
Trustees of the American Medical Association supports passage
of the health

[[Page S1956]]

system reform legislation under consideration . . . as a step
forward in the journey to provide health care for all
Americans.

In addition, I have a letter from the Federation of American
Hospitals:

On behalf of the Federation of American Hospitals and our
more than 1,000 hospitals throughout the United States, I
express our strong support for health reform and the
Reconciliation Act of 2010. This legislation is long overdue,
and we urge all Senators to seize this historic opportunity.
. . .

It is signed by Charles Kahn of the Federation of American Hospitals.
I also have a statement here from the AARP, the association of
retired folks. Basically it states:

After a thorough analysis of the reform package, we believe
this legislation brings us so much closer to helping millions
of older Americans get quality, affordable health care.

Again, that is from the AARP.
So there are many letters of endorsement, and I ask unanimous consent
that these three letters be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

American Medical Association,

Chicago, IL, March 19, 2010.
Hon. Nancy Pelosi,
Speaker, House of Representatives,
Washington, DC.
Dear Speaker Pelosi: After careful review and
consideration, the Board of Trustees of the American Medical
Association (AMA) supports passage of the health system
reform legislation under consideration in the House as a step
forward in the journey to provide health care coverage for
all Americans.
When H.R. 3590 was being considered in the Senate, the AMA
supported its passage while expressing opposition to certain
provisions that we believed could be resolved in the
conference committee process. Working with the
Administration, congressional leaders and their very
dedicated staff, significant progress was made toward
resolving many of our most serious concerns. Unfortunately,
there are issues in H.R. 3590 that cannot be addressed
through the current reconciliation process and so will still
need to be addressed by Congress and the Administration.
This forced us to weigh very carefully whether the
legislation, on balance, will enhance patient care and the
fundamental patient-physician relationship. By extending
coverage to the vast majority of the uninsured, improving
competition and choice in the insurance marketplace,
promoting prevention and wellness, reducing administrative
burdens, and promoting clinical comparative effectiveness
research, we believe that H.R. 3590 does, in fact, improve
the ability of patients and their physicians to achieve
better health outcomes.
The pending bill is an imperfect product. Congress needs to
act very soon to preserve access to care for seniors and
military families by permanently repealing the Medicare
sustainable growth rate formula that will trigger physician
payment cuts of over 21 percent next month. House and Senate
leaders must also move immediately to correct problems with
the proposed Independent Payment Advisory Board. Other
provisions that must be promptly addressed in a subsequent
corrections bill include the cost-quality value index and
safeguards for data release and public reporting activities.
The health care system will be further improved by reining in
unnecessary costs through enactment of effective medical
liability reforms.
The AMA will be relentless in our pursuit of these
important policy adjustments.
Passage of H.R. 3590 marks an important step toward
improving the health of the American people, but our work
here is far from done. Additional congressional action is
needed to address outstanding issues. We look forward to
working with you on the next steps to strengthen our health
care system.
Sincerely,
J. James Rohack,
President.
____

Federation of American Hospitals,

Washington, DC, March 22, 2010.
Hon. Harry Reid,
Majority Leader,
U.S. Senate,
Washington, DC.
Dear Majority Leader Reid: On behalf of the Federation of
American Hospitals (FAH) and our more than 1,000 hospitals
throughout the United States, I express our strong support
for health reform and the Reconciliation Act of 2010. This
legislation is long overdue, and we urge all Senators to
seize this historic opportunity by supporting the
reconciliation package as it was reported out of the House of
Representatives.
The hundreds of thousands of Americans who treat patients
in our hospitals understand the plight of the uninsured and
the need to provide health security for all Americans. The
Reconciliation Act of 2010, together with the recently
enacted Patient Protection and Affordable Care Act, advance
this shared goal by expanding health care coverage to 32
million Americans.
Equally vital, they provide a framework for health care
delivery reform that will improve health care for Americans,
and, by extension, strengthen our economy and global
competitiveness by reducing costs and increasing efficiency.
That is why hospitals will forgo $155 billion in Medicare
and Medicaid payments over 10 years as part of a shared
sacrifice to bring about the benefits that health reform will
deliver to all Americans.
It is no exaggeration to say this is the last opportunity
in our generation to bring about durable reform that will
make a real difference in the lives of all of us. The time
for action has come, and the FAH urges all Senators to
support the budget reconciliation package without amendment.
Thank you for your strong and unwavering leadership.
Sincerely,
Charles N. Kahn III,
President.
____

(From the AARP Press Center, Mar. 19, 2010)

AARP Statement on Historic Health Insurance Reform Package

Washington.--Today, AARP Board Chair Bonnie M. Cramer,
M.S.W., announced the Association's support for health
insurance reform legislation containing key reform provisions
that will improve health care for older Americans and their
families. For more than two years, AARP has fought for health
insurance reform that helps Americans 50-plus get the care
and medications they need at a price they can afford.
Cramer's statement follows:
``After a thorough analysis of the reform package, we
believe this legislation brings us so much closer to helping
millions of older Americans get quality, affordable health
care. For too long, our members and others have faced
spiraling prescription drug costs, discriminatory practices
by insurance companies and a Medicare system awash in fraud,
waste and abuse.
``The legislative package cracks down on insurance company
abuses and protects and strengthens guaranteed benefits in
Medicare, the program millions of our members depend on and
in which millions more will soon enroll. It closes the
dreaded Medicare Part D `doughnut hole,' a gap in
prescription drug coverage that is life threatening for many.
The package stops insurance companies from pricing people out
of coverage because they have an existing health problem or
arbitrarily limiting the amount of care someone can receive.
It also limits insurance companies' ability to charge higher
premiums based solely on age. And it improves efforts to
crack down on fraud and waste in Medicare, strengthening the
program for today's seniors and future generations.
``For every American who has struggled without access to
health insurance--and for all those at risk of losing their
current coverage with the next job loss, illness or premium
hike--this package presents the best hope to offer health
security for them and their families. We understand that
significant work remains even after this package becomes law,
but we cannot lose the opportunity looking for a `next time'
that is doomed to be `too late.'
``We urge Congress to seize this opportunity to improve
health care so older Americans and their families get the
care they need.''
Also today, AARP CEO A. Barry Rand sent a letter to every
member of the House of Representatives, urging them to put
the health of Americans age 50-plus first and vote ``yes'' on
the legislative package.
AARP members can see how their representatives voted on the
health insurance reform package by going to <a href='http://www.aarp.org/
'>www.aarp.org/
</a> governmentwatch. AARP's Government Watch is a one-stop online
portal that will be tracking and publicizing every designated
key vote on issues facing Americans age 50-plus. A ``Key Vote
Summary'' highlighting votes on these issues will be
published at the end of each congressional session.
AARP is a nonprofit, nonpartisan membership organization
that helps people 50+ have independence, choice and control
in ways that are beneficial and affordable to them and
society as a whole. AARP does not endorse candidates for
public office or make contributions to either political
campaigns or candidates. We produce AARP The Magazine, the
definitive voice for 50+ Americans and the world's largest-
circulation magazine with over 35.7 million readers; AARP
Bulletin, the go-to news source for AARP's millions of
members and Americans 50+; AARP Segunda Juventud, the only
bilingual U.S. publication dedicated exclusively to the 50+
Hispanic community; and our website, AARP.org. AARP
Foundation is an affiliated charity that provides security,
protection, and empowerment to older persons in need with
support from thousands of volunteers, donors, and sponsors.
We have staffed offices in all 50 states, the District of
Columbia, Puerto Rico, and the U.S. Virgin Islands.

Mr. BAUCUS. Madam President, I now ask for 1 hour of debate evenly
divided, a half hour on the Republican side and a half hour on the
majority side. I ask unanimous consent that we proceed in that respect.
I note that the next half hour will be under the control of the
Republicans and, as I said earlier, the next half hour is to be
controlled by the majority. I note that thereafter the Republicans will
be due an amount of time greater than half an hour, and I propose that
we balance that out in the next consent.

[[Page S1957]]

The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The Senator from Maine.

Amendment No. 3638

Ms. COLLINS. Madam President, I ask unanimous consent to temporarily
set aside the pending motions and amendments so that I may offer an
amendment which is at the desk.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The clerk will report.
The assistant legislative clerk read as follows:

The Senator from Maine [Ms. Collins] proposes an amendment
numbered 3638.

Ms. COLLINS. Madam President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To improve the bill by waiving the $40,000 penalty on hiring
previously unemployed individuals)

At the end of section 1003, add the following:
(e) Unemployed Individual Not Taken Into Account.--
Paragraph (5) of section 4980H(d) of the Internal Revenue
Code of 1986, as added by the Patient Protection and
Affordable Care Act, is amended by adding at the end the
following new subparagraph:
``(C) Exception for previously unemployed individuals.--
``(i) In general.--The term `full-time employee' shall not
include any individual who certifies by signed affidavit,
under penalties of perjury, that such individual has not been
employed from more than 40 hours during the 60-day period
ending on the date such individual begins such employment.
``(ii) Exception for replacement workers.--Clause (i) shall
not apply to an individual who is employed by the employer to
replace another employee of such employer unless such other
employee separated from employment voluntarily or for
cause.''.

Ms. COLLINS. Madam President, I rise to speak on behalf of the
amendment I have offered which would waive the job-killing fines in the
reconciliation bill in cases where an employer hires an unemployed
worker.
I think these penalties will come as a surprise to most Americans.
With unemployment at 9.7 percent, and a real concern that we may be on
the brink of a double-dip recession, most Americans will be shocked to
learn that Washington wants to slap fines on small businesses that
choose to hire more workers. But the new health care law does exactly
that.
Incredibly, this reconciliation package makes this problem even
worse. Here is how. In the reconciliation package, small businesses
that cannot afford to provide health insurance to their employees would
be fined $2,000 for each worker on their payroll. The way the formula
works, the fines kick in at $40,000 when a small business reaches 50
employees. After that, they go up at a rate of $2,000 for each new
worker.
Imagine what this will do to job growth. Our country relies on small
businesses to create new jobs. In fact, time and time again, you will
hear on the Senate floor that small businesses are the engine of the
American economy. I certainly agree with that. But this reconciliation
bill creates a wall--40,000 dollars high--around any small business
that wants to grow past 49 workers.
Think what these job-killing penalties will mean to the unemployed.
More than 8 million Americans have lost their jobs since 2007. More
than 6 million have been unemployed longer than 27 weeks. But beyond
even these grim statistics, the true picture of unemployment in this
country is actually far worse. Broader measures of unemployment show
that 16 percent of the American people are without jobs or cannot find
full-time work.
I recognize some in this body will argue we should not be bothered
with these penalties now because they do not become effective right
away. But those who would say such a thing simply do not understand how
small businesses work. We are not talking about big multinational
conglomerates here. We are talking about Main Street businesses that
are already struggling. Many of them are family-owned enterprises. They
do not look at their employees as interchangeable parts, and they do
not make hiring decisions to ``get rich quick.'' When they bring a new
employee on board, they are choosing someone who they know will become
part of their team and the face of their business to the community they
serve.
Having these fines on the books will discourage job growth now, no
matter when they become effective, because small businesses will not
hire and train workers today just to fire them tomorrow when these
penalties go into effect.
Ironically, less than a week ago, the President signed into law the
so-called HIRE Act. It contains a provision authored by Senators
Schumer and Hatch to provide a temporary tax credit to encourage
companies to hire unemployed workers. That is a creative idea, and I
supported it. But for the life of me, I do not understand how a week
later we could vote for a bill that imposes fines that will hit small
businesses when they hire new workers.
This makes no sense to me, and it is completely contrary to the
policy we passed a week ago when we gave tax credits to encourage
businesses to hire workers who are unemployed. With this bill, we are
going to fine them if they hire workers who are unemployed if they
cannot afford to provide them with health insurance. That is why I am
offering this commonsense amendment. It would waive the fines, the
onerous fines that are in the reconciliation bill when small businesses
and medium-size businesses hire workers who were previously unemployed.
The mechanism to determine which workers qualify is exactly the same
one we adopted in the jobs bill passed by this body last week. It is
the height of irony that we would even consider imposing penalties and
fines on businesses that are hiring more workers, particularly during
this difficult economic time.
I encourage my colleagues to support this commonsense amendment.
Thank you, Madam President.
The PRESIDING OFFICER. The Senator from South Dakota.

Amendment No. 3639

Mr. THUNE. Madam President, I ask unanimous consent to temporarily
set aside the pending motions and amendments to offer an amendment
which is at the desk.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report.
The assistant legislative clerk read as follows:

The Senator from South Dakota [Mr. Thune] proposes an
amendment numbered 3639.

Mr. THUNE. Madam President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To ensure that no State experiences a net job loss as a
result of the enactment of the SAFRA Act)

Beginning on page 123, strike line 10 and all that follows
through page 124, line 10, and insert the following:

SEC. 2201. TERMINATION OF FEDERAL FAMILY EDUCATION LOAN
APPROPRIATIONS.

Section 421 (20 U.S.C. 1071) is amended--
(1) in subsection (b), in the first sentence of the matter
following paragraph (6), by inserting ``, except that no sums
may be expended after June 30, 2010, with respect to loans
under this part for which the first disbursement is after
such date if the Secretary certifies that no State will
experience a net job loss as a result of the enactment of the
SAFRA Act'' after ``expended''; and
(2) by adding at the end the following new subsection:
``(d) Termination of Authority To Make or Insure New
Loans.--Notwithstanding paragraphs (1) through (6) of
subsection (b) or any other provision of law--
``(1) no new loans (including consolidation loans) may be
made or insured under this part after June 30, 2010 if the
Secretary certifies that no State will experience a net job
loss as a result of the enactment of the SAFRA Act; and
``(2) no funds are authorized to be appropriated, or may be
expended, under this Act or any other Act to make or insure
loans under this part (including consolidation loans) for
which the first disbursement is after June 30, 2010 if the
Secretary certifies that no State will experience a net job
loss as a result of the enactment of the SAFRA Act,

except as expressly authorized by an Act of Congress enacted
after the date of enactment of the SAFRA Act.''.

Amendment No. 3640

Mr. THUNE. Madam President, I have another amendment and I ask
unanimous consent to temporarily set aside the pending motions and
amendments so that I may offer another amendment which is also at the
desk.
The PRESIDING OFFICER. Without objection, it is so ordered.

[[Page S1958]]

The clerk will report.
The assistant legislative clerk read as follows:

The Senator from South Dakota [Mr. Thune], for himself, Mr.
Coburn, and Mr. Crapo, proposes an amendment numbered 3640.

Mr. THUNE. Madam President, I ask unanimous consent that reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To repeal the CLASS Act)

At the end of subtitle B of title II, add the following:

SEC. 2304. REPEAL OF THE CLASS ACT.

Title VIII of the Patient Protection and Affordable Care
Act and the amendments made by that title are repealed.

Mr. BAUCUS addressed the Chair.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, might I ask the Senator from South
Dakota if he could identify his two amendments for the sake of clarity?
Mr. THUNE. Sure. I would ask the Chair, is there a number on those
amendments?
The PRESIDING OFFICER. Yes, 3639 and 3640.
Mr. THUNE. Madam President, 3639 and 3640--one dealing with student
loans, the other dealing with striking the CLASS Act from the
underlying bill.

Mr. BAUCUS. I thank the Senator.
Mr. THUNE. Madam President, in speaking to both these amendments
today, I wish to make a couple of observations about the reconciliation
bill that is before the Senate. Of course, it does make amendments and
modifications to the Senate-passed health care bill that went through
the House last week and the House adopted many of these changes. I
think the thing that perhaps didn't get discussed as much as it should
have throughout the course of the debate is the impact this is going to
have down the road on future generations.
Obviously, the other side, of course, talked about the additional
expansions of coverage that are in the bill. Folks on our side talked
about the impact it is going to have in the form of higher taxes on
small businesses, the Medicare cuts that are going to impact seniors
across this country, the higher premiums many Americans are going to be
faced with. Those are all still fundamental features of this bill. In
fact, many have gotten worse through this reconciliation process
because the tax increases are now $50 billion higher than they were
before. So now we are raising taxes even $50 billion more than we were
previously, which is $\1/2\ trillion. The Medicare cuts have now gone
from $465 billion over the 10 years in the bill that left the Senate in
December, and the Medicare cuts now have been increased by $66 billion.
So we are raising taxes more, cutting Medicare even deeper, and at the
same time adding gimmicks that I think understate the true cost of this
bill.
We have all talked about this throughout the course of this debate.
The other side has said it is $1 trillion or $900-some billion over 10
years, but when you look at the way it is scored, there are 10 years of
revenues, 10 years of tax increases, and only 6 years of spending, so
that understates the cost over 10 years.
We have a number of other budget gimmicks, some of which I will speak
to in a few moments. But when you look at it when it is fully
implemented--and I think that is the number the American people need to
focus on--when this is fully implemented, it is $2.5 trillion of
expansion of health care in this country, and it is going to be greater
intervention than we have ever seen before by the Federal Government in
the delivery of health care in this country.
I wish to speak for a moment--because one of my amendments deals with
this issue--on how the cost of this is being understated because of the
various gimmicks and tricks being used. The CLASS Act is a program that
is created in the bill. It is a program where there is an assumption
that there is $70 billion available in the CLASS Act to pay for this
new health care entitlement. What it does is it creates a new
entitlement. As if the existing entitlement programs we have that are
already on the way to bankruptcy aren't enough, we now have to add
another one to it. So the CLASS Act is a long-term care entitlement
program, which in and of itself perhaps isn't a bad idea if it were
structured correctly and if the premiums that are going to be paid by
people for long-term care insurance were actually going to go into the
payment of benefits.
What this does is it assumes $70 billion from this new CLASS Act
program, the proceeds from which would be used to pay for this new
health care entitlement program. So it overstates the amount of revenue
that is coming in by $70 billion. Here is why. At some point, if you
are an elderly person or perhaps even a younger person today who wants
to buy into this new CLASS Act long-term care program, you would pay
premiums. Those premiums, allegedly, would go into a fund that would
then be available to pay benefits when the time came to pay benefits.
That is not going to happen because you are taking that $70 billion and
you are spending it on this new health care entitlement. So at some
point in the future, when those people who have gone into this program
thinking they are paying these premiums so they can derive a benefit at
some time in the future if they need to, when the time comes to pay out
that benefit, there will not be any money. So what happens? It is
borrowed. It is added to the debt. So you have another $70 billion that
goes on the backs of our children and grandchildren to pay for this new
entitlement program, which, again, understates the cost of this bill.
That is the CLASS Act bill, and my amendment would strike that from
the underlying bill. By the way, I offered that during the debate on
the Senate floor during the health care discussion we had the first
time around, and I got 51 votes for it. There were 12 Democrats who
voted with me in support of taking the CLASS Act out of the bill. One
of the reasons I think there is so much bipartisan opposition to it is
because everybody recognizes what a sham this is. The chairman of the
Budget Committee, Senator Conrad from North Dakota, said: This is a
Ponzi scheme of the highest order, something that Bernie Madoff would
be proud of. That is what he said about the CLASS Act. Even the
Washington Post went so far as to make the statement that the CLASS Act
is a gimmick designed to pretend that health care is fully paid for.
That is what the Washington Post editorialized about the CLASS Act--a
gimmick designed to pretend that health care is fully paid for.
So you take that $70 billion off the overall revenues that come in
under the bill and you are already creating a $70 billion hole. You add
to that the $29 billion in Social Security payroll taxes that are
assumed are going to come in as people who get hit--the employers that
get hit with the high-end Cadillac tax, currently paying out to their
employees in the form of health care benefits that are tax free, start
shifting to cash compensation which would be taxable; therefore,
payroll taxes would apply. That would generate another $29 billion in
Social Security payroll taxes. But, there again, those are payroll
taxes that at some point are going to have to pay benefits, but we
don't assume that here. We assume it is going to go on to fund this new
health care entitlement program. So it is another $29 billion that at
some point in the future, when somebody decides: I want to draw my
Social Security benefits, they are not going to be there. Therefore, we
put it back on the debt. More borrowing.
So we have $79 billion, $29 billion, and then we have the
implementation cost of this, which CBO has not fully given us because
they don't know what it is going to cost in the outyears. But based
upon what they have given us of what it is going to cost in the near
term, we have extrapolated that it will cost about $114 billion to
implement this new health care extravaganza run out of Washington, DC.
When you add that onto the cost, none of which is accounted for in the
underlying bill, you have another $114 billion in cost of this thing
not paid for.
Then, we take the Medicare double counting, which is interesting,
because you have these cuts that are going to occur in Medicare; you
have these payroll tax increases that are supposed to occur in Medicare
that are going to generate, collectively, $529 billion in additional
revenue. But, here again, what is wrong with this picture? The
assumption is, these are Medicare payroll taxes that are going to go
into a

[[Page S1959]]

Medicare fund that, at some point in the future, will pay Medicare
benefits. Yet, at the same time, we are saying these Medicare revenues
are going to be used to finance this new health care expansion.
So what are you doing? You are double counting. You cannot spend that
money twice. We are taking $529 billion in Medicare cuts, in Medicare
payroll tax increases that supposedly would go into a Medicare trust
fund to pay benefits at some point in the future to beneficiaries,
recipients of those funds, but, no, we are going to spend that on this
new health care entitlement.
What happens then? Someday in the future that Medicare recipient is
going to say: OK, it is time to pay out these Medicare benefits. I have
reached the appropriate age, I am eligible, and I want to get into the
Medicare Program, and all that money that was supposed to have been in
the program to pay for those benefits isn't there. Why? Because it was
spent on this new health care entitlement program. So what happens? To
pay those benefits, the Federal Government will then have to borrow--
more debt that goes on the backs of our children and grandchildren--
another $529 billion.
So the last point I will make is--because I have another amendment
that addresses this issue--this reconciliation bill did something that
obviously was not included in the health care bill that passed the
Senate the first time; that is, this takeover of the student loan
program in this country. It is something that has been proposed around
here for some time. The way student loans are distributed across the
country today is we have 2,000 lenders out there who make these loans.
Students can go there and get these loans. What this will do is
eliminate that model, will draw all these student loans into
Washington, DC. There will be four Federal call centers where students
will go to get their loans. What does that do? Well, first off, it
kills a lot of jobs. I have 1,200 jobs in South Dakota that are related
to the student lending business, and those are all now going to be
bureaucratic jobs in Washington, DC. There are 31,000 jobs across the
country where you have people who are working in the student loan
business. Those jobs are in jeopardy because that is all going to be
drawn into Washington DC. I don't think the American people have
effectively focused on what is being done in this reconciliation bill
above and beyond the bad stuff that is related to health care.
So we have this student loan program which is coming back into the
Federal Government and a lot of the revenues now are being earmarked
for other things. They are being earmarked for the health care bill: $9
billion is being used to pay for the health care expansion; $10 billion
is going toward ``deficit reduction,'' but we have another $19 billion
coming out of the student loan program. Who is going to pay for that?
Students are. Students are going to pay for it in the form of higher
interest rates on their loans. Essentially, we are now not only taxing
small businesses, cutting Medicare recipients, but we are also taxing
students to pay for this expansion of health care.
We have another $19 billion which, at some point in the future--of
course, this is all going to have to be paid for again by our children
and grandchildren, but we have all this double counting that is going
on and all these gimmicks that are being used to understate the cost of
this bill. When you add it all up, $143 billion so-called budget
savings ends up in a $618 billion cost. In other words, instead of
running, as the other side has said, a $143 billion budget surplus
because of this health care expansion, if you take out all the
gimmicks--the CLASS Act, the revenues, the Social Security payroll tax
revenues which are double counting, the Medicare double counting, and
the student loan program--we have a real deficit of $618 billion in the
first 10 years. If you extrapolate that out into the second 10 years,
it is $1.8 trillion that will have to be borrowed under this bill to
pay for the costs of it. That is the cost that we know today. That is
all going to be passed on to future generations, to our children and
grandchildren.
The dirty little story that hasn't been told in this whole debate is
how much this is going to cost future generations because of the
enormous debt we are piling up and all the games and the gimmicks and
the tricks and the chicanery that are being used to understate the true
cost of this: $183 billion ``savings'' in this bill. When you take out
all the double counting, all the gimmicks, we end up with a $618
billion deficit in the first 10 years. That is tragic.

That is why I am offering this amendment to strike this CLASS Act. We
shouldn't be creating another new entitlement program when we can't pay
for the entitlement programs we have. They are all going bankrupt, and
we are going to create yet another one, which is going to lay more debt
on the backs of our children and grandchildren.
The other thing I wish to mention just briefly in closing speaks to
the other amendment. The other amendment, as I said, because of this
takeover of the student loan business in this country, there are lots
of States that are going to lose significant numbers of jobs. My State
has over 1,200 jobs related to student lending; Minnesota, 675; Iowa,
526; Nebraska, 891. There are lots of places around this country where
student lending creates jobs, private sector jobs. We are going to do
away with those and bring all those jobs back to Washington, DC, and
make students come to Washington to get their student loans, as it
turns out, at a higher cost because we are using some of the proceeds
of that program to pay for the cost of a new health care program.
What my amendment essentially would do is say the Department of
Education has to certify that there will be no jobs lost across the
country associated with this takeover of the student lending business
and bringing all that power and consolidating it all in Washington, DC.
So those are the two amendments I offer. I hope my colleagues will
vote for those. This is bad policy in so many ways, but in taking over
yet another industry in this country that is creating a lot of jobs and
therefore killing a lot of jobs is the wrong way to move forward when
you are trying to pull an economy out of a recession.
I yield the remainder of my time.
The PRESIDING OFFICER. The Senator from Texas.

Motion to Commit

Mr. CORNYN. Madam President, I ask unanimous consent to temporarily
set aside the pending motions and amendments so I may offer a motion to
commit, which is at the desk.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The clerk will report the motion.
The assistant legislative clerk read as follows:

The Senator from Texas [Mr. Cornyn] moves to commit the
bill H.R. 4872 to the Committee on Finance with instructions
to report the same back to the Senate within 3 days with
changes to strike the 3.8 percent tax on net investment
income.

Mr. CORNYN. Madam President, my amendment is a motion to commit the
reconciliation bill back to the Finance Committee to report the bill
back without a brandnew tax on savings and investment for certain
taxpayers. This is an additional 3.8-percent tax on savings, which
includes dividends, capital gains, ordinary savings for many consumers,
many Americans who have not had to pay before but which this bill
imposes. This is a $123 billion tax hike on those categories of income.
This is a mistake for a lot of reasons. One, it will discourage the
very thing we need to be doing more of, which is saving. It will reduce
productivity, and it depresses wages and the standard of living for
millions of Americans. Simply put, increasing taxes, particularly
during a recession, on the very sectors of the economy that we want to
invest and to create jobs is a terrible mistake.
According to forecasts by the Institute for Research on the Economics
of Taxation, a 2.9-percent tax increase--not 3.8 percent but a 2.9-
percent previously proposed--would depress economic growth by 1.3
percent and reduce capital formation by 3.4 percent.
The damage to jobs and economic growth during a recession when
unemployment is at 9.7 percent would be even greater under the current
proposal because we are talking about a 3.8-percent tax, not a 2.9-
percent tax, which was the subject of a Wall Street Journal article and
this report from the Institute for Research on the Economics of
Taxation.

[[Page S1960]]

Not only will this motion protect jobs and the investment security of
taxpayers, it will also make sure the reconciliation bill does not
break yet another one of President Obama's promises. This is just
another one of the President's promises that have been broken by this
bill when he said, talking about this bill:

Everyone in America--everyone--will pay lower taxes than
they would under the rates Bill Clinton had in the 1990s.

But the truth is, this additional tax on savings and investment will
make taxes higher than they were even back in the 1990s when Bill
Clinton was President of the United States.
I ask my colleagues to support my motion to commit this bill to the
Finance Committee.
I also ask unanimous consent to have printed in the Record at the
conclusion of my remarks two articles--a March 17 Wall Street Journal
article entitled ``ObamaCare's Worst Tax Hike'' and the report I
referred to a moment ago from the Institute for Research on the
Economics of Taxation.
The PRESIDING OFFICER. Without objection, it is so ordered.
(See exhibit 1.)
Mr. CORNYN. Madam President, this is not the only job-killing
provision in this bill, this brandnew 3.8 percent tax increase that
will attack savings and investment. Other examples of job-killing
proposals in this bill include increasing the hospital insurance
payroll tax. This tax is increased to 3.8 percent. It will hit
thousands of small businesses that file as subchapter S corporations
and pay taxes at individual rates. In addition, this revenue will not
be used to pay for Medicare but will be used to fund a brandnew
entitlement.
Another job-killing proposal in this bill includes new taxes and fees
on health care consumers. That is right, the very people for whom we
are trying to lower costs and trying to make health care more
affordable, many will have to pay additional taxes and fees to the tune
of $100 billion which both the Congressional Budget Office and the
Joint Tax Committee have confirmed will inevitably be passed down to
consumers.
Then there are the higher premiums for individuals who do not get
their health coverage from their employer but have to go into the group
market. We are talking about a lot of small businesses, individuals,
partnerships, sole proprietors, and the like. One consulting firm
concluded that premiums in the group market could go up as much as 20
percent because of the mandated, government-approved insurance that has
to be sold under this bill. CBO said they concluded a somewhat lower
level--between 10 and 13 percent. But still, if the purpose of health
care reform is to make health care more affordable, this bill simply
goes in the wrong direction.
Then there is the employer mandate. I met this morning with
representatives of the Hispanic Chamber of Commerce. The Hispanic
Chamber told me something I knew before but reiterated--the important
role of small businesses in terms of job creation--and pointed out to
me how many Hispanics and minority business owners are engaged in the
very kind of job creation we should be encouraging, not discouraging.
This employer mandate will kill jobs because the additional cost of
health insurance will be passed along to workers in the form of lower
wages or result in reduced hours or layoffs. In a July 2009 report
entitled ``Effects of Changes to the Health Care Insurance System on
Labor Markets,'' the CBO concluded that the employer mandate is
``likely to reduce employment.''
At a time when unemployment is at 9.7 percent, people are losing
their jobs, and they cannot pay their mortgages, so they are being
kicked out of their homes due to foreclosure, we are making things
worse with this bill, not better.
All told, this bill that has been signed into law by the President
and the bill before the Senate, this reconciliation bill, include more
than $500 billion in tax increases. It makes no sense, except in the
rarefied air under this dome, for Congress to even consider raising
taxes, imposing new mandates on employers and individuals at a time
when unemployment is so high and when that is the most pressing issue
confronting the Nation today. Congress is making this worse, not
better. Why Congress would pass a new tax on investment that will act
like a wet blanket on the economy to further exacerbate unemployment
and make recovery harder is, frankly, beyond me.
Madam President, I yield the floor.

Exhibit 1

[From the Wall Street Journal, Mar. 17, 2010]

ObamaCare's Worst Tax Hike

The forced march to pass ObamaCare continues, and all that
matters now is raw politics. But opponents should go down
swinging, and that means exposing such policy debacles as
President Obama's 11th-hour decision to apply the 2.9%
Medicare payroll tax to ``unearned income.''
That's what savings and investment income are called in
Washington, and this destructive tax wasn't in either the
House or Senate bills, though it may now become law with
almost no scrutiny.
For the first time, the combined employer-worker 2.9%
Medicare rate would be extended beyond wages to interest,
dividends, capital gains, annuities, royalties and rents for
individuals with adjusted gross income above $200,000 and
joint filers over $250,000.
That would lift the top capital-gains rate to 22.9% as the
regular rate bounces back to 20% from 15% when the Bush tax
cuts expire at the end of this year. The top rate for
dividends would rise to 42.5% when the Bush income-tax rates
expire. The White House plan also raises the ordinary
Medicare payroll tax by 0.9 percentage points for the same
filers, bringing it to 3.8%.
Preliminary estimates from the Joint Committee on Taxation
peg the revenue from these changes at $183.6 billion over 10
years. The Tax Policy Center of the Urban Institute and
Brookings Institution estimates that 86% of the revenue from
the investment tax would come from people making more than
$624,000, or about 1.2 million taxpayers. This has led many
liberals to claim that it won't matter to investors or harm
the economy.
Yet these static analyses ignore the incentive effects
forecast by the Institute for Research on the Economics of
Taxation. Stephen Entin and colleagues estimates that the
investment tax would depress GDP by about 1.3% and reduce
capital formation by 3.4%, and thus reduce the after-tax
incomes of everyone not paying the tax directly in the
neighborhood of 1.1% to 1.2%. Labor productivity and wages
would fall across the board, while the lost government
revenues from the more-sluggish economy would offset the
expected receipts.
Senate Democrats rejected Nancy Pelosi's favored 5.4-
percentage-point ``surcharge'' on modified adjusted gross
income above $1 million as too radical. But they seem to be
fine with its 2.9-percentage-point alter ego, although the
Tax Policy Center concludes (on paper) that they'll soak more
or less the same people for more or less the same amount.
Earning even a single dollar more than $200,000 in adjusted
gross income will slap the 2.9% tax on every dollar of a
taxpayer's investment income, creating a huge marginal-rate
spike that will most hurt middle-class earners, as opposed to
the superrich.
This two-tier tax also fundamentally and probably
irrevocably alters the social insurance model that has
governed Medicare for more than a half-century. Medicare is
supposed to be a universal entitlement with at least some
connection between the taxes paid on wages in return for
benefits. The investment tax, and the apparatus of ObamaCare
financing more generally, severs this link by redirecting
Medicare's ``dedicated'' revenues toward a new entitlement.
Even Bill Clinton didn't cross this policy threshold in the
health debate of the early 1990s, proposing to fund
HillaryCare entirely through new corporate taxes and
preserving Medicare as its own discrete program.
Mr. Obama gave a preview of the fiscal confusion this
creates at a Wednesday campaign stop in St. Charles. Shortly
after accusing his critics of being ``just plain wrong''
about everything, he went on to boast that ``we're going to
be able to help ensure Medicare's solvency for an additional
decade'' and also ``reduce the deficit by a trillion
dollars.''
Yet his claims are just plain wrong, as already exposed by
the Congressional Budget Office. The government can't spend
the same Medicare dollar twice: Either it can reduce the
deficit or extend the life of Medicare, but not both. This
may seem an arcane point, but the White House obviously knows
better and yet continues to peddle this falsehood.
The White House has embraced this investment tax because
Big Labor opposed its preferred excise tax on high-cost
health plans. So the White House decided to delay the excise
tax, which meant losing $116.2 billion in revenue over the
first 10 years. Voila, out came the 2.9% investment tax.
So for reasons of political expediency, Democrats will now
impose a destructive tax that will permanently skew the
incentives to work, save and create jobs. Come to think of
it, that sums up this entire exercise.
____

[From the Institute for Research on the Economics of Taxation, Mar. 1,
2010]

The Obama Administration's Proposed 2.9% ``HI'' Surtax Would Harm the
Economy and Lose Revenue

President Obama has recommended imposing a 2.9% ``HI''
surtax on ``passive income'' (income from saving and
investment) to help

[[Page S1961]]

fund his health insurance overhaul. Social Security taxes for
retirement and medical programs for the elderly taxes have
always been levied on wages, as a form of social insurance.
Extending the Hospital Insurance tax to income from savings
would be a sharp departure from previous practice and very
bad economics.

Economic consequences of the 2.9% rate hike

On a static basis, our preliminary estimate is that the
Obama plan's 2.9% surtax on the capital gains, dividends,
interest, and certain other income of upper-middle class and
wealthy taxpayers would:
Raise approximately $39 billion yearly (at 2009 income
levels);
Affect only a small number of upper-income individuals.
In reality, on a dynamic basis, the 2.9% surtax would,
after the economy has adjusted to it:
Depress GDP by about 1.3%;
Reduce private-sector capital formation by about 3.4%;
Cut the wage rate by about 1.1%, and hours worked by about
0.2%;
Reduce the after-tax incomes of the people in the income
ranges supposedly not touched by the proposed 2.9% surtax by
1.1%-1.2%;
Lose about 70% of its anticipated income tax revenue gain
due to lower GDP and incomes across-the-board;
Decrease other federal tax revenues, causing total federal
receipts actually to fall by about $5 billion yearly (at 2009
income levels).

Discussion

Capital formation is very sensitive to taxes on capital
income, and reduced capital formation reduces labor
productivity and wages across the board. We estimate that the
proposed surtax will depress capital formation, GDP, and
wages. The resulting loss of income, payroll, corporate,
excise, and other taxes will offset the assumed revenue
gains. The wage depression will affect all income levels, and
the tax burden will not be confined to the top income
earners.
The 2.9% passive income surtax (equal to the Medicare Part
A--or Hospital Insurance--payroll tax rate) would be imposed
on dividends, interest, capital gains, rents, royalties, and
other income from saving and investing. The tax would hit
couples with more than $250,000 in adjusted gross income
($200,000 trigger for singles and heads of households). The
tax would be triggered by earning even a single dollar above
the thresholds, after which all of the taxpayers' passive
income would be immediately subject to the tax. This creates
a huge tax rate spike or ``cliff' at the thresholds. It would
be imposed on AGI instead of taxable income, taking no
consideration of itemized deductions and the differing
circumstances of families which the deductions reveal.
The surtax would depress capital formation and wages, and
fail to bring in the expected revenue. The numbers below are
for the 2.9% rate hike in isolation. The Administration's
proposal to raise the top tax rates on capital gains and
dividends would produce additional losses. Further losses
would result from the Administration's proposal that the Bush
tax cuts expire for upper-income taxpayers, which would
increase the top two tax rates on interest income and other
``passive'' income to 36% and 39.6%. The return of the
itemized deduction limitation and the personal exemption
phase-out would raise upper-income individuals' marginal
rates even higher and add more economic damage. (The rise in
the top two rates would also apply to labor income, and the
Administration's health care proposal, taking a page from the
health care bill that the Senate passed on Christmas Eve,
would pile on a 0.9% surtax on wages and self-employment
income.)
The House health bill has a 5.4% surtax on AGI. The Senate
considered that but dropped it as ill-advised and instead
opted for a 0.9% surtax on wage and self-employment income
only, building on the existing payroll tax. Any surtax is
undesirable, but a surtax on capital income would be
especially damaging, and the ``cliff' in the Obama
Administration's plan would compound the harm and is
especially inept.

The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, has the time on the Republican side
expired?
The PRESIDING OFFICER. There are 25 seconds remaining.
Mr. BAUCUS. I assume they do not want to use those 25 seconds,
hearing no objection.
Madam President, we have several speakers. We are waiting for Senator
Shaheen, Senator Feingold, Senator Sanders, Senator Nelson, and Senator
McCaskill. I do not see any of them right now.
While we are waiting, I wish to make a point about CBO's analysis
with respect to premiums.
The Congressional Budget Office says that the health care reform bill
will lower premiums for all--millions--Americans--all. The
Congressional Budget Office said health insurance premiums would fall
by 14 to 20 percent for the same plan in the individual market and the
small group market, up to 2 percent lower. Let me repeat that. The
individual market for the same plan, the Congressional Budget Office
says premiums will fall under this legislation. They will be lower,
they will be less by 14 to 20 percent than the same plan in the
individual market, as people buy insurance individually, and premiums
for the small group market--that is roughly small business--would be up
to 2 percent lower than currently.
Why is all that? It is basically because there are savings. The
savings come from lower administrative costs, increased competition,
and from better pooling of risk.
The analogy I like to refer to is Orbitz and Travelocity. Today with
Orbitz, you shop online for an airline ticket. You look for fares and
you look for times. The same type of operation would occur with respect
to insurance--you get on the exchange and shop for insurance.
I see the Senator from New Hampshire is now on the floor. I yield 4
minutes to the Senator from New Hampshire.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mrs. SHAHEEN. Madam President, I thank Senator Baucus.
I am pleased to be here to join in this effort to talk about the
importance of what we are doing with health care reform. We have waited
so long for health care reform, and yesterday it became a reality.
Today, we celebrate a reformed health care system that President Obama
has signed into law. With this historic step, we have ensured that more
Americans have the health care security and stability they need. We
have ensured that families will have choices for coverage even if their
jobs do not provide it. We have ended denials for preexisting
conditions, and we have a guarantee that no one has to pay more for
health insurance if they get sick and that the insurance coverage
cannot be taken away. We no longer allow insurance companies to put
lifetime limits on the amounts of benefits they will cover.
But insurance reforms are not the only thing we have done. We have
made health care more affordable for those who need it most and made it
easier for small businesses to provide coverage for their employees. We
made important steps to encourage everyone to take advantage of
preventive care, and we have created incentives for people to enroll in
wellness programs and encourage communities to address the public
health of their citizens. Finally, we are changing the way doctors
provide care, making it better coordinated and more patient-centered.
I am pleased we are here building on the success of the health care
reform legislation that was just signed into law. Our resolve is
strong, make no mistake about that. We must continue our work in making
a good bill even better.
The legislation we are now considering makes great strides to
strengthen the new law. It will provide more tax relief to families to
help them afford health care and more help for seniors to pay for
prescription drugs.
I have talked with seniors throughout New Hampshire who struggle with
the high cost of prescription drugs. The Medicare doughnut hole, as it
is known, causes great stress in family budgets when seniors have to
pay full price for the drugs they need, people such as Sue Quinlan from
Portsmouth, who recently wrote me about her experience with the
doughnut hole. She wrote:

This year, because of my illness, my drug costs have
doubled, and in September I experienced the ``donut hole.''
This meant that when my Total Drug Cost reached $2,400 for
the year, I was on my own.

She went on to say:

You know you are in the donut hole when a drug you have
been paying $90 for is now $364.47. You know you are in the
donut hole when the mail order prescription company calls to
warn you that your order is going to cost $720.82 and wants
to confirm that you really do want them to send it, and you
have no choice except to send it unless you want to stop
taking the medications. You know you are in the donut hole
when the pharmacist gives you a sympathetic smile when they
hand you your order.

Under this bill, seniors such as Sue no longer need to worry. They
will get a discount on medicine critical to their health, and we will
begin to close the doughnut hole. Seniors will now have access to
affordable drugs on which they depend. We have all heard the

[[Page S1962]]

story of seniors breaking their pills in half or skipping their daily
doses because of the cost. Under this bill, a senior with high
cholesterol and heart disease who relies on Lipitor and
antihypertension medication to stay healthy now can take these drugs
with peace of mind and less financial stress.
This bill will expand affordable coverage to 32 million Americans.
The bill will provide the same Medicaid deals for every State so that
the Federal Government will help share in the burden the States face in
providing coverage for new populations. The bill also builds on the
previous bill to attack waste, fraud, and abuse in our health care
system.
This is a historic time. Today, we build on that historic legislation
with improvements to make it stronger and even better for American
families and seniors.
I yield the floor.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Madam President, I yield 6\1/2\ minutes to the Senator
from Wisconsin.
The PRESIDING OFFICER. The Senator from Wisconsin.
Mr. FEINGOLD. Madam President, for far too long, my constituents have
been at the mercy of the health insurance industry which has dictated
how and whether they get health care coverage. Wisconsinites have been
denied coverage because of preexisting conditions, dropped from
coverage because they made too many claims, or simply forced to pay
through the nose for skyrocketing premiums. Those days are now coming
to an end thanks to the Patient Protection and Affordable Care Act.
We have taken an important step with the enactment of that bill, but
as you know, our work is not done. The Patient Protection and
Affordable Care Act is not perfect, and Congress must be committed to
strengthening and adjusting this law as necessary in the years to come.
The first step, of course, is for the Senate to pass the Health Care
Education Reconciliation Act of 2010, which the Senate is now debating.
This bill will strengthen our health care reform law to ensure that
health insurance is even more affordable for working families and that
seniors actually pay less for prescription drug coverage.
Taken together with the Patient Protection and Affordable Care Act,
this bill would help Wisconsinites purchase good, affordable health
insurance and health care. As a result, this year children will no
longer be denied coverage for preexisting conditions, insurance
companies will no longer drop Americans because they are sick, young
Americans can remain on their parents' coverage longer, and the
Medicare doughnut hole that shortchanges seniors will begin to be
filled. Then, over the next 4 years, States will prepare to set up
health insurance exchanges for individuals and small businesses to
purchase more affordable health insurance. As a result, an estimated
541,000 Wisconsinites who are uninsured and 320,000 Wisconsinites who
have individual market insurance will gain access to affordable
coverage. As many as 358,000 Wisconsinites are expected to qualify for
premium tax credits to help them purchase health care coverage. Experts
believe this reform effort will lower premiums in the nongroup market
by 14 to 20 percent for the same benefits--premium savings of $1,540 to
$2,200 for a family in Wisconsin. Now, this is real savings.

According to the nonpartisan experts at CBO, over the next 10 years,
our national deficit will decrease by $143 billion and up to $1.2
trillion in the following 10 years. Those savings come from a number of
cost containment provisions, including one which I strongly support
that will begin to reimburse physicians based on the quality of care
they provide rather than on the quantity of care. This movement toward
value-based health care purchasing is one that is already seeing great
success in hospitals and medical groups around my State of Wisconsin. I
was so pleased to work with our nationally recognized medical centers
around Wisconsin on these successful efforts.
Health reform also means more choice, more affordability, and more
protections for Wisconsin businesses. Over 77,400 small businesses
throughout the State of Wisconsin are eligible now for tax credits
starting this year to help purchase health insurance for business
owners and their employees. No longer will small businesses be
vulnerable to insurance practices of raising rates on a year-to-year
basis due to an employee falling ill.
I visit all 72 counties in Wisconsin every year, and I always hear
about the burden of health care costs on small businesses. So many
Wisconsinites are discouraged from striking out on their own to start a
small business or to expand it because they can't afford or couldn't
get health insurance on their own. This bill will help those
Wisconsinites start businesses and create jobs by providing the
affordability and protections of the large insurance group market to
small business owners.
Reform also means better and more affordable health care for
Wisconsin's seniors. The bill we are debating will build upon
improvements made by the Patient Protection and Affordable Care Act by
closing the Medicare Part D prescription drug doughnut hole by 2020.
Beginning this year already seniors who reach the doughnut hole will
receive a $250 rebate, with more and more assistance available each
year until the doughnut hole is ultimately closed. Seniors will also be
guaranteed an annual wellness visit and no cost sharing on preventive
care visits to their physician.
Of course, we know this reconciliation bill is not just about health
care. It also ends unjustified subsidies for private banks and lenders
to issue Federal student loans. By transferring the authority to make
all Federal student loans over to the existing Federal Direct Loan
Program effective July 1 of this year, we will save approximately $61
billion over 10 years. The savings will in part be used to help ensure
that students do not see a reduction in their Pell grant awards next
year, providing much needed assistance to Wisconsin's low-income and
middle-income students when they need it the most.
Historic health care reform is now the law of the land. But we have
to do more, and passing this bill is the next step.
The ACTING PRESIDENT pro tempore. The Senator's time has expired.
Mr. FEINGOLD. I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Montana.
Mr. BAUCUS. Mr. President, I yield 7 minutes to the Senator from
Florida, a very valued member of the Finance Committee.
Mr. NELSON of Florida. I thank the Presiding Officer and the
chairman.
For the first time as a nation, we are recognizing that people have a
right to not be destroyed by sickness. Under the Senate bill passed by
the House and signed into law yesterday by the President, folks are no
longer going to have to choose between their health and their
pocketbooks. Parents will no longer have to worry about whether they
can afford to get their kids to the doctor. Seniors will not have to
wonder if Medicare will still be there for them several years down the
road.
Health care reform doesn't mean people would not have to continue
taking responsibility for themselves. The bill we passed, and even the
one we are now debating, improves health care affordability and access
for all, but it still requires folks to do their part. Families who can
afford to will be asked to contribute to the cost of their coverage.
People are expected to get regular primary care so they do not end up
in the emergency room with something that could have been treated
easily and cheaply if it had been addressed sooner.
But, very importantly, we are also going to hold the insurance
companies accountable. We are finally telling them: You can't drop
someone just because they get sick; you can't cap someone's benefits
just because you are tired of paying for their care; and you can't
decide not to offer someone coverage because they have a preexisting
condition. We are telling them: No more, no more, no more.
We are also saying to our seniors that we, as a nation, remain
unwavering in our commitment to protecting and preserving Medicare for
today, tomorrow, and the next millennium.
There has been an awful lot of misinformation going around about
Medicare and something called Medicare Advantage. The fact is, the
original Senate bill proposed an unfair way to fix overpayments to
these private Medicare HMO insurance plans. The fix

[[Page S1963]]

would have come at the expense of seniors living in areas with high
medical costs, such as my State of Florida. I was able to pass an
amendment in committee that fixed that problem fairly.
Under this reconciliation bill, the President has proposed another
way to rein in those Medicare Advantage insurance companies, and this,
upon close inspection, also treats seniors fairly. It puts companies on
the hook for their performance. If they do not provide quality service,
their reimbursements are cut. Their enrollees--the seniors--are going
to demand that they provide quality service. I appreciate the
President's leadership on this issue and the fact that he heard the
concerns expressed by a number of us, including Senator Schumer and
Senator Wyden.
But having said all this, we have left something undone in this
Senate bill that is now law and even in this reconciliation package. I
am not happy this legislation lets the drug companies pretty much off
the hook. You all know that over the past few years I have been voicing
the concerns and fears of residents in my State about what is happening
to their drug prices. I also hear from the folks who can't afford their
medications when they hit the prescription drug coverage gap known as
the doughnut hole. They skimp on food or split their pills or stop
taking them altogether. While this bill offers a discount to seniors in
the doughnut hole, there is nothing to keep drug companies from
continuing to jack up the prices until that discount is meaningless.
I also hear from folks who are frustrated that in other countries
folks are getting the very same drugs for much less than we pay here. I
had an amendment that would have required the drug industry to pay its
fair share of the tab for health care reform. It required the drug
manufacturers to give the government price breaks on drugs for a lot of
our low-income seniors, and that would have saved us $106 billion of
taxpayer money, which was more than enough to fill the doughnut hole
altogether and then make a dent in offsetting the Federal deficit.
So I intend to come back and revisit this. In the meantime, I want to
say this reconciliation bill deepens and extends the promise of the
health care reform bill that was signed into law just yesterday. I
stood with the President when he put pen to paper yesterday. I think it
is great we have begun the process of health care reform.
It has been said by many folks in many different ways that we are not
put on Earth for ourselves, but we are placed here for each other.
Well, here we are, and here we are debating legislation that stands to
improve the lives of tens of millions of Americans. So despite its
flaws, I will vote to pass this legislation.
Mr. President, I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Montana.
Mr. BAUCUS. Mr. President, I thank the Senator from Florida for his
very considered and thoughtful conclusion in deciding to vote for this
legislation. I deeply appreciate that very much. He is a wonderful
member of the committee.
Mr. President, I yield 7 minutes to the Senator from Vermont.
The ACTING PRESIDENT pro tempore. The Senator from Vermont is
recognized.
Mr. SANDERS. I thank the Senator from Montana for yielding.
Mr. President, my Republican colleagues have reached the conclusion
that this is not a perfect bill. Well, they are right. While my
problems with this bill are very different than theirs, I do hope that
in the weeks and months to come, after we pass this reconciliation
package, we will improve it. But I would ask my Republican colleagues
to tell me something: When they controlled the White House and they
controlled the Senate and they controlled the House, when President
Bush was our President--during that period--7 million more Americans
lost their health insurance and health care costs soared. Where were
they then in talking about health care? Did they have one substantive
idea during that period about how we were going to lower the cost of
health care for Americans and provide health insurance for all of our
people?
I do hope that after we pass reconciliation we are going to improve
this bill. In that regard I want to thank Majority Leader Reid who has
promised us--Senator Merkley, myself and others--that we will have the
chance to vote on a public option provision. I think millions of
Americans understand that public option is a choice that people should
have--the right to go outside of the private insurance companies for
their health insurance. That public option will provide competitive
pressure on the insurance industry to control soaring health care
costs. So I very much appreciate Senator Reid telling us that we are
going to have a vote on that issue within a couple of months.
This bill is a strong step forward. It is no small thing that we are
providing health insurance to 32 million more Americans. It is no small
thing that we are moving to eliminate preexisting conditions as a
grounds for rejecting someone for health care. It is no small thing
that we are going to begin to fill that doughnut hole so that seniors
will be able to get the prescription drugs they need in an affordable
way. Those are, among other achievements, quite significant.
But having said that, after the passage of this legislation, we still
have to deal with the reality that we will continue to spend far more
per capita on health care than any other major country.
A few days ago, we had the Ambassador from Denmark visiting Vermont.
In that country, they provide quality care for all of their people, and
they do it spending about 50 percent of what we do because they have
eliminated private insurance companies and all of the administrative
and profiteering costs associated with private insurance companies. I
hope we will one day at least allow States the option to move forward
with a single-payer, Medicare-for-all program, which I think ultimately
is the way we are going to go as a nation if we are going to solve the
need for comprehensive universal and cost-effective health care for all
of our people.
I do want to say a word on one aspect, one provision of this bill
which I think is enormously important, and I am very excited it is
included in this bill. Again, I thank Senator Reid for his help in
making sure it remained in and is amply funded. That is that in this
legislation we are going to take a giant step forward in providing
primary health care to the people of this country through a major
expansion of Community Health Centers and the National Health Service
Corps. This legislation provides enough funding so that we are going to
create, over the next 5 years, 8,000 new health center sites, more than
doubling the number that now exists. We are going to increase access
for primary health care, dental care, mental health counseling, and
low-cost prescription drugs by doubling the number of Americans with
access to community health centers from 20 million to 40 million in
every State, and in every region of this country. That is a huge step
forward in providing basic health care to millions of Americans who
today cannot access that care.

While we do that, we are also going to significantly expand the
number of doctors, the number of nurse practitioners and dentists that
we desperately need in order to provide primary health care to our
people.
This legislation--over a 5-year period--triples the amount of money
going into the National Health Service Corps, a program which provides
debt forgiveness and scholarships for those doctors and dentists who
will be serving in underserved areas throughout this country.
Through the National Health Service Corps, we are going to support an
additional 17,000 new primary health care doctors, dentists, nurse
practitioners, and mental health professionals. What this means is that
if somebody has no health insurance, if somebody has Medicaid, if
somebody has Medicare, if somebody has private health insurance, that
individual is going to be able to walk into a community health center
and get the high quality care they need. The incredible thing, and this
is quite remarkable, is that by doing this we are going to actually
save taxpayers money because we are going to keep people out of the
emergency room, which is the most expensive form of primary health
care; we are going to prevent people from becoming sicker than they
should and ending up in the

[[Page S1964]]

hospital at great expense. Based on a study by the Geiger-Gibson
Program at George Washington University, it is conservatively estimated
that, by investing $12.5 billion in health centers and the National
Health Service Corps, we will save Medicaid alone over $17 billion over
the next 5 years.
This legislation is going to be very significant in providing the
primary health care that we need as a nation, and I am very
appreciative it is part of the bill.
Mr. President, as I conclude, I ask unanimous consent to have printed
in the Record the findings of the study by the Geiger-Gibson/RCHN
Community Health Foundation Research Collaborative, George Washington
University, dated October 14, 2009.
There being no objection, the material was ordered to be printed in
the Record, as follows:

Findings

Since health centers are non-profit entities that operate
subject to comprehensive federal standards, our models assume
that health centers will serve as many patients as their
revenues permit. As a result, the number of patients served
at health centers depends on the revenue available to health
centers and the distribution of insurance coverage among
health center patients. The Senate provisions increase health
center revenues in three key ways: (1) by increasing federal
health center grants; (2) by increasing Medicaid revenues as
a result of expanded Medicaid coverage; and (3) by assuring
higher private insurance revenues as a result of the
extension of the Prospective Payment System (PPS) to health
center patients insured through a health exchange. By
lowering the number of uninsured patients, health reform thus
will allow health centers to use their grant funds to reach
additional uninsured patients, thereby increasing the number
of patients who can be served.
It is important to note that federal health center grants
and payments under Medicaid and private health insurance
represent only a portion of total health center revenue.
Other important sources include other federal, state, local
and private grants or contracts. As in our prior report, we
conservatively assume that these other funding sources will
grow by only five percent annually.
We estimate that by 2019, these combined policy changes
would roughly triple the number of patients receiving care at
health centers. The number of patients would rise from an
estimated 19.0 million in 2009 to 44.2 million in 2015 and to
60.4 million by 2019. In order to expand to serve this many
patients, we assume that the number of health center grantees
and the number of health center delivery sites (i.e.,
clinics) would grow substantially, permitting a major
expansion of health centers and clinics into more medically
underserved rural, suburban and urban communities.
In our prior paper, we analyzed data from the 2006 Medical
Expenditure Panel Survey to compare the medical expenditures
of people who receive the majority of ambulatory care at
health centers and those who do not. We found that, after
adjusting for health status, age, gender, race/ethnicity, and
health insurance coverage, the average patient receiving care
at a community health center had annual medical expenditures
$1,093 lower than an average patient who did not use health
centers. This estimated savings includes both reduced
ambulatory costs as a result of health center efficiencies as
well as reduced inpatient medical expenses, which may be due
to the prevention of more severe health problems requiring
hospitalization. These findings are consistent with numerous
prior studies showing that health centers are efficient
providers of quality primary care and that more effective use
of primary care can reduce hospital and specialty care costs.
Using the estimate of $1,093 savings per health center
patient in 2006, we applied the estimates of the increased
number of health center patients and adjusted savings to
account for health care inflation to estimate total medical
savings associated with the expansion of services at health
centers over the next ten years. These are summarized in
Table 1.

TABLE 1--ESTIMATED INCREASE IN HEALTH CENTER PATIENTS, TOTAL MEDICAL SAVINGS AND FEDERAL MEDICAID SAVINGS UNDER
THE SENATE PROVISIONS, 2010 TO 2019
----------------------------------------------------------------------------------------------------------------
2009        2015        2019      2010-2015   2010-2019
----------------------------------------------------------------------------------------------------------------
Total Number of Patients (mil)......................        19.0        44.2        60.4  ..........  ..........
Increase Over 2009 Patients (mil)...................  ..........        25.2        41.4  ..........  ..........
Est. Total Med Savings Per Person...................      $1,262      $1,551      $1,780  ..........  ..........
Est. Total Medical Savings (bil)....................          --       $39.0       $73.7      $129.1      $369.2
Est. Federal Medicaid Savings (bil).................          --       $11.0       $22.5       $34.2     $105.0
----------------------------------------------------------------------------------------------------------------
Source: Authors' estimates.

As seen in Table 1, in 2019, we estimate that the number of
patients receiving primary care services at health centers
will rise by 41.4 million over the 2009 level of 19.0
million, to 60.4 million total patients. This growing use of
health centers to serve an additional 41.4 million patients
times the medical savings of $1,780 per patient yields an
overall medical savings estimate of $73.7 billion in 2019
alone. Over the 2010-2019 period, we estimate that an
increase in the number of patients who receive their health
care through health centers will lead to $369 billion in
total medical savings. (Following the approach used by the
Congressional Budget Office, we estimate only the additional
savings due to increases in the number of patients served at
health centers. We estimate that the 19 million patients
already served in 2009 create medical savings of $24 billion
in that year alone; savings from the existing 19 million
patients are not included in the estimates shown in Table 1
above.)
This estimate includes all medical savings, whether public
or private. From the federal perspective, the critical
question is federal savings. We estimate savings attributable
to federal spending by focusing on federal Medicaid savings,
accounting both for the increased volume of Medicaid patients
and the effective increases in federal matching shares for
Medicaid. (There are also state Medicaid savings not included
in the estimate of federal savings.) This calculation yields
an estimated federal Medicaid savings of $22.5 billion in
2019 and $105 billion between 2010 and 2019. This is a
conservative estimate of federal savings, since there would
also be savings under Medicare as well as in the federal
subsidies spent to purchase health insurance through
exchanges.

The ACTING PRESIDENT pro tempore. The time of the Senator has
expired.
Mr. BAUCUS. Mr. President, how much time remains on our half hour?
The ACTING PRESIDENT pro tempore. There remains 2 minutes 40 seconds.
Mr. BAUCUS. I yield 2 minutes 40 seconds to the Senator from
Missouri.
The ACTING PRESIDENT pro tempore. The Senator from Missouri is
recognized.
Mrs. McCASKILL. Mr. President, we have had a lot of that childhood
story we all learned of ``Chicken Little.'' We have had a lot of
Chicken Little around this building in the last few months: The sky is
falling, the sky is falling. You know, I woke up this morning, I looked
up and the sky was not falling. Every day that goes by in America
people are going to realize the sky is not falling. In fact, as time
goes on that sky is going to get bluer and brighter because people in
America are going to realize this bill is not full of booby traps, it
is full of good things that will reform health care.
I rise this afternoon to take a couple of minutes to talk about a new
low of obstructionism, taking game playing to a whole new level. In 10
minutes I was supposed to convene a hearing on the contracts for police
training in Afghanistan. This is a very important part of our mission
in Afghanistan, the training of local police departments. There was a
witness who was going to be there from the State Department, a witness
there from the Defense Department, the Inspectors General were going to
be there.
Just last week GAO wiped out a contract that had been let on police
training because of problems in the way the contract was competed. So
this hearing was timely and it is important. We cannot succeed in
Afghanistan if we do not have effective police training. These
contracts are problematic. The State Department is supposed to be
overseeing them. We have hundreds of millions of dollars not accounted
for.
So what do I find out this morning? The Republican party is not going
to let us have the hearing. What in the world? Why in the world are we
not being allowed to work this afternoon? Why in the world are we not
able to ask questions at a hearing in a few minutes as to why the
police training is not going well in Afghanistan and how we can do
better?
Our men and women are over there and they are at risk if we do not
get this right. I don't get it. I don't get what the purpose of saying
no is. I don't get what we accomplish. We are sent here to work. We are
paid by the people of this country to work. The idea that I had to call
these witnesses and say go home because the Republicans will not let us
have a hearing--

[[Page S1965]]

somebody has to explain this to me. Disagree with us, debate, vote no--
but let us work. I implore you: Let us work.
The ACTING PRESIDENT pro tempore. The Senator's time has expired.
The Senator from Montana is recognized.
Mr. BAUCUS. Mr. President, I have one unanimous consent request that
we continue altering sides of the debate. I ask consent we continuing
alternating back and forth, and the next half hour be on the Republican
side.
I ask unanimous consent the next half hour be controlled by the
Republicans and the half hour thereafter be controlled by the majority,
and the half hour after that be controlled by Republicans.
The ACTING PRESIDENT pro tempore. Is there objection?
Without objection, it is so ordered.
Mr. BAUCUS. Mr. President, for the information of Senators, the final
block of time is reserved to be under the control of the chairman for
concluding remarks; that is, prior to a series of votes. I make that
statement for the information of Senators.
The ACTING PRESIDENT pro tempore. The Senator from Kansas is
recognized.

Amendment No. 3579

Mr. ROBERTS. I ask consent to call up Roberts-Inhofe-Brown amendment
No. 3579, and I ask unanimous consent Senator Crapo be added as
cosponsor.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
The clerk will report.
The bill clerk read as follows:

The Senator from Kansas [Mr. ROBERTS], for himself, Mr.
Inhofe, Mr. Brown of Massachusetts, and Mr. Crapo, proposes
an amendment numbered 3579.

Mr. ROBERTS. I ask unanimous consent the reading of the amendment be
dispensed with.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
The amendment is as follows:

(Purpose: To strike the medical device tax)

Strike section 1405 and insert the following:

SEC. 1405. REPEAL OF MEDICAL DEVICE FEE.

(a) In General.--Section 9009 of the Patient Protection and
Affordable Care Act, as amended by section 10904 of such Act,
is repealed effective as of the date of the enactment of that
Act.
(b) Expansion of Affordability Exception to Individual
Mandate.--Section 5000A(e)(1)(A) of the Internal Revenue Code
of 1986, as added by section 1501(b) of the Patient
Protection and Affordable Care Act and amended by section
10106 of such Act, is amended by striking ``8 percent'' and
inserting ``5 percent''.
(c) Application of Provision.--The amendment made by
subsection (b) shall apply as if included in the Patient
Protection and Affordable Care Act.

Mr. ROBERTS. Mr. President, included in the half trillion dollars in
new taxes in this health reform bill is a tax hike of $20 billion on
medical devices, a $20 billion excise tax on lifesaving medical
devices. The nonpartisan Congressional Budget Office and Joint
Committee on Taxation have both confirmed that these excise taxes will
not be borne by the medical device industry if in fact that is what the
other side wanted to do. Instead, the tax will be passed on to patients
in the form of higher prices and higher insurance premiums. My
colleagues are going to speak in greater detail about this tax, but let
me take a moment to talk about some of the people who will bear the
burden, and what types of devices will be taxed.
People with disabilities, diabetics, amputees, people with cancer and
people with Alzheimer's are just some of the folks who will see their
tax costs go up because of this tax. My amendment prevents this new tax
from raising the already high cost for these groups by striking the tax
on medical devices.
This is a tax on innovative devices as well, a device such as the
cyberknife. The cyberknife is a noninvasive alternative to surgery for
the treatment of both cancerous and noncancerous tumors anywhere in the
body. Yet under this bill, such cutting-edge devices will be taxed.
Those who need the treatment offered by the cyberknife will see the
cost of that treatment go up. When innovative and lifesaving
technologies such as the cyberknife are taxed, when the costs of many
tests increase because the devices used in the tests are taxed, when
the new devices are not developed and when fewer manufacturers are able
to survive in the anticompetitive environment this tax will create,
consumers of health care will suffer for it.
I urge my colleagues to support this amendment, and yield the
remainder of my time to the distinguished Senator from Massachusetts,
Mr. Brown.
The ACTING PRESIDENT pro tempore. The Senator from Massachusetts is
recognized.
Mr. BROWN of Massachusetts. Mr. President, I thank Senator Roberts
for bringing this very important issue to the forefront. Many of you
know I live in Massachusetts. We have over 225 medical device companies
there. Before I got here, I visited many of them and the message was
very clear, that if in fact that 3-percent medical device tax goes into
effect, it is virtually all of their profit for many of these young
companies and established companies.
Placing a tax on medical devices, in my opinion and their opinion,
will dramatically affect jobs, not only in Massachusetts but throughout
the country.
Unemployment in my State is hovering near 10 percent and we should be
doing everything we can at this point to create jobs and stimulate the
economy. I am hopeful that in the effort I made in the beginning for a
bipartisan effort to start jobs with the first jobs bill that we can
look at the areas we are trying to focus on to make this bill better. I
am hopeful once again, through the Senator's leadership and that of
Senator Roberts and others who sponsored it, we will look twice at what
we are trying to do here in order to pay for the so-called health care
bill.
As we are in the middle of a 2-year recession, taxing companies,
especially vibrant companies throughout my State and throughout the
country, I am fearful they will leave and go to other countries to do
their business.
I yield the remainder of my time.
The ACTING PRESIDENT pro tempore. The Senator from Oklahoma is
recognized.

Amendment No. 3588

Mr. INHOFE. Mr. President, I call up amendment No. 3588 and make it
pending.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered. The clerk will report.
The bill clerk read as follows:

The Senator from Oklahoma [Mr. INHOFE] proposes an
amendment numbered 3588.

Mr. INHOFE. I ask unanimous consent we dispense with the reading of
the amendment.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
The amendment is as follows:

(Purpose: To exclude pediatric devices and devices for persons with
disabilities from the medical device tax)

On page 99, between lines 9 and 10, insert the following:
(e) Exclusion of Medical Devices for Pediatric Use and
Persons With Disabilities.--
(1) In general.--For purposes of section 4191(b)(1) of the
Internal Revenue Code of 1986, as added by subsection (a),
the term ``taxable medical device'' shall not include any
device which is primarily designed--
(A) to be used by or for pediatric patients, or
(B) to assist persons with disabilities with tasks of daily
life.
(2) Expansion of affordability exception to individual
mandate.--Section 5000A(e)(1)(A) of the Internal Revenue Code
of 1986, as added by section 1501(b) of the Patient
Protection and Affordable Care Act and amended by section
10106 of such Act, is amended by striking ``8 percent'' and
inserting ``5 percent''.
(3) Application of provision.--The amendment made by
paragraph (2) shall apply as if included in the Patient
Protection and Affordable Care Act.

Mr. INHOFE. Mr. President, President Obama repeatedly promised during
the campaign that no one making under $250,000 per year would see their
taxes increase. However, the Democrats claim to spend $2.6 trillion in
new health care at a time when the country cannot afford the promises
they have already made and we have a record 1-year budget deficit, $1.4
trillion.
We hear President Obama always talking about what he inherited from
George W. Bush. What he inherited was nothing like what he did. He
actually raised the deficit $1.4 trillion in 1 year. That is more than
President Bush did in his last 5 years.
The HELP bill, which recently passed the House, represents an
unprecedented

[[Page S1966]]

expansion of government control and increases taxes on Americans during
a difficult economic time. But the Democrats did not stop with one
expensive health care bill. Now the Senate is debating a fix-it bill
which increases taxes an additional $50 billion on the American people.
Reading through the legislation, I am struck by a myriad of ways this
raises taxes on American citizens, from job-creating small businesses
to middle-income families--over a half trillion dollars of new taxes.
If you happen to need a medical device--that is what we are talking
about right now--you get taxed under the bill. Section 9009 of the
recently passed health care bill imposes a new tax on assistive
devices, which includes items such as pacemakers, ventilators, and
prosthetics, and incubators for premature babies. The fix-it bill--I
call this the payoff bill because as you all know the Speaker of the
House had to pay off all these individuals. We understand how that
works. That is what this bill is all about right now. That is why it
needs to be amended. This is what we are currently debating. It
actually expands to include more medical devices such as tongue
depressors, elastic bandages, most hand-held dental instruments, and
examination gloves.
I am joining with my Republican colleagues to propose an amendment
striking the tax on medical devices.
Additionally, I have filed amendment No. 3588--that is what we are
talking about now--that will strike this expansion of taxes on
assistive devices for two of the most vulnerable populations, children
and individuals with disabilities.
I have previously spoken on the floor about this new tax and how it
hurts Americans. Let me remind you of a couple of examples.
My son-in-law Brad Swan installs pacemakers and defibrillators. I
know this is true because he lives right across the street from us. At
1 o'clock in the morning he was called to an emergency involving a
young 8-year-old boy with no heartbeat whatsoever.
He was born with congenital heart disease, was able to have a
pacemaker put in that morning, right after he was called, and now he
has a full, healthy life ahead of him. My older sister Marilyn faced a
similar situation and is alive and healthy today. Additionally, Dr.
Stanley DeFehr, a cardiologist in Bartlesville, OK, explained to me
that:

The cost of a pacemaker [we are talking about $5,000; it is
something that lasts 10 years] pales in comparison to the
cost of a stroke or multiple fractures.

Now with this tax, we are making these medical devices more expensive
for families, which may prevent others from accessing the device they
need in order to enhance or even save their lives.
I have never been through anything like this in the 20 years I have
been here. We look at the tax increase in this bill of $569 billion;
now it is going to be more than that.
Additionally, I was talking this morning in Chickasha, OK, on a radio
show, and the person intervening me was talking about his 94-year-old
mother and how she depends on Medicare. I explained that there is $523
billion in Medicare cuts in this bill.
So, you know, the White House was celebrating. You could hear the
champagne corks popping all night long. Yes, they successfully
increased taxes by $569 billion.
So I encourage people to vote for this amendment to at least relieve
part of the problem that is out there. It is amendment No. 3588.
I yield the floor.
The ACTING PRESIDENT pro tempore. The Senator from Utah is
recognized.

Amendment No. 3644

Mr. HATCH. Mr. President, I ask unanimous consent that the pending
amendment be set aside. I have an amendment at the desk.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered. The clerk will report.
The bill clerk read as follows:

The Senator from Utah [Mr. Hatch], for himself, Mr. Coburn,
and Mr. Crapo, proposes an amendment numbered 3644.

Mr. HATCH. Mr. President, I ask unanimous consent that the reading of
the amendment be dispensed with.
The ACTING PRESIDENT pro tempore. Without objection, it is so
ordered.
The amendment is as follows:

(Purpose: To protect access for America's wounded warriors)

On page 99, between lines 9 and 10, insert the following:
(e) Exclusion of Medical Devices Sold Under the TRICARE for
Life Program or Veteran's Health Care Programs.--
(1) In general.--For purposes of section 4191(b)(1) of the
Internal Revenue Code of 1986, as added by subsection (a),
the term ``taxable medical device'' shall not include any
device which is sold to individuals covered under the TRICARE
for Life program or the veteran's health care program under
chapter 17 of title 38, United States Code, any portion of
the cost of which is paid or reimbursed under either such
program.
(2) Expansion of affordability exception to individual
mandate.--Section 5000A(e)(1)(A) of the Internal Revenue Code
of 1986, as added by section 1501(b) of the Patient
Protection and Affordable Care Act and amended by section
10106 of such Act, is amended by striking ``8 percent'' and
inserting ``5 percent''.
(3) Application of provision.--The amendment made by
paragraph (2) shall apply as if included in the Patient
Protection and Affordable Care Act.

Mr. HATCH. Mr. President, before I talk about my amendment to exempt
our Nation's wounded warriors from this new medical device tax, let me
take a moment to talk about the enormous tax burden imposed under this
bill.
Republicans in Congress agree with the majority of Americans who
believe that simply throwing more hard-earned taxpayer dollars at a
$2.5 trillion health care system will not deliver meaningful reform.
Simply raising more than $650 billion in new taxes at a time when our
national unemployment rate stagnates near double digits is a really bad
idea.
Now, let us take a look at the claims that despite more than $650
billion in new taxes in this bill, this big government bill will not
raise taxes for Americans making less than $200,000 a year, a pledge
that President Obama repeatedly mentioned both as a candidate and then
as our President. Well, the Democratic chairman of the Finance
Committee, and I commend him for his honesty, in his floor remarks on
March 23, 2010, stated: One other point that I think is very important
to make is that it is true that in certain cases, the taxes will go up
for some Americans who might be making less than $200,000. We have
known all along that this pledge is an illusion that will slowly but
continuously disappear over time.
A recent analysis by former Congressional Budget Office Director
Douglas Holtz-Eakin based on data provided by the Joint Committee on
Taxation revealed some startling facts on the distributional impact of
the Senate-passed bill. Let me share these findings with you:
Only 7 percent of Americans would qualify for the new government
subsidy to help them pay for mandatory health insurance. 93 percent of
all Americans will not be eligible for a tax benefit under this bill.
Twenty-five percent of Americans earning less than $200,000 a year
would see their taxes rise.
So what does this all mean? For every one family that receives the
government subsidy, three middle-class families will pay higher taxes.
Simply put, we will continue our march towards the Europeanization of
America as fewer and fewer Americans continue to bear the burden of
supporting the needs of a growing majority.
By the way, the figures I just discussed, do not take into account
all the tax increases in this bill signed by the President yesterday,
including hundreds of billions in new taxes on employers who do not
provide coverage to insurance premiums, prescription drugs and medical
devices.
Representatives from both the Congressional Budget Office and the
Joint Committee on Taxation testified before the Finance Committee that
these taxes will be passed on to the consumers. So even though the bill
tries to hide these taxes as fees, average Americans who purchase
health plans, use prescription drugs and buy medical devices will end
up footing the bill. Every American knows that there is no such thing
as a free lunch in this town.
Included in the $650 billion of new taxes in this health bill is a
tax hike of $20 billion on medical devices. Of the few exemptions
included in the reconciliation bill, there is no mention of

[[Page S1967]]

the brave men and women in the military and our veterans who have
sustained injuries defending this country during the wars.
My amendment would prevent this new tax from raising costs or hurting
access for American soldiers and veterans by exempting medical devices
used by the TRICARE program and the Veterans health care program. We
must protect our wounded warriors who rely on these life-saving and
life-enhancing medical devices.
I urge my colleagues to stand up for our brave warriors and support
this amendment.
Let me tell you, I hope my colleagues on both sides will stand up for
the wounded warriors. I hope they will stand up and realize that these
folks should not be hammered with higher costs on medical devices. We
owe them a debt of gratitude not more taxes.
The ACTING PRESIDENT pro tempore. The Senator from Iowa.
Mr. GRASSLEY. I wish to speak in support of Senator Inhofe's
amendment No. 3588, which would be to exclude medical devices for
children and persons with disabilities from a medical device tax.
I know that when you talk about a medical device tax and if it is on
the manufacturers, you are going to say: Well, what should I be
concerned about that for because some manufacturer is going to pay it.
Well, don't fool yourself. You know, corporations do not pay taxes,
only people pay taxes, and there are three categories of people who pay
taxes: stockholders or employees or consumers. And I will bet in most
cases consumers end up paying for that.
So this provision in this bill is much broader than the Inhofe
amendment would apply to, but I think Senator Inhofe has picked out a
very important aspect of adding taxes, the extent to which surely the
vulnerable people whom you call children and persons with disabilities
are consumers who shouldn't be paying for a tax to pay for a bill that
59 percent of the people in this country say they are against. But
because the majority party and the President want to make history, just
make history, don't worry about the people at the grassroots of
America, what they think.
So there are all these taxes and all of these fees in here, and I
compliment Senator Inhofe for his leadership in at least trying to
reduce this burden on people who are very vulnerable, people with
disabilities.
Of the many taxes in this bill, I am especially worried about the tax
on medical devices. What will happen when the Democrats impose a new
tax hike on $20 billion of these innovative medical devices? During the
markup of the Finance Committee bill, I asked the question to the
nonpartisan Congressional Budget Office and the nonpartisan Joint
Committee on Taxation.
For people who might not understand the emphasis of ``nonpartisan''
about the Congressional Budget Office and the Joint Committee on
Taxation, I would like to say it is very important that you understand
that because everybody thinks everything connected with Congress is
totally political. Well, these are professionals who are around here a
lot longer than a lot of Senators and Representatives, and then their
job is, in a professional way, to look at what things cost and how much
money certain taxes will raise. So they are kind of like God around
here. They are believed. If you want to overrule them, you know, it
takes 60 votes. That is a lot of power when you have to have 60 votes
to overrule something on a point of order.
So explaining what nonpartisanship is with the Congressional Budget
Office and our constituents understanding that so they understand we
are not quoting a Republican or a Democrat, we are quoting
professionals, I think is very basic to understanding the points we
individually make so that they are accepted as intellectually honest.
In this particular case where these two offices--both of them said
these excise taxes will be passed on to consumers in the form of higher
prices and higher insurance premiums. When I began my remarks, I said
that is what is going to happen. Well, Chuck Grassley said that, but I
want you to know that is what these professionals in the Joint
Committee on Taxation and the Congressional Budget Office backed me up
in saying.
Who are the consumers of these devices? I have the exact language
here of how these things are going to be passed on to consumers so that
you know, you see the document right here.
Who are these consumers of these devices who will bear the burden of
the new medical device excise tax? I would like to tell the story of
the Tillman family, a family who would bear the burden of this new
medical device tax.
At only 5 months old, Tiana Tillman had her life saved by a medical
device.
This story has received a lot of attention because Tiana's father is
a professional football player for the Chicago Bears. However,
lifesaving stories like this happen all across the country.
When Charles Tillman reported to training camp in 2008, it was not
long before his coach told him his 5-month-old daughter Tiana had been
rushed to the hospital. When Charles got to the hospital, Tiana's heart
rate was over 200 beats per minute. The doctor told Charles and his
wife Jackie that Tiana may not make it through the night.
Tiana survived the night, and after a series of tests, she was
diagnosed with cardiomyopathy, that is, an enlarged heart that is
unable to function properly. Her condition was critical, and without a
heart transplant, she would not survive. But finding pediatric donors
is very difficult, and many children do not survive that long wait
time.
Tiana was immediately put on ECMO, a device that would help the
functions of the heart while Tiana waited for a transplant. However,
ECMO is an old device that has many shortcomings.
The Tillmans waited for one of two outcomes: either Tiana would
receive the transplant or she would die waiting on ECMO.
If you want to know, ECMO is E-C-M-O, an acronym.
But then doctors told them about the new pediatric medical device
called the Berlin Heart--the Berlin Heart is an external device that
performs the function of the heart and lungs--the Tillmans decided to
move forward with the Berlin Heart. After 13 days of being on ECMO
without any movement, Tiana underwent surgery to connect the Berlin
Heart. After the operation, you can see Tiana in that photo. It pumped
her blood through her body--a job her heart could not perform on its
own. Doctors said the Berlin Heart helped Tiana regain her strength
because she was off the paralytic medication and finally moving.
Not long after Tiana connected to the Berlin Heart, a donor was found
and Tiana underwent an 8-hour transplant surgery. The risky surgery was
a success, thank God. Usually it takes some time for a new heart to
start working, but doctors said that due to Tiana's strength, her new
heart started working immediately.
So you see here Tiana today. She probably loves that football just
like her dad loved the football. She is a happy and healthy 2-year-old
girl. She enjoys playing on her swing and watching her dad play
football.
Without the Berlin Heart to keep her alive and help her to gain
strength, she might not, in fact, be alive. Democrats would increase
costs for families such as the Tillmans with this tax, particularly.
But it will be relieved somewhat if we adopt the Inhofe amendment. In
fact, the Democratic bill would tax most pediatric medical devices. I
wish to make clear that any vote against the Inhofe amendment is an
endorsement of the tax on devices such as the Berlin Heart and many
others children across this country rely upon. Not only that, it would
also probably have a great impact upon research that brings about some
of these miracle medical devices that make a difference. Taking money
away from research at businesses is going to delay the miracle things
that come along, whether they are pharmaceuticals or medical devices.
We should not be discouraging that. In the rest of the world, there
has not been as much research done in the rest of the world as is done
in the United States. Maybe go back 50 years ago and you had Germany
and other European countries very much involved. But their government
taking over everything and their high rates of taxation are drying up
resources used for research. So the United States has been the
beneficiary of that. Our pharmaceutical industry and medical device

[[Page S1968]]

industry have taken advantage of it. So much new development around the
world in the enhancement of these devices as well as pharmaceuticals
have come because of the research we do. This tremendous tax burden
that the American consumer is going to feel from the massive money
coming in to fund this bill, which isn't going to drive down health
care costs, is going to stymie a lot of innovation we should not want
to stymie.
May I ask the Chair how many minutes my side has remaining?
The ACTING PRESIDENT pro tempore. The Senator has 3\1/2\ minutes
remaining.
Mr. GRASSLEY. I will take that 3\1/2\ minutes to comment on another
aspect of the bill. This is not on the Inhofe amendment, at this point.
It is something unrelated to health care, but in a sense it is related
to health care. This is the nationalization of the student loan
program. For a long time, colleges on behalf of their students have had
the benefit of going with a direct student loan from the government or
getting it through the banks. They have voted by their feet, by the
overwhelming amount of them going to the banks to get their student
loans. Now this reconciliation is going to nationalize student loans,
have just direct loans. There are about 31,000 people around the
country who have something to do with student loans. Those people are
going to be out of work at a time when we are all talking about jobs.
We need to do something for jobs. So we're going to nationalize
education loans and have that unemployment and then take four call
centers around the country to take its place. Do you think college
students are going to get the service they get when they have to deal
with the Federal bureaucracy redtape? I don't believe so. But there's
supposedly a certain amount of savings in this. I don't know whether it
is real savings, but the CBO, which I say is God around here, scored it
as a certain amount of savings, even considering the fact that the
government is going to have to borrow $\1/2\ trillion to get this
program underway. They are going to use those supposed savings from the
student loan program to fund this bill, the health care bill.
We are in a situation that is just something that common sense
Americans in the Midwest are not going to understand. But it is
something, I suppose, you would expect to happen in Washington, DC,
which is an island surrounded by reality, that you are going to have
college students who are going to pay 6.75 percent interest on their
loans to the Federal Government that the government only pays 2.75
percent to borrow, that you are going to be taxing college students to
pay for health care. It doesn't add up, at the very same time that too
many of us in this body are complaining about the increased cost of
education.
I hope the college students will speak up in this particular instance
about what is being done, that college students should not be taxed to
provide health insurance. But this whole health care bill taxes
everything. It just seems like everything.
How many minutes are remaining?
The ACTING PRESIDENT pro tempore. The time of the Senator has
expired.
The Senator from Montana.
Mr. BAUCUS. Mr. President, I yield 5 minutes to the Senator from New
Jersey, Mr. Lautenberg.
The ACTING PRESIDENT pro tempore. The Senator from New Jersey is
recognized.
Mr. LAUTENBERG. Mr. President, I thank Senator Baucus for his
leadership on this health care reform effort that is underway.
This is the most astounding thing. For all these weeks, our friends
on the other side have said no, no, no to health care. Not one good
word. Not one of them stood and said: Yes, we should cover 32 million
people who don't have coverage; yes, we should cover young people who
want to join their parents' health insurance policy. They said no to
small businesses that need help in providing affordable health coverage
to their employees.
Many know that recently I was stricken with an illness. Five weeks
ago this time, I was in an ambulance on my way to the hospital,
bleeding profusely, very sick. I was lucky. I had health care coverage.
The doctors were there waiting for me. They were there to give me
transfusions. They were there to give me intravenous fluids. They were
there to care for me. I had nursing care, and I came through a crisis,
as my children stood by, my four children stood by with their fingers
crossed, pleading for my health to return. It was because I had health
care coverage that I am standing here today on my way to a full cure--
less hair but still willing to fight the fight for the people I
represent, for the people across this country who are being denied
coverage in any way they can do it.
What we see is obstructionism at its worst. I have yet to hear them
say: Let our conscience come out here and say we ought to cover these
people, that we ought to make sure health care is affordable.
The night I was brought into the hospital and was so fortunate enough
to have the health care coverage I had, during the days of recovery I
thought: What would happen if I was 40 years younger, had two or three
kids, had no health care coverage, and I came in, in this kind of
critical condition? The chances of my walking out of that hospital
would have been very low.
So I say to my friends on the other side, they are not bad people,
they are just totally wrong. They don't want to say that a young person
can join their family's affordable health care insurance. They don't
want to encourage people to find insurance that is affordable through
the exchanges that are provided. They don't want to permit people who
are there without coverage, who would force their way into an emergency
room, perhaps, and say: Look, I am very ill. I have no pep. I feel
terrible. Take care of me. Yes? Take a number like you do in a
supermarket. You are No. 32. We will get to you. Don't worry about it.
Well, I worry about it because I know a different kind of America. I
know an America that was there for me when I needed an education. I
know an America that is there for people. I get letters from them all
the time that say thank you for helping us to be able to afford a
better education. Thank you for the things you can do.
I say to my colleagues on the other side: Open up. Tell the truth. If
you don't want to give those people affordable coverage, then throw in
the coverage you have. Throw in your policy. When you say no to the 32
million people, say: I mean it when I say no. I am giving up my
coverage similar to those people out there. Tell the truth about how
you feel about the people who stand there without coverage, worrying
every day whether an illness is going to rob them of their jobs, of
their opportunity to perform their parental duties or any duties. That
is what ought to happen. Stand. Vote no, vote no against anything that
improves or might improve this insurance and say: No, I mean it when I
say no. I mean it. I am willing to give up the coverage I and my family
have.
I am talking to the Senators on the other side. Say no and mean no.
But mean it for yourselves as well as the people outside who are
begging for the coverage.
I thank the Chair.
Mr. BAUCUS. Mr. President, I thank my good friend from New Jersey. I
am reminded how he led the fight years ago to stop cigarette smoking in
airlines. I was so pleased when he did that. I know many millions of
Americans who are still pleased. It was he who did it.
I yield 10 minutes to the Senator from Oregon, a big leader in health
care reform. He has been working health care reform as long as I can
remember. I thank the Senator from Oregon.
The ACTING PRESIDENT pro tempore. The Senator from Oregon is
recognized for 10 minutes.
Mr. WYDEN. Before he leaves the floor, let me echo the praise for our
friend from New Jersey, who has prosecuted the case against cigarettes
for so many years. We are thankful to him. What a strong advocate he
is.
I thank the chairman as well for all his efforts. I wish to highlight
a couple provisions he and I worked on together that speak to the
headlines we are seeing in this morning's newspaper; in particular, the
provision he and I partnered on that allows States to innovate and take
their own fresh approaches in terms of addressing health care
challenges. We all read today about how roughly a dozen States are

[[Page S1969]]

already challenging the important, recently-signed health care law on
the grounds that the individual mandate is unconstitutional. He and I
worked very closely together to ensure that States could have a waiver
to, in effect, go out and set up their own approach. In fact, counsel
to the Senate Finance Committee specifically said, in response to our
questions during the markup of health reform, that if a State could
meet the general framework of our legislation, it did not have to do it
with an individual mandate.
I thank the chairman for stepping up and empowering the States. I
want the country to know that under the legislation Chairman Baucus
worked on with me, every State does not have to litigate. They can
innovate. They can go out and look at fresh approaches to address our
health care challenges. That would include doing health reform without
an individual mandate. I have followed the discussion on the floor over
the last couple days about how somehow reform would Europeanize the
health care system. On the contrary, what Chairman Baucus has done,
with Section 1332 of the health reform bill, similar to what I sought
to do in the legislation I drafted that had bipartisan support, is to
send a message to all the States all across the country that we invite
them to come up with the kind of fresh, creative ideas that are going
to help us hold health care costs down. In fact, the chairman and I
spent a lot of time trying to make sure States could tailor their own
health insurance exchanges, which would be fresh marketplaces, so that,
for example, an approach in Montana or Oregon that folks there thought
made sense, could be entirely different than a strategy New York would
try on its own. Not only is section 1332 a provision that allows for
State innovation, but, as the chairman knows, there is also another
approach that our colleague Senator Cantwell came up with that advances
similar State innovation, allowing States to set up a basic health care
plan.

So my message to these States talking about litigating right now is,
why would you say at this point you are going to go out and go to court
and sue everybody in sight when, in fact, what the President signed
yesterday gives the States the authority to come up with their own
approach? Senate Finance Committee counsel is on record as saying that
States could pursue their own approach without an individual mandate. I
hope--given the amount of attention that is being paid this afternoon
to the question of States filing these lawsuits, alleging the law is
unconstitutional because of the individual mandate--I hope some of
those States will take a look at section 1332 that, in my view, ought
to be attractive to elected officials all across the political spectrum
who share the view Chairman Baucus and I share; which is, we would like
to empower the States.
Another area where innovation is encouraged to occur is the Medicare
Advantage provision in our legislation. We have had a lot of discussion
on the floor about Medicare Advantage. Having been involved with this
program for a number of years, and its predecessors during the days
when I was codirector of the Gray Panthers, I wish to offer up to
colleagues that not all Medicare Advantage is created equal. Two years
ago, we heard testimony in the Senate Finance Committee about some
Medicare Advantage products that, as far as I am concerned, are so
shoddy and so devoid of consumer protection the people who sold them
ought to be in jail. We have taken steps to add consumer protection to
the Medicare Advantage Program.
On the other hand, there are very good Medicare Advantage Programs in
our part of the country that have been able to win recognition from the
Federal Government as high quality plans. In fact, under this
legislation, plans that have earned a high quality rating from the
Federal Government on the basis of, for example, how they manage
chronic conditions, the kinds of screenings they do of a preventive
nature, and their responsiveness to member complaints, when they get a
high rating from the Federal Government on the basis of such criteria
and earn those extra stars, they will get bonus payments. This was an
idea the Chairman worked closely with me on when the legislation was
advanced by the Finance Committee.
We will probably have further discussions on the floor about Medicare
Advantage, but I only come to the floor today to say--for those who are
interested in promoting quality; for those who believe that no matter
how much you do to contain costs, you also have to beef up quality--
take a look at the work that was done with respect to Medicare
Advantage. It acknowledges that not all Medicare Advantage is created
equal.
(Mr. MERKLEY assumed the Chair.)
Mr. WYDEN. The Presiding Officer in the Senate, who has just joined
us, knows that our home State has the largest percentage of folks in
Medicare Advantage than any other State in the United States: over 40
percent. They happen to be in good plans with those high ratings I
mentioned from the Federal Government. So clearly, our States with high
quality are going to be appreciative of this. But so will all the other
programs across the land that have similar ratings, and we will have
created an incentive for all of those other Medicare Advantage Programs
in the years ahead to meet our standards.
I come to the floor briefly this afternoon to point out these two
provisions in the bill that promote quality and innovation. First, I
hope States will use the provision that creates incentives for them to
innovate. Our message ought to be innovate rather than litigate. I hope
attorneys general will remember that in the days and weeks ahead.
Second, I hope colleagues will look at the new incentives in this
legislation to promote quality in the Medicare Advantage program and
beyond because I believe those two provisions in this legislation--that
encourage State innovation, that promote quality in the Medicare
Program--ought to be widely supported by colleagues on both sides of
the aisle in the days ahead.
That is, in my view, the kind of approach that can bring the American
people together and help us implement this law in a fashion that is in
line with what Americans want: good quality, affordable care, and
reform that works for them.
Mr. Chairman, I thank you for this time and particularly for your
help on those two provisions that I think ought to appeal to both
Republicans and Democrats in the days ahead.
Mr. BAUCUS. I thank the Senator very much.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Might I inquire, Mr. President, how much time remains on
this side for this block?
The PRESIDING OFFICER. Fifteen minutes.
Mr. BAUCUS. I thank the Chair.
Mr. President, I yield 10 minutes--5 minutes--to the Senator from
Colorado.
The PRESIDING OFFICER. The Senator from Colorado.
Mr. BENNET. Thank you, Mr. President. I say thank you to the Senator
from Montana for his generosity. I will not take 10 minutes. I know the
Senator from Pennsylvania is here.
Mr. President, I stand here today for the millions of Coloradans and
American families who are sick and tired of the name calling, the
bickering, and the partisanship in Washington.
I am here today for over 800,000 uninsured Coloradans who will now
have a fighting chance to get the health care they need.
I am here for the 1.2 million Coloradan children who will never again
be at risk of being denied coverage because they have a preexisting
condition.
I am here for the 70,000 small businesses that will get a tax cut to
provide health insurance, so they do not have to make the terrible
choice between providing health care coverage for their employees and
keeping their doors open.
I am here for the hundreds of thousands of seniors who depend on
Medicare and expect us to protect and preserve it for generations to
come.
We have passed a bill that makes our country more competitive, ends
insurance company abuses, gives people more coverage, and starts
putting our country on a more sound fiscal footing for the next 20
years.
I join those on this side of the aisle and on the other side of the
aisle who have said this is not a perfect piece of legislation. No
piece of legislation is perfect. But it is a great first step for the
reasons I said.

[[Page S1970]]

The nonpartisan Congressional Budget Office has confirmed a $143
billion reduction in the Federal deficit over 10 years, as a
consequence of our passing this legislation, and a $1.2 trillion
reduction in the first 20 years.
Now we need to pass this reconciliation bill--a bill that gets rid of
the special deals I spoke out against at the end of the year, a bill
that makes sure our seniors can afford the prescription drugs they
need, a bill that covers more people in my State of Colorado.
But the insurance companies and the special interests have not given
up. The defenders of the status quo are still at it. Put simply, to
amend the bill is to kill this bill. The only reason we are going
through this process is because opponents of health care reform want to
kill the bill. Now is not the time to play games with the lives of
thousands of Coloradans and millions of Americans, and I will not do
it.
There are also some who are well intentioned and want to amend this
bill to include a public option. I am and have been a strong proponent
of a public option and, like a lot of people, have taken a lot of heat
for it. I am not sure why because everywhere I went in Colorado people
said to me: Michael, if you are going to require us to have insurance,
we want as many choices as possible for our family. Please don't force
us into this private insurance if there are other options out there.

A lot of us did all we could to convince the House to include it in
this bill, and we were disappointed when they did not. We are going to
continue to fight for it until we get a vote. We will have our vote on
a public option. But I will not risk the well-being of Coloradans to do
it, and I will not play into the hands of those who want to kill the
bill.
So today I stand with many of my colleagues, with the American
Diabetes Association, the American Hospice Foundation, the Autism
Society, Doctors for America, Easter Seals, and the National Alliance
on Mental Illness, along with over 150 organizations that want us to
pass this bill as well. I stand with AARP which knows that changing
this bill now will put seniors at risk.
But more important than all of that, I stand with the people of
Colorado who expect more from their government and who want more for
their children and grandchildren than politics and name calling.
I urge all of my colleagues to pass reconciliation and send this bill
to the President's desk.
I yield the floor.
Thank you, Mr. President.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I yield the remainder of the time to the
Senator from Pennsylvania, Mr. Casey.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. CASEY. Mr. President, I am grateful for this opportunity to speak
about health care. I commend our chairman, Senator Baucus, for his
great leadership in the Finance Committee and on so many other
important issues we have been wrestling with with regard to health
care.
We have had a chance over many months now--and even as we speak
today--to talk about a lot of the policy of the bill the President
signed into law, our health care bill we passed here in the Senate,
and, of course, the policy contained in the bill we are considering
now. But sometimes it is important for us to step back and talk about
some--not all--but a few examples of some of the real people out there
on whom this legislation will have an impact.
I have spoken a number of times about Trisha Urban from Berks County,
PA--all the problems she and her family had with their health care:
denied coverage because of a preexisting condition, running into
problems when the insurance company dropped coverage. Her husband died
in the process. And the same day he died, her daughter was born. I have
told that story a number of times, and I will tell it again.
I also want to highlight what has happened to another family, the
Ritter family from Manheim, PA, Lancaster County. The family has two
young girls whom I have met. I met them in 2009. As children, these two
little girls, Hannah and Madeline Ritter, hit their lifetime cap on
their cancer treatment before they completed their course of treatment.
When they hit this cap, they were 4 years old, these two Ritter twins.
If that is not proof that comprehensive health reform is needed now, I
do not know what more we can say.
We are very happy the President signed into law the bill we passed in
December. Now the health care reform is the law of the land. The Ritter
twins--Hannah and Madeline Ritter--will not have to worry about how to
get or keep health insurance coverage throughout their lives because,
in 2010, strong consumer protections will go into effect. Not only will
these protections ensure that these two little girls--Hannah and
Madeline--not only will it ensure they can have access to the medical
care they need to grow up healthy, but also they will be able to reap
the benefits of other parts of this bill.
This bill will also help hard-working insured Americans from having
to declare bankruptcy due to medical bills, as the Ritter family of
Manheim, PA, had to do at one point. I do not have the time in this
segment to be able to tell their whole story, but suffice it to say, in
addition to the nightmare their daughters lived through, the family had
to declare bankruptcy.
But some highlights of what this bill means to real families: Health
insurance reform puts American families and small business owners--not
their insurance companies--in control of their own health care.
Secondly, this bill makes health insurance affordable for middle-
class families and small businesses--one of the largest tax cuts in
history--reducing premiums and out-of-pocket costs.
Third, it holds insurance companies accountable, at long last, to
keep premiums down and prevent denial of care and coverage, including
for preexisting conditions.
No. 4, this legislation improves Medicare benefits with lower
prescription drug costs for those in the doughnut hole, better chronic
care, free prevention care, and nearly a decade more of solvency for
Medicare.
Finally, No. 5--and this is not a comprehensive summary but one more
point--this legislation reduces the deficit, according to the
Congressional Budget Office, by $143 billion over the next 10 years. If
you look at the 10 years after that, 20 years in total, it is well over
$1 trillion.
So this is a bill, and this is legislation, whose time has come. At a
time when our State--in Pennsylvania, where we have 577,000 people out
of work, almost a record number of people out of work in Pennsylvania--
we have to make sure that one of the things we put in place is a more
secure health care system for workers and their families.
We all have heard the list of provisions that will go into effect
right away. Small businesses will have access to--have the eligibility,
I should say--for tax credits. Some companies will get credits up to 35
percent of the dollars they spend on premiums. The Federal Government
will be investing in community health centers even in greater amounts
than the Federal Government does now. Older citizens would not be
affected by the doughnut hole problem where they have to pay the whole
freight for prescription drug costs for several thousands of dollars'
worth of care. They are going to get relief from that. In 3 months'
time--3 months from yesterday--people with preexisting conditions will
be able to get help from a high-risk pool, a special fund to help them
in that crisis.
As we know, in 6 months--in September--children will have the full
legal protection in new insurance plans for denials of coverage--or I
should say against denials of coverage--for a preexisting condition.
So for all of those reasons and more, whether we are thinking about
the problem that Trisha Urban and her family had before and certainly
after her husband's death, or the Ritter twins, Hannah and Madeline
Ritter, we hope more families have the benefit of the protections in
this bill. We know one thing. We know small businesses across the
country are starting to get a sense now of what this will mean in terms
of helping them with the tax credit, helping their employees with the
critically important issue of health care.
Mr. President, I yield the floor and note the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.

[[Page S1971]]

The assistant legislative clerk proceeded to call the roll.
Mr. GREGG. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. GREGG. Mr. President, I believe the Senator from Tennessee is
here and ready to speak.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. CORKER. Mr. President, I might meditate for about 60 seconds and
step back up. I now notice the absence of a quorum, unless I should
give it to the other side.
Mr. GREGG. No. If the Senator is not ready to speak, I will speak.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mr. GREGG. The Senator from Tennessee is going to offer an amendment
in a second, and I will follow him with an amendment. I wish to
highlight what my amendment will do as we are waiting.
One of the extraordinary shell games that is played under this bill
in the ``Alice in Wonderland'' claim that this bill is paid for is the
fact that the doctors will receive a $285 billion cut in their
reimbursements if this bill goes forward in its present form. We all
know that is not going to happen. So at some point there is going to
have to be a doctors fix, which means $285 billion not accounted for in
this bill will have to be spent over the next 10 years. Of course, if
they had included this in the bill--this fact that doctors are being
underreimbursed and that we are going to correct this; this is called
the doctor fix, and we do it every year on an annual basis--if they had
included it in the bill, as they should have because this is, after
all, called health care reform, then the bill would have been in
deficit even under the gamesmanship played by the Democratic Party on
this bill.
Remember, the way they got a surplus in this bill in the first 10
years was they took 10 years of spending cuts, 10 years of revenues,
and matched them against 6 years--6 years--of programmatic
expenditures. So they were able to get a surplus, and CBO has to score
what is given to them. If you are given phony ideas, you have to score
them. In any event, what CBO was not asked to score as part of this
health care, because there was no attempt to correct it, and even
though it is the essence of health care, is how do you correct the
reimbursed doctors.
So after the Senator from Tennessee proceeds, and I think he may be
ready to proceed at this time, I am going to offer an amendment for a
doctors fix so that this bill will address that issue which is,
obviously, one of the core issues on the question of health care reform
around here.
So I will reserve now on that issue and turn to the Senator from
Tennessee who I see is ready to proceed.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. CORKER. Mr. President, I wish to thank the Senator from New
Hampshire who I think has offered extraordinary leadership on this
issue and on the issues regarding our country's huge amount of
indebtedness. As does Senator Gregg, I find it hard to believe that we
are taking over $500 billion in savings from Medicare, as he just
mentioned, to leverage a new entitlement when we know that Medicare
itself has a $37 trillion unfunded liability. As he mentioned, we go
further by not even dealing with this doc fix which he was just
discussing.
I look forward to his amendment, I look forward to supporting it, and
I thank him for his leadership.
I wish to speak today about unfunded liabilities. I was the mayor of
a city. I know the Presiding Officer served in the general assembly in
the State from where he comes. I was the commissioner of finance for
our State where we dealt with all of our financial issues for the State
of Tennessee. I know Senator Gregg was a Governor.
One of the things that I think bothered all of us who used to serve
at the city and State levels was unfunded mandates. It is an incredible
thing where Washington will pass a piece of legislation and, by the
way, have a major signing ceremony where everybody is patting each
other on the back and celebrating that they just passed something, and
the part that is left out is that the States across this country are
left with a huge unfunded mandate.
We have a very good Governor in our State. His name is Phil Bredesen.
He is a Democrat. He has spent a lifetime in health care. He has
handled our State's finances very well. He called me on Friday with a
sense of tremendous concern in his voice talking about the fact that
this bill was going to cause the State of Tennessee, which is already
experiencing huge tuition increases--we have all kinds of services
there that we are having difficulties dealing with--and this bill is
going to create a $1.1 billion unfunded liability for the State of
Tennessee. I just find it hard to believe that, again, knowing the
stress our States around this country are dealing with, we are passing
legislation that puts in place a $1.1 billion unfunded mandate on the
State of Tennessee.
But let me go a step further. This bill also violates something we
thought was sacrosanct around here and that was the Unfunded Mandates
Reform Act, which basically said that we acknowledge--most of us have
come from other places, served in local and State governments, and we
acknowledge that we should not be passing legislation that creates
unfunded mandates. We shouldn't be patting ourselves on the back,
passing legislation that we say is good for the people back home, and
then sending the tab there.
So this bill violates that. I think everybody in this body knows it
violates that. So it is just kind of, yes, we said we didn't want to
deal inappropriately with States, but we decided we wanted to pass
health care reform, and we are going to do it.
Let me come to the one that I find most fascinating. Senator Gregg
was just talking about the fact that we have this 21-percent cut coming
for physicians who treat Medicare recipients, and instead of taking the
Medicare savings that we found in this bill and using that to make sure
these physicians are paid, we are not going to do that. So in a short
time, without us taking, again, emergency action--$200 billion or so--
these physicians are going to have a cut.
Let me tell my colleagues what we are doing in this bill, and I think
the Presiding Officer may already know this, but in addition to
creating in our State a $1.1 billion unfunded mandate, we are going to
pay physicians who treat Medicaid recipients at the same level as, if
you are a primary care physician, as Medicare reimbursements are today,
but we are going to do that for 2 years.
Now, this is like the worst joke ever that we can play on our States.
What we are saying is, we are going to mandate to the States that the
primary care physicians who treat Medicaid recipients, their rate has
to be jacked up, and we are going to provide the money for that for 2
years, but then that drops off. So not only do we have this issue of
the unfunded mandate, we are creating that exact cliff issue for States
in this bill, which means that after this 2-year period ends--after
this 2-year period ends and we have given them the money to pay these
physicians at Medicare rates instead of Medicaid, which is much lower--
we are going to cut off the funding.
So the State is going to be in the position, obviously, of having to
keep that up. It is like the worst joke ever.
I don't know how we can come up with legislation such as this and
call it reform. I said this before. Half the people who are going to be
receiving health insurance after this bill passes are going on a
Medicaid Program.

There was a bill in the Senate that Senators Wyden and Bennett worked
on together. It had some flaws. It would have been an interesting
starting place, though, and that bill did away with Medicaid and caused
Medicaid recipients to have the same kind of health care that you and I
have. What we have done in this bill instead of that--instead of
focusing on cost--we are going to put half of the new recipients in a
program that none of us--none of us--would want to be in, and we are
calling that health care reform.
So I do plan later to offer an amendment to deal with this issue of
unfunded mandates. I think it is wrong for us as a country to have
people in Federal office who push their desires off on people and then
call them to pick up the tab. I was a mayor. I was a commissioner of
finance. The Presiding Officer served in the general assembly. Senator
Gregg served as a Governor.

[[Page S1972]]

We know that is wrong. I don't know why we are doing it. I plan to
offer an amendment to correct it.
Mr. President, I thank you for the time, and I note the absence of a
quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. GREGG. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 3651

Mr. GREGG. The States don't have the elasticity the Federal
Government has, which we will not have much longer, by the way, as a
result of passing this bill specifically because our debt is growing so
fast that it is going to be very hard for us 5 or 6 years from now to
be able to sell our debt at a reasonable price, in my opinion, and we
are going to find that maybe some people don't even want to buy our
debt.
There was a very significant event this week when it was determined
that the debt issued by Warren Buffett was going out at a lower cost
than the debt issued by the United States of America. That is the first
time that anybody can remember something like that, and that is a very
clear statement by the markets that they are getting very worried about
how much deficit and debt this government is running up.
Now we pass this bill which adds $2.6 trillion to the spending of the
U.S. Government and alleges it is paid for, but we know it is not going
to be, and creates new entitlement programs which we know would not be
fully funded. Even if it were paid for, it takes resources which should
be used to reduce the debt, especially in the area of making Medicare
more solvent, and uses them to expand new programs.
This event, as I have described it, is an astroid of debt headed at
our country. The simple fact is, it is going to have an effect. The
effect will be that we will have more difficulty selling our debt, the
deficits and debt we pass on to our children will be extraordinary, and
their ability to have a higher standard of living will be reduced as a
result of that.
But the point, of course, is this bill, on top of all of the other
egregious things it does in the area of fiscal policy--of running up
debt and creating a massive government that we can't afford, being
intrusive in everybody's health care delivery system, undermining the
ability of small businesses to offer insurance, raising premiums,
raising taxes on people not only earning more than $200,000 but earning
less than $200,000, replete with special deals--on top of all of that,
this bill, as Senator Corker said, puts pressure on the States and
local communities.
It asks them to spend money which they did not want to spend and
which is not reimbursed. That is not fair. It is called unfunded
mandates. It is inappropriate. We actually have a law around here that
this bill basically runs over that says we will not do that.
As I said earlier, another thing this bill does, which I find
extraordinary, is it does not address one of the elephants in the room
relative to the cost of health care in this country, which is the fact
that we are not adequately reimbursing our doctors; that our doctors
are going to receive a $285 billion cut over the next 10 years, a $65
billion cut over the next 3 years unless we correct that. This is from
basically a freeze level of reimbursement.
Every year we adjust that payment so doctors do get their money they
deserve or at least some portion of it in that we do not keep up with
inflation. But this bill, which is supposed to be a comprehensive
resolution of health care, leaves the doctors out in the cold. It means
every year they are going to have to come hat in hand, one more time,
asking for something they should not have to ask for, which is a fair
reimbursement for their services.
We will every year, hopefully, address it. But it is not right that
we have a bill that does not even account for that.
Why was it not put in? It was not put in because if it had been put
in, this bill could not meet the budgetary rules that give it the
special protection that allows it to come to the floor of the Senate,
and it would have been in deficit, at least over the first 10 years, by
$100 billion, even using the gamesmanship scoring the other side of the
aisle has used relative to the big bill.
This is not fair to the doctors. The doctors deserve better than
this. We should correct this right now as part of this process. This
trailer bill has the title ``fix-it bill'' on it. One thing we should
definitely fix is the fact the doctors are getting shortchanged. So
let's fix it. That is what my amendment does.
My amendment says: OK, this bill alleges it generates a surplus.
Let's use part of that surplus to make the doctors whole for the next 3
years. It is a paid-for amendment. I cannot imagine anybody would want
to oppose this amendment. After all, after we complete this bill--
immediately after we complete this bill--we are going to do, I believe
it is a 1-month extension to try to correct the doctor problem. How
inconsistent, how fundamentally hypocritical is it for us to pass a
major health care reform bill, and then in the next breath--literally
the next breath--within the next 24 hours, this body will take up a
bill to give a 1-month extension to the doctors fix. I think it is 1
month. That is not right. Let's do it now. Let's do it in this bill.
Let's do the doctors fix. I have come up with a proposal that will take
care of the doctors in a fair and forthright manner for 3 years.
That is my amendment. I am not sure if it is at the desk or whether I
have to send it to the desk.
I send my amendment to the desk.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:

The Senator from New Hampshire [Mr. Gregg] proposes an
amendment numbered 3651.

Mr. GREGG. Mr. President, I ask unanimous consent that the reading of
the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide for a long-term fix to the Medicare sustainable
growth rate formula in order to improve access for Medicare
beneficiaries)

On page 61, between lines 3 and 4, insert the following:

SEC. __. INCREASE IN THE MEDICARE PHYSICIAN PAYMENT UPDATE
FOR THE LAST 9 MONTHS OF 2010 AND ALL OF 2011
THROUGH 2013.

Paragraph (1) of section 1848(d) of the Social Security
Act, as added by section 1011(a) of the Department of Defense
Appropriations Act, 2010 (Public Law 111-118) and as amended
by section 5 of the Temporary Extension Act of 2010 (Public
Law 111-144), is amended to read as follows:
``(10) Update for 2010 through 2013.--
``(A) In general.--Subject to paragraphs (7)(B), (8)(B),
and (9)(B), in lieu of the update to the single conversion
factor established in paragraph (1)(C) that would otherwise
apply for each of 2010, 2011, 2012, and 2013, the update to
the single conversion factor shall be 0 percent for such
years.
``(B) No effect on computation of conversion factor for
2014 and subsequent years.--The conversion factor under this
subsection shall be computed under paragraph (1)(A) for 2014
and subsequent years as if subparagraph (A) had never
applied.''.

Mr. GREGG. Mr. President, let me summarize it again. We know the
doctors are being shortchanged. They deserve fair treatment. It is
pretty obvious that if we are going to do a health care reform bill,
the proper place to correct the doctor issue of reimbursement is in
that bill, not the next day in a short-term extension.
This is a forthright and fully paid-for attempt--and if it is passed
it will occur--to reimburse the doctors at a fair rate for the next 3
years and correct what is known as the SGR problem relative to doctor
reimbursement.
I cannot understand why we would not want to do something such as
this.
I see the Senator from North Carolina. I will be happy to yield to
him for any thoughts he may have on this amendment or the Senator from
Oklahoma.
The PRESIDING OFFICER. The Senator from North Carolina.
Mr. BURR. Mr. President, I wish to reiterate the fact that this
should be part of health care reform. It is not. It is shocking that we
would have something of this magnitude that is not fixed in a reform
bill. We have an opportunity in a bill that has now come before us,
which is to fix the things they missed in the health care bill, to
provide a 3-year comfort on the part of physicians around the country
that their reimbursements are not going to

[[Page S1973]]

be cut. They are targeted for 21 percent. It expires March 31. There is
not a more appropriate time than right now.
What a lot of us have said is: Let's pay for it. Let's simply pay for
it. Enough is enough on spending money we do not have. Here is an
excellent opportunity, where we have savings from the health care
reform bill that we can now pump back in to pay for the fix to the
sustainable growth rate about which the doctors have been under the
gun.
We have extended it every 30 days for some time without paying for
it. Here is a real opportunity in a bill that is designed specifically
to fix things that were missed in the health care bill.
I thank my colleague, Senator Gregg, for understanding the importance
of this issue and working up an amendment but, more importantly, saying
to every physician in America: We can finally fix this, we can do it
with money that is paid for and, more importantly, we can take you out
of the box of this horror story of wondering what your reimbursement
for services is going to be at any given point in time in the future.
Let's seize this opportunity in this bill and fix this sustainable
growth rate.
The PRESIDING OFFICER. The Senator from Oklahoma.
Mr. COBURN. Mr. President, what needs to be fixed in this bill is a
whole lot more than that, but this is a great attempt to try to solve a
problem.
Let me describe a scenario, what is getting ready to happen. Every
State is cutting Medicaid reimbursement. We are going to add 16 million
people to Medicaid. We cannot get them all seen now. Then we have a
doctor cut that is coming to 21 percent for people who are under
Medicare. What is going to happen? What do you think the average
physician in this country is going to do? I can tell you that they are
going to do three things: Fewer will see Medicaid patients so there
will be fewer doctors taking Medicaid at the time we increase the
enrollment by 50 percent. That is No. 1.
No. 2, fewer doctors are going to take Medicare as we have this
ballooning increase of baby boomers going into Medicare.
No. 3--and this is probably more important than anything--we are
going to see a large percentage of doctors, with this bill passed with
no continuity as to how they are ever going to get funded under
Medicare, quit. They are going to quit. They can take their training,
their effort, their education and knowledge and apply it in some other
field of endeavor and not have to live with the hassle of a 21-percent
cut hanging over their head.
Even if we fix it for 3 years, 3 years from now the same problem is
going to come up, except it is going to be worse. So there is no fix in
it. There is an unrecognized $300 billion to get doctors even, let
alone take away the cut--no increase--with this amendment. My hope
would be we would fix this situation for 3 years.
Mr. GREGG. Mr. President, I ask unanimous consent that we be able to
participate in a colloquy on our side of the aisle.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. GREGG. Mr. President, I wish to ask the Senator from Oklahoma,
who is obviously a physician and has an indepth knowledge of this
issue, I heard the other side of the aisle say: There are no cuts to
the benefits of people on Medicare. If you reduce doctor payments under
Medicare 21 percent, don't you think that is going to affect what they
receive? Technically, there will be no cut because they will still have
the right to see a doctor. Is it not going to be hard to see a doctor
because doctors will stop seeing them?
Mr. COBURN. They are not going to find a doctor, and that is the
whole problem. Whatever we see in the urban areas now, multiply it
tenfold in the rural areas. We are going to increase eligibility for
Medicaid to 133 percent of the poverty level, we are going to add 16
million people to a system that is not handling the people who are in
it today, so we are going to promise them: Here is your Medicaid.
Now where is the care? It is not going to be there. There is not the
available physicians in this country to care for 16 million new
Medicaid patients.
If we, in fact, do not fix long term the SGR, physicians are going to
do one of two things. They are either going to completely quit seeing
Medicaid and Medicare patients or they are going to retire. Quite
frankly, physicians my age who are still practicing are not doing it
for the money; they are doing it because they love the patients. But
they are going to be forced to quit because they will not even be able
to pay their overhead to care for those patients.
Mr. BURR. If I may add to Dr. Coburn's comments and say, when you
double the size of the Medicaid population, you are already forcing
more doctors to say: I am not going to see Medicaid patients. But you
are changing the payer mix. Every provider, every practice, every
hospital is going to see more patients whose reimbursement is less.
That is automatically going to affect Medicare right there because
people are going to have to try to bring in more private pay, private
insurance.
Mr. COBURN. Will the Senator yield for a second?
Mr. BURR. Absolutely.
Mr. COBURN. What it is going to do is exacerbate the cost shifting
going on with Medicare and Medicaid right now, which means insurance
rates for everybody else in the country are going to go up.
Mr. GREGG. I thought we were told insurance rates were not going to
go up.
Mr. COBURN. All I will tell you is, the best guess of CBO--wonderful
people, but they can only make decisions within the parameters they are
given. There is no question private insurance, individual and family
insurance, is going to go up, but everybody else's is because we are
going to increase the trend of cost shifting from government programs
to the private sector.
You are going to end up with three taxes. You will pay income taxes,
you will pay a Medicare tax, and then you will pay a tax on your
insurance--actually, you will pay four--and then you are going to pay
higher health insurance premiums because the government does not cover
the cost.

Mr. GREGG. I assume that is not just going to be people with incomes
over $200,000.
Mr. COBURN. That is everybody in this country who has private
insurance, either through their employer or the individual market.
Mr. GREGG. Isn't it equally likely that a large number of small
employers will get frustrated with the rate increases they are getting
in order to support people on Medicaid that they will simply drop that
and push their membership, their employees over into this new exchange?
Mr. COBURN. Yes, they will pay the fee. They will pay the tax and say
it is easier. Consequently, the young people in our country, because we
do not have a big enough payment under the ``individual mandate,'' are
going to say it is smarter for me to save my money, pay the fine, and
not get insurance because when I get sick, I can get it. You are going
to get what is called adverse selection, which is even going to drive
the rates up further. Anybody 40 or older, watch out, your health
insurance rates are getting ready to bloom.
Mr. GREGG. We have basically a multiplier effect----
Mr. COBURN. That is correct.
Mr. GREGG. In the area of costs being driven up as a result of this
new policy of adding a huge number of people to an uninsured system
that cannot afford it right now, Medicaid. The costs are going to
multiply on people in the private sector. The effect will be higher
premiums, less opportunity for your employer to give you insurance and,
in the end, a higher tax rate for you, Americans who are just working
Americans, not people with high incomes.
Mr. COBURN. And people who are not necessarily getting a subsidy.
Mr. GREGG. Then they do not even take care of the doctors. They cut
the doctors 21 percent on top of all this.
Mr. COBURN. What happens to all this? What is the ultimate? The
ultimate is failure of the insurance market.
Mr. GREGG. That is the goal, isn't it?
Mr. COBURN. That is the goal, so the government can control it all. I
yield back.
Mr. BURR. Let me add, if I may, to my good friend, Senator Gregg,
even though some would choose not to have coverage and pay the fine, we
have an

[[Page S1974]]

emergency room system that is obligated to see those individuals when
they have traumatic care. For those who claim we have sorted out the
system where the high-cost delivery of care does not exist, no, we have
again exacerbated the problem.
I think Senator Coburn hit on the key. As you try to handle the
health care of individuals by limiting the reimbursement, whether that
is the way we are limited in the problem you are trying to fix, whether
we do it by shoving them into Medicaid, you have now cost shifted more
money to the side causing greater inflation for the health care in this
country.
Mr. GREGG. The Senator is absolutely right. Isn't it true one of the
ultimate cost shifts is to claim that the health care bill is fiscally
responsible when it ignores the fact that the doctors are being cut by
21 percent and does not even attempt to address that huge problem which
represents $65 billion over 3 years?
Mr. BURR. I have learned throughout this whole process to never try
to figure out what promises have been made. But I know the promise we
have made to physicians--to reimburse them fairly for the services they
provide--and anything less than that jeopardizes the pool of health
care professionals we have and eventually will affect the quality of
care simply because if the pool is not big enough to handle the
patients, the quality will suffer.
Mr. GREGG. So I guess I would get on to the next question because it
is pretty obvious we have to correct this problem with the physicians.
In fact, as I understand it, the next bill immediately that we will
consider will correct it for 30 days. Why wouldn't we correct it right
now for 3 years, get that 3-year consistency in the system so
physicians can have some confidence in their reimbursement rates, fully
paid for? What possible, conceivable reason would there be not to vote
for this type of amendment?
Mr. BURR. Because the Senator from New Hampshire remembers this body
did pass a bill that partially paid for an extension of this through
September of this year. The problem was, when they passed the health
care bill, they used the pay-fors out of that extension bill to be
included in this health care bill. Now they have gone to a point that
they just seek the 30-day renewals and claim it is an emergency. One, I
don't think that passes the threshold of emergency. I think it should
be paid for. And there is a legitimate way to pay for it and extend it
for 3 years, where this Congress can fully understand the implications
of the current health care bill as it is implemented and put back the
comfort of physicians around this country and their trust back in the
system.
Mr. GREGG. Well, I think the Senator is absolutely right, but I would
also suggest that maybe there is another reason they haven't paid for
it in this bill or put the correction in this bill, which is that if
they did that, the bill would fall because it would be out of
compliance with the budget because it is a $285 billion cost over 10
years. Therefore, aren't they sort of trying to pull the wool over
somebody's eyes here? Aren't they trying to act as if this bill that we
know exists for our doctors, that we are never going to pay for it? We
are not going to pay; we are just going to act as if it doesn't exist?
We know as soon as this bill is over, we will have to do something
about it, at least for the next 30 days.
Mr. BURR. You are absolutely right, it will be the first order of
business when this bill is finished if we miss the opportunity to fix
it in this bill and fix it for 3 years and actually fix it in a way
that it is paid for.
Mr. GREGG. I see the Senator from Arizona has arrived.
Mr. McCAIN. Mr. President, I ask unanimous consent to be included in
the colloquy.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCAIN. I would say to the Senator from New Hampshire that there
is some recent information that I find hard to believe, but apparently
it may be the case. As we go through this 2,733-page piece of
legislation, the IRS may need up to $10 billion to administer the new
health care program this decade, and it may need to hire as many as
16,500 additional auditors, agents, and other employees to investigate
and collect billions of new taxes from Americans. Is that possible, in
this legislation, I would ask the Senator from New Hampshire?
Mr. GREGG. The Senator is absolutely correct, and that does call into
question the representation that this bill is not a tax increase on
Americans that we need 16,000 new IRS agents to enforce it.
Mr. McCAIN. At $10 billion to administer. That is probably
believable, given what is in 2,733 pages.
Mr. GREGG. Well, you are going to need one IRS person for everybody
in America who doesn't have insurance, I guess, or however the ratio
works out. Everybody has to buy insurance under this bill, and your
local IRS agent is going to show up at your door to tell you that you
better do it or else you will have to answer to the IRS.
We know there are no new taxes in this bill because that has been
represented to us a number of times.
Mr. BURR. If I could add, it also adds some insight into how many
people will choose not to have insurance and make themselves
susceptible to the fine. The anticipation is the IRS is going to chase
a lot of people to recover the fine.
Mr. McCAIN. I would also finally add that perhaps we could get some
indication--I think we should before we vote on passage of this bill--
as to how many new bureaucrats and bureaucracies there are going to be
with 193 new boards and commissions and other layers of bureaucracy. I
think the American people are owed at least a round figure as to how
many new bureaucrats there are going to be to administer this program.
I see the Senator from Montana, and I don't want to impede on what
has been the agreed-upon rule here, but I did want to continue and say
to my friends very quickly that I think there are several myths here
that have to be refuted by the facts.
One is that this legislation will result in a tax cut for the
American people. I would say to my friend from New Hampshire, we have
to rebut that in the next hour.
The next myth is that the health care bill won't increase taxes on
individuals with incomes under $250,000. The fact is, millions of
Americans with incomes below $250,000 will pay higher taxes.
Another myth: The legislation will reduce the growth of health
costs--President Obama's stated goal for health reform--and premiums
will go down. The fact is, national health expenditures and premiums
will increase.
Another myth: The legislation is deficit neutral. The fact is,
commitment to health care spending under existing obligations increases
the deficit.
Myth: ``If you like the plan you have, you can keep it.'' Fact:
Millions of Americans with coverage will lose their current coverage,
including 330,000 citizens of my State who have the Medicare Advantage
Program.
Finally, the myth is that the law will provide immediate coverage for
children with preexisting conditions. The fact is, children are not
necessarily protected against discrimination for preexisting
conditions.
So I hope we have a chance, I would say to my friend from New
Hampshire, to address the allegations about this legislation, and
perhaps the first one is that legislation will result in a tax cut for
the American people when the fact is that taxes will increase for
millions of Americans.
I would yield to my colleague from New Hampshire.
Mr. GREGG. I thank the Senator from Arizona, who has been one of the
most cogent and thoughtful speakers on the issue of what this bill
really does. He has hit the nail on the head time and time again with
his points. They are all absolutely accurate.
Has the Senator completed his statement?
Mr. McCAIN. Well, I just wanted to throw in here that perhaps one of
the most egregious statements, and it is worth repeating, is this so-
called doc fix. They are using an assumption that we will cut
physicians' fees by 21 percent sometime this fall in order to make up--
and please correct me if I am wrong--some $281 billion over 10 years,
which we know is not going to happen. And the reason it is not going to
happen is because doctors would refuse to take Medicare patients if
they cut their reimbursement by some 21 percent.

[[Page S1975]]

So this is one of the fundamental assumptions they are selling this
on, is that it is deficit neutral when it is not.
Mr. COBURN. If I may, I would like to add one other thing here. Think
about it. We are talking about the cuts that are set to go. But since
there is no tort reform in this bill, we spend $250 billion on
defensive medicine and liability costs continue to rise. You could
bring them back whole, but if you give them no increase, they are still
going to quit seeing Medicare patients.
One other point I would like to make is with the student loan program
being totally taken over by the government, 31,800 people in this
country this July will lose their jobs. So we are going to lose 31,800
jobs in the private sector, but we will add 16,500 jobs at the IRS. I
don't think anybody in America would like to see that happen.
Mr. McCAIN. The CEO of Caterpillar wrote a letter saying that the
taxes for Caterpillar would go up by $100 million next year. What does
that do to Caterpillar? It obviously makes them either not hire or lay
off individuals as they pay an additional $100 million. And I might
point out, as we all know, Caterpillar's headquarters is in Peoria, IL.
So, again, I would ask the Senator from New Hampshire, is this
legislation deficit neutral?
Mr. GREGG. No, it is not deficit neutral if you actually score the
number of years of income against the number of years of expenditures
or you include the doctors fix. Either one would throw this into a
deficit-negative situation.
Mr. McCAIN. Isn't that another of the great scams, that for 4 years
the benefits are cut and the taxes are increased, and for most--not all
but most--of this bill, none of the benefits really kick in until after
4 years?
Mr. GREGG. That is right.
Mr. McCAIN. So when you score it, that is the way you make it deficit
neutral over 10 years?
Mr. GREGG. That is correct. And it is a bit of a scam, as you say.
I am going to have to reserve the remainder of our time here for a
moment, but I understand the Senator from North Carolina wants to bring
up an amendment.

Amendment No. 3652

Mr. BURR. Mr. President, I ask unanimous consent to temporarily set
aside the pending motions and amendments so that I may offer an
amendment that is at the desk.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report.
The bill clerk read as follows:

The Senator from North Carolina [Mr. Burr] proposes an
amendment numbered 3652.

Mr. BURR. Mr. President, I ask unanimous consent that the amendment
be considered as read.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To protect the integrity of Department of Veterans Affairs
and Department of Defense health care programs for veterans, active-
duty service members, their families, widows and widowers, and orphans
who have sacrificed in defense of our Nation)

At the end of subtitle F of title I, insert the following:

SEC. 1__. TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS AND
DEPARTMENT OF DEFENSE HEALTH PROGRAMS.

Subtitle G of title I of the Patient Protection and
Affordable Care Act is amended by adding at the end the
following new section:

``SEC. 1564. DEPARTMENT OF VETERANS AFFAIRS AND DEPARTMENT OF
DEFENSE HEALTH PROGRAMS.

``(a) Clarifications With Respect to Certain Programs and
Authorities.--Nothing in this Act or in the amendments made
by this Act shall be construed as affecting any of the
following:
``(1) Any authority under title 38, United States Code.
``(2) Any authority under chapter 55 of title 10, United
States Code.
``(3) Any health care or health care benefit provided under
the TRICARE program under chapter 55 of title 10, United
States Code, or by the Secretary of Veterans Affairs under
the laws administered by such Secretary.
``(b) Clarification With Respect to Minimum Essential
Coverage.--For purposes of this Act and the amendments made
by this Act, the term `minimum essential coverage' includes
the following:
``(1) Coverage provided under chapter 55 of title 10,
United States Code.
``(2) Eligibility for health care provided by the Secretary
of Veterans Affairs under title 38, United States Code.''.

Mr. BURR. Mr. President, I yield the floor, and I protect the
remainder of the time.
The PRESIDING OFFICER. Who yields time?
The Senator from Montana.
Mr. BAUCUS. Mr. President, the debate on this bill is winding to a
close, so let me return to the nonpartisan Congressional Budget Office.
The Congressional Budget Office is the referee we all turn to as an
impartial judge of whether we are accomplishing what we set out to do,
so I will take a moment and quote from the Congressional Budget Office.
It is very appropriate as it relates to the prior conversation on the
other side. Let me read excerpts from the most recent Congressional
Budget Office statement on deficits, debt, and coverage and whether
this is deficit neutral. This was released Saturday. This is a
statement by the Congressional Budget Office and the Joint Committee on
Taxation. They are our scorekeepers. They determine how much we are
spending and how much revenue we are taking in on legislation and what
the net result is.
Here are the highlights of the letter:

Enacting both pieces of legislation--H.R. 3590--

That is basically our Senate bill that passed the House and the
President signed--

--and the reconciliation proposal--would produce a net
reduction in Federal deficits of $143 billion over the 2010-
2019 period.

That is a direct quote from the CBO.
Further quoting:

Enacting H.R. 3590 by itself would yield a net reduction in
Federal deficits of $118 billion over the 2010-2019 period.

Further quoting:

The incremental effect of enacting the reconciliation
proposal would be an estimated net reduction in Federal
deficits of $25 billion during the 2010-2019 period over and
above the savings from enacting H.R. 3590 by itself.

Further quoting CBO:

The combined effect of enacting H.R. 3590 and the
reconciliation proposal would be to reduce the number of
nonelderly people who are uninsured by about 32 million
people. The share of legal nonelderly residents with
insurance coverage would rise from about 83 percent currently
to about 94 percent.

CBO said of the new health care law:

Enacting H.R. 3590 would reduce Federal budget deficits
over the ensuing decade--

That is the next decade, the second decade--

with a total effect during that decade in a broad range
between one-quarter percent and one-half percent of gross
domestic product.

But what is more, CBO further said:

The combined effect of enacting H.R. 3590 and the
reconciliation proposal would also be to reduce Federal
budget deficits over the ensuing decade . . . with a total
effect during that decade of a broad range around one-half
percent of GDP.

I might add parenthetically, that is about $1.3 trillion.
CBO continues:

The incremental effect of enacting the reconciliation bill
over and above the effect of enacting H.R. 3590 by itself
would thus be to further reduce Federal budget deficits in
that decade, with an effect in a broad range between zero and
one-quarter percent of GDP.

In other words, the new health care formula would accomplish major
deficit reduction. This is the CBO talking, not Senators. Don't take my
word for it. Don't take anyone else's word for it. This is the
Congressional Budget Office. This reconciliation bill itself would
accomplish major deficit reduction, probably the greatest deficit
reduction actually we are going to take over a long period of time--the
preceding perhaps 8, 9, 10 years and a subsequent period of time. We
don't know that, but this is certainly major deficit reduction.
Together, these two bills would accomplish deficit reduction of
historic proportions.
Let me continue to quote the letter from the Congressional Budget
Office.

[T]he reconciliation proposal would probably continue--

Get this--

to reduce deficit budget deficits relative to those under
subsequent decades. . . .

Not just this period, not next decade but subsequent decades. This is
my edit now. This means this bill continues to reduce the deficit in
year after year after the second decade, according to the Congressional
Budget Office.
Finally, CBO says:

In subsequent years, the effects of the provisions of the
two bills combined that would tend to decrease the federal
budgetary commitment to health care would grow faster

[[Page S1976]]

than the effects of the provision that would increase it.

Let me get to that statement. It gets to the Federal involvement in
health care as a result of the consequences of this bill.

In subsequent years the effect of the provisions of the two
bills combined that would tend to decrease the federal
budgetary commitment to health care would grow faster than
the effects of the provisions that would increase it.

Further quoting:

As a result, CBO expects that enacting both proposals would
generate a reduction in the federal budgetary commitment to
health care during the decade following the 10-year budget
window. . . .

Even less government in the second 10 years relative to current law.
In other words, CBO says that after the first decade, health care
reform will reduce--yes, reduce--the budgetary role of government in
the health care sector.
Whom do we trust? Whom else are we going to listen to? We all have
opinions. Those folks at CBO have sharp pencils. They are very good at
what they do. They are nonpartisan. Nobody has ever suggested they are
partisan. Nobody has ever questioned their professionalism. They are
very good. This is what CBO says.
That is it. CBO says health care reform cuts the deficit. Let me
pause there and let that sink in. CBO says health care reform will cut
the deficit. CBO also says it expands coverage. More people will get
health insurance, from 83 percent to 94 percent. Also, this legislation
reduces the Government's budgetary role in health care. It reduces it.
That is quite a feat--more coverage, deficit reduction, and less
Federal involvement in health care. I think this bill is pretty well
designed to accomplish all those purposes--cuts cost, increases
coverage, and reforms the health insurance market, most significantly
in the individual market and also in the small group market.
On another matter, I think it is relevant and important--this is a
letter from AARP, dated March 24 of this year. It says:

Dear Senator,
We have made enormous progress advancing historic, urgently
needed health care reform legislation but we are not done
yet.

This is from the AARP. Continuing:

We now urge you to promptly pass the Health Care an
Education Affordability Reconciliation Act of 2010--without
amendments.

Let me repeat that. AARP, in a letter dated March 24, strongly
suggests the Congress, especially Senate, pass this legislation without
amendments. Those are their own words, ``without amendments,'' in order
``to help make affordable, high-quality health care available to all
Americans.''
The letter is much longer. I just wanted to quote the more salient
provisions, where the AARP suggests amendments not be adopted so we can
get reconciliation passed so we can implement the law which the
President already signed and get health care to Americans who
desperately need it and reform of the health care industry, which is
desperately needed, and start getting control of health care costs,
which is desperately needed.
I ask unanimous consent the full letter be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

AARP--Nancy A. LeaMond, Executive Vice President, AARP
Social Impact Group,
March 24, 2010.

Dear Senator: We have made enormous progress advancing
historic, urgently needed health care reform legislation, but
we are not done yet. We now urge you to promptly pass the
Health Care and Education Affordability Reconciliation Act of
2010--without amendments--to help make affordable, high
quality health care available to all Americans.
The Reconciliation Act will:
1. Close Medicare's dreaded ``doughnut hole'' drug coverage
gap for all beneficiaries. This is a top priority for AARP
because it helps older Americans afford drugs they need to
stay healthy and avoid costlier treatments;
2. Make coverage more affordable for hard-working middle-
income families who now too often are uninsured because the
cost of coverage is beyond their modest means. Added help is
vital to meet the public's demand for coverage that is truly
affordable for all Americans;
3. Further strengthen our fight against fraud, waste and
abuse, a key component to better controlling rising costs in
our health care system; and
4. Improve Medicare's fiscal health and extend the solvency
of the Medicare Trust. Fund.
These provisions build on the solid foundation of the
Patient Protection and Affordable Care Act that the Senate
passed in December. These two bills together will protect and
strengthen Medicare's guaranteed benefits, eliminate barriers
to prevention, and crack down on insurance company abuses,
such as denying affordable coverage because of age or health
status and setting arbitrary caps on how much care they will
cover. The legislative package will also provide affordable
coverage options to millions of Americans and small
businesses, help Americans to better plan for their future
long-term care needs, and receive services to help them
remain in their own homes and stay out of costly nursing
facilities.
We, like you, hear countless stories from our members who
were denied coverage or cannot afford their prescriptions or
insurance premiums. Health care remains among the most
important and personal economic issues for the vast majority
of Americans.
Health expenditures consume roughly one sixth of our
economy today, and will reach 20 percent in seven years if
current trends continue. These skyrocketing costs strain the
budgets of families and businesses as well as the
government--crowding out other priorities--as health care
costs continue to grow 2-3 times faster than general
inflation. That is why all the major health care stakeholders
have come to the table to solve this unsustainable situation.
Delay will only mean more Medicare beneficiaries will not
be able to afford the drugs they need. Millions of our family
members and neighbors will not be able to afford the coverage
they need. Billions of additional dollars in uncompensated
care costs will unfairly shift to those who do have coverage.
More individuals will impoverish themselves to get the health
care they need. Skyrocketing costs will continue to strain
even more family, business, and government budgets.
AARP therefore urges all Senators to vote in favor of the
Health Care and Education Affordability Reconciliation Act of
2010. Both the economic and physical health of our members,
their families, and our nation are at stake,
Because AARP members have a strong interest in how their
elected officials vote on key issues, we will be informing
them about how their Senators vote on this important issue.
Sincerely,
Addison Barry Rand.

Mr. GREGG. What is the time situation?
The PRESIDING OFFICER (Mr. Franken). We have 27 minutes 51 seconds on
the majority side and 35 minutes 42 seconds on the minority side.
Mr. GREGG. Let me make two quick points. The only way CBO gets to the
conclusions they reach, and they had to get to those conclusions, is
because of the facts put before them. One of those facts, they have to
presume Medicare is going to be cut $500 billion in the first years
before full implementation, $1 trillion in the second 10 years during
full implementation, and $3 trillion during the first 20 years of full
implementation--$3 trillion.
All that money is going to be taken out of Medicare and moved over to
start new programs, new entitlements to benefit people who are not
senior citizens and who, for the most part, have never paid into
Medicare. That is a serious problem.
You can score that positively if you wish, but first off I do not
think it will happen. I think what will end up happening is, it will
get put on our children's backs as debt. But second, if it does happen,
it is wrong because Medicare has to be fixed and you are taking the
money that should be used to fix it, if you believe in these types of
cuts in Medicare, and you are spending them on a new entitlement.
Mr. BAUCUS. Mr. President, may I ask my colleague a friendly
question?
Mr. GREGG. On your time you may ask a question, including my answer,
which may take 24 minutes.
Mr. BAUCUS. I trust in the good faith of the Senator from New
Hampshire not to abuse the situation.
As I understand it, basically the Senator does not question the
professionalism of CBO. Clearly, CBO had all the facts. All Senators
have them, all Senators, House Members, the whole world has. CBO has
all the facts. You are not questioning their professionalism. You do
question their conclusions.
Mr. GREGG. I certainly don't question their professionalism. They are
an extraordinarily good organization with a wonderful leader who is
fair and unbiased. I don't question their conclusions because what they
have to score is a fact pattern that was given them and

[[Page S1977]]

the fact pattern given them by this bill is, on its face, not
believable relative to what is going to happen in the outyears, even
though they have to score it as believable. It is a fantasy.
Mr. McCAIN. I ask the Senator from New Hampshire, while the Senator
from Montana is here, maybe it is a legitimate question. Does the
Senator from Montana believe that the assumption given to the
Congressional Budget Office that the so-called doc fix, reimbursement
for physicians who treat Medicare patients, will be cut by 21 percent?
The Senator from Montana knows full well the AMA has been told in no
uncertain terms it will be fixed between now and when it is supposed to
take effect because the fact is, as the Senator from Montana knows, you
can cut Medicare physician reimbursement. Then doctors will not treat
Medicare patients. So maybe the Senator from Montana would tell us if
that was a valid assumption given to the CBO, that there would be some
$281 billion that would be accrued because physicians' payments would
be reduced by some 21 percent?
Mr. GREGG. I simply ask the time of the Senator from Arizona come off
ours and the time of the Senator from Montana for his answer come off
his.
Mr. BAUCUS. Mr. President, that sounds fair.
Let me say to my good friend from Arizona, first of all, clearly this
body, the Senate and the Congress, is going to not let the SGR problem
expire; that is, doctors are not going to be cut 21 percent, whatever
the rate is the first year or more and so on. That is not going to
happen. First, from the seniors' point of view, second from the
doctors' point of view, that is not going to happen. I do not want to
take too much time on the subject, but the long and short of it simply
is we are going to have to find a way, this Congress, to address that
problem. If I might finish, it is not part of health care reform, and
we will find a way. A question is going to be how much will be paid
for. That is a judgment this body is going to have to make in the
pretty near future.
Mr. McCAIN. I appreciate very much the acknowledgment, on the part of
the manager of the bill, that the assumption that provides us with
deficit neutrality is not valid. That is the point we have been trying
to make. It is based on false assumptions. The assumption that
doctors--I am very happy to hear the Senator from Montana state
unequivocally what was given and assumed by the CBO when they gave us
our numbers is not true. So we will be voting, in a short period of
time, on a piece of legislation which is based on false assumptions. I
think that is an unfortunate circumstance.
Mr. GREGG. I simply note the Senator from Montana made the case for
my amendment rather eloquently because my amendment does address the
doctors fix and it is paid for. Therefore, I certainly hope the Senator
might consider voting for it.
At this point, I yield 5 minutes to the Senator from Georgia.
Mr. CHAMBLISS. I thank the Senator, from New Hampshire. Let me
reiterate what just came out of this dialog and colloquy between the
Senator from Montana and the Senator from Arizona. That is this. CBO
has said this is going to be a deficit saver, a deficit reducer, and
the President is going around the country talking about the fact that
this bill is going to reduce the deficit.
What the President is not going to say but what the Senator from
Montana just agreed to, is the fact that our physicians who are due a
21-percent decrease in Medicare reimbursement payments are not, in
fact, going to have that 21-percent reduction. That decrease was
included in this bill to make it appear more deficit-neutral over the
first 10 years. When you factor that in, this not only does not reduce
the deficit, but it adds to the deficit an additional $281 billion
difference in what the number of the CBO says we are going to reduce
the deficit by.
You know very clearly we are going to add to the deficit when we pass
this bill because the Senator from Montana is right, we are not going
to see that 21-percent reduction. I suspect that the $523 billion in
Medicare cuts that are provided for in this bill, that are scheduled to
take effect in future years, may not ever happen. If that is the case,
then not only are we looking at an additional cost of that $523
billion, the $281 billion for the SGR fix or the doctors fix, but we
are looking at increasing the deficit to fund a domestic program in a
future way.
One thing the CBO does say is, this bill provides an additional
$569.2 billion in new taxes, new taxes on the American people,
particularly the small business community that is hit the hardest by
this.
The American people have made it very clear: They do not want these
bills to become law. Two new polls by CBS and CNN show that only 20
percent of Americans believe this legislation will benefit them and
their families. Still, the majority party has chosen to push these
unpopular proposals through.
My constituents in Georgia have reached out in record numbers to
register their opposition to President Obama's plan.
Why? For starters, because this is an unprecedented government
involvement in an industry that constitutes one-sixth of the Nation's
economy. If we get it wrong, if we overreach, our fragile economy will
suffer and a recovery will lag, perhaps for years.
This bill also does something very un-American: It would penalize
individuals for not purchasing health insurance. Today, we have seen 13
State attorneys general file lawsuits challenging the constitutionality
of fining Americans for not purchasing insurance.
The bill that passed the Senate and was signed by the president is
filled with backroom deal-making, partisan arm-twisting and special
carve-outs for some of my wavering colleagues on the other side of the
aisle.
Now, instead of working together on a bill that would be more
palatable to all Americans, my colleagues on the other side of the
aisle have decided to push forward in the face of united opposition.
The Governor of Georgia recently expressed concern regarding the
unfunded mandates in this legislation. Our State faces an additional
billion dollars or more of Medicaid spending per year.
These new costs that will be absorbed by the State will require
further tax hikes on Georgians or cuts to public safety, education and
other core State government services.
The bill that was just signed contains $518.5 billion in gross tax
increases. It cuts Medicare by $465 billion--and, more importantly--
does nothing to bend the health care cost curve down.
With Medicare on the verge of insolvency, this bill takes money from
the Hospital Insurance Trust Fund to pay for unrelated entitlement
spending.
Under this new plan, new Federal taxes on Americans start
immediately. But full benefits won't take effect until 2014. The bill
raises $60 billion in taxes before any of the major benefits go into
effect.
Looking at the years 2013-2024, the 10-year period after the law is
fully implemented, the overall cost is estimated to be $2.6 trillion.
Some of these numbers are so large that its tough to get your head
around them. But rest assured that they will detrimentally impact
Americans and our economy.
There is also substantial evidence that this new law will hurt small
businesses.
The bill imposes $493 billion in new taxes that will fall
disproportionately on the backs of small-business owners.
A $54 billion increase in the Medicare payroll tax will hit
approximately one-third of the small-business owners across the
country.
A $60 billion tax on insurers means small businesses that manage to
provide health insurance coverage for their employees will see this tax
passed on to them, increasing premiums.
The CLASS Act portion of the new law appears to make it less costly
because, as the CBO said, ``the program would pay out far less in
benefits than it would receive in premiums over the 10-year budget
window,'' raising $70 billion in premiums that will fund benefits
outside the window. Outlays in later years will increase significantly.
And the legislation just signed into law is still filled with the
sweetheart deals that have so angered Americans.
That includes the Cornhusker Kickback, in which the Federal
Government pays the entire tab of Nebraska's Medicaid expansion.
It also includes the Louisiana Purchase, in which the Federal
Government pays an extra $300 million in

[[Page S1978]]

Medicaid dollars to the State of Louisiana.
And it still has the Gator Aid Florida Medicare Advantage grandfather
clause to protect certain areas of Florida from Medicare Advantage cuts
that all other seniors in America will face.
Meanwhile, the 176,000 seniors in Georgia who rely on Medicare
Advantage to supplement the gaps in traditional Medicare will see their
benefits cut by $33 each month.
The new law significantly raises taxes, cuts benefits for seniors,
adds to the Federal deficit and allows the government to make decisions
that should be between a patient and his doctor.
The reconciliation bill--optimistically deemed a ``fix-it'' bill--is
actually a ``make-it-worse'' bill.
The legislation before us today raises taxes by an additional $50
billion more than the Senate bill. That is an overall tax increase of
$569.2 billion.
The reconciliation bill nearly doubles the tax on health insurers
beginning in 2014, and also raises taxes and fees on drugmakers and
medical devices. The Congressional Budget Office has specifically
stated that these taxes will be passed on to all Americans in the form
of higher health costs and rising insurance premiums.
The reconciliation bill raises another $66.1 billion from Medicare
Advantage, bringing total Medicare cuts in both bills to $523 billion.
And it forces an additional 1 million individuals into Medicaid on
top of the 15 million already added to Medicaid in the Senate bill.
That means 16 million of the 32 million newly insured individuals would
obtain that coverage through Medicaid--a program President Obama
admitted already suffers from serious access problems.
It also increases penalties for businesses that don't offer health
insurance and have at least one employee receiving a subsidy in the
exchange from $750 per full-time employee to $2,000 per full-time
employee.
And, among other things, it penalizes many Americans with higher
incomes from rent, interest, royalties and individuals by forcing an
almost 4 percent Medicare tax on their investment income.
According to the Congressional Budget Office, this bill is going to
cost $940 billion over 10 years.
We are burdening our children and grandchildren--generations of
America's future--by creating a behemoth new government entitlement
program.
And in the same week of its creation, we turned around and
immediately added to this new program almost $1 trillion more.
The American people are asking a simple question: Where does the
spending end?
Also, I wish to talk about a specific provision that is going to have
an immediate, direct impact on my taxpayers in Georgia; that is, with
the increase in the threshold to qualify for Medicaid going from 100
percent to 133 percent, in my State, according to our Governor--and he
has run the numbers--that is going to cost the taxpayers of Georgia, in
addition to their share of this $569.2 billion in additional taxes, an
additional $1 billion per year that Georgia taxpayers are going to have
to pay.
We are in difficult times in my State, as all 50 States are right
now. That is a new provision, a new tax.
I ask unanimous consent that a statement from the Governor of
Georgia, the Honorable Sonny Perdue, be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

[From the Office of the Governor, Mar. 22, 2010]

Statement of Governor Sonny Perdue Regarding the Healthcare Legislation
Passed by the United States Congress

Atlanta.--Governor Sonny Perdue issued the following
statement today regarding the healthcare legislation passed
by the United States Congress:
``Unfortunately, the United States House of Representatives
last night chose politics over the will of the American
people. The enormous upheaval of our healthcare system was
pushed through the House against the wishes of the majority
of American families and businesses.
Here in Georgia, this vote will force an additional billion
dollars or more of Medicaid spending per year, requiring
either a tax hike or offsetting cuts to public safety,
education and other core services of state government. While
this colossal unfunded mandate cripples our budget, I am even
more concerned about the debilitating impact it will have on
Georgia's small businesses. The extension of the Medicare tax
on all non-wage income means that small business owners will
see their top rate increased by 20 percent and investment
income taxes increasing 60 percent.
What is most unfortunate is that the American people had no
voice at the table in Washington during the course of this
debate. The only glimpse citizens saw of the process were
closed-door meetings that resulted in backroom deals and the
buying of votes to ensure passage. I am today renewing my
December request to the Attorney General that he join other
states in reviewing the constitutionality of this travesty.
My office has already begun to review any and all legal
options to challenge this legislation.
I also urge the Georgia General Assembly to continue moving
forward on my proposal to allow Georgians to purchase
insurance plans across state lines. Now that Congress is
mandating that every American purchase health insurance, we
should open the individual market to as much competition as
possible.
Since this bill has such a significant impact on future
state budgets, it is imperative that current candidates for
elected office publicly state their plans to either support
the Obama-Pelosi legislation or fight for the people of
Georgia.''

Mr. CHAMBLISS. Let me say that within the last 48 hours we have
discovered that the agency that is going to be administering the new
health care reform bill the President signed into law is none other
than the Internal Revenue Service. The Internal Revenue Service has
said that in order to review the tax returns of every taxpayer in
America to ensure that they have complied with the law and bought
insurance or had insurance taken out through their employer, they are
going to have to have an additional 16,500 Internal Revenue Service
Agents at a cost of an additional $10 billion to the taxpayers. That
$10 billion is not factored in here in anyway.
We are dealing with a piece of legislation that the American public
has shown, over and over in every poll taken, whether it is by a
Democratic pollster, Republican pollster or an independent pollster,
that they do not want. We are going to force that bill down on the
American people and that is wrong, that is not the way this body and
the body across the Capitol should be working with respect to the best
interests of the American people.
I urge my colleagues at the appropriate time during the vote on the
amendments this afternoon and tonight to repeal this bill and let us
replace it with a true, meaningful health care reform bill that we can
all agree on. There are a lot of provisions in those 2,700 pages plus,
the length of this so-called fix-it bill that we can agree on, that we
can replace this bill with, that will provide the American people with
true, meaningful health care reform that they need and deserve.
We will not see all of these huge increases in taxes, we will not see
all of these huge reductions in Medicare benefits, and we can do the
will of the people in the right and appropriate way.
I yield the floor.
Mr. GREGG. Mr. President, I yield 2\1/2\ minutes to the Senator from
Louisiana.

Amendment No. 3553

Mr. VITTER. Mr. President, at this point I ask unanimous consent to
set aside any pending amendment and call up amendment No. 3553.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report.
The bill clerk read as follows:

The Senator from Louisiana [Mr. Vitter] proposes an
amendment numbered 3553.

Mr. VITTER. I ask unanimous consent that the reading of the amendment
be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To repeal the government takeover of health care)

Strike all after the enacting clause and insert the
following:

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Patient Choice Restoration
Act''.

SEC. 2. REPEAL.

The Patient Protection and Affordable Care Act, and the
amendments made by that Act, are repealed.

Mr. VITTER. Mr. President, this amendment is very simple, and it goes
to the heart of all of these arguments. This amendment would repeal
this new ObamaCare plan.
All of us on this side urge this action and urge us to focus instead
on a focused step-by-step approach to solve

[[Page S1979]]

specific, real problems with specific solutions. This gargantuan plan
which this amendment would repeal does not do that. This gargantuan
plan has fundamental problems at its core that my colleagues have been
talking about; truly offensive, fundamental problems such as over a
$\1/2\ trillion cut to Medicare. The American people do not want to pay
for anything through that. Over $\1/2\ trillion of increased taxes and
costs. The American people do not want an approach that does that,
increasing health ObamaCare costs, when the American people know our
big challenge is to do the opposite.
Nonpartisan sources such as the Congressional Budget Office confirm
that the ObamaCare plan does not decrease health ObamaCare costs, it
increases health ObamaCare costs from their rising rate already. It
pushes that cost curve up and growing the bureaucracy, including
thousands of new IRS workers, and putting them and the Federal
Government between you and your doctor.
These are not minor parts of the ObamaCare plan. This is the core of
that plan. That is why we absolutely need to repeal it and take a
fundamentally different approach, an approach that is focused like a
laser beam on real problems and that deals with those real problems
with real and targeted and step-by-step solutions.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. VITTER. I urge support of amendment No. 3553.
The PRESIDING OFFICER. The Senator from Montana is recognized.
Mr. BAUCUS. Mr. President, we are coming to a close, or a beginning,
I am not sure which, when we start the vote on amendments. If my
calculation is correct, the time for debate on this reconciliation bill
will expire around 5:10, about that time, approximately.
At that time, approximately, we will start voting on amendments. By
my count we have 21 amendments pending, and if we vote on amendments in
the time in which it usually takes to vote on amendments in a series,
my experience is it roughly takes around an hour for three amendments.
Maybe we can speed that up. With 21 amendments, that is 7 hours. That
is the good news. There probably will be some intervening disruptions.
But the good news is, that means the earliest we might be finished is
around midnight. But, of course, that is not the case, because there
will be other amendments offered.
For the information of my colleagues, we will probably start voting
on amendments at approximately around 5:10, thereabouts. We have 21
amendments pending at the present time. It takes about 1 hour to vote
on three amendments. I believe we can squeeze that time down. It is my
hope that we can. But that is my experience around here, it takes about
that long.
Because there are a lot more amendments most likely to be offered, I
inform my colleagues that we will be in very late tonight, certainly
way past midnight, because of the number of amendments that are
currently pending.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mr. GREGG. What is the time situation?
The PRESIDING OFFICER. The minority has 23 minutes 47 seconds left.
Mr. GREGG. And the majority?
The PRESIDING OFFICER. The majority has 24 minutes 52 seconds.
Mr. GREGG. I yield 10 minutes to the Senator from Tennessee.
Mr. ALEXANDER. Mr. President, could you let me know when 8 minutes
has been consumed?
The PRESIDING OFFICER. The Chair will advise the Senator.
Mr. ALEXANDER. Mr. President, this has been a debate filled with
passion and good intentions and a lot of hard work. Our political
parties have come to vastly different conclusions. The President and
the majority have said, this is an historic occasion. I agree.
But I believe, as do most of us, that it is an historic mistake, and
it is important to say why we think that. This is the fundamental
mistake, that with the law that was passed yesterday and what the
majority has proposed to do in this second bill, to expand a health
ObamaCare delivery system that we all know is more expensive than we
can afford, instead of stepping back and instead seeking to reduce the
cost of that health ObamaCare delivery system so that more Americans
can afford to buy health insurance. That is the mistake.
I wish to try to say in 3 or 4 minutes what this bill means to
Tennesseans. I was listening to the Senator from Montana and the
Republican Senators talk about debt. We believe, I believe, that this
bill, these two bills, will increase each Tennessean's share of the
national debt.
The Senator from Montana says: Well, but the Congressional Budget
Office says it does not. Well, that would be like going to the
Congressional Budget Office and saying: I have got a horse farm here.
Tell me how much it costs to operate over the next 10 years. The CBO
would say: Would you like me to tell you how to do it with the horses
or without the horses? If you tell me how to do it without the horses,
it is not going to cost as much. Or, if I have a gas station, would you
like me to tell you how to operate that with the gas in it or without
the gasoline?
That is what we are saying here. They have gone to the Congressional
Budget Office and said: Tell us how much this health bill costs. They
have said to them: With the doctors or without the doctors?
They say: Oh, no, keep the doctors out.
Because, according to the President's own budget, that is $371
billion over 10 years. If you put that in, then the whole bill adds to
the deficit, so they leave it out. So that is why we say, and I would
say, that the first thing this bill does is add to the debt, each
Tennessean's share of the debt.
The second thing is, it adds $8,470 in new spending for every
Tennessean. Thirdly there are 243,000 Tennesseans enrolled in Medicare
Advantage, which is about one out of four persons in Medicare who will
have their benefits reduced by half, according to the Congressional
Budget Office Director in testimony before Congress, whose veracity we
have been hearing extolled on all sides.
The next thing it does is about 1.4 million Tennesseans making less
than $200,000 will pay higher taxes, based on estimates by the Joint
Committee on Taxation. Some 300,000 Tennesseans in the individual
health insurance market will see premium rate increases of 30 to 45
percent based upon a Blue Cross/Blue Shield study of Tennessee and
other analysis.
Next, Tennessee's small businesses employing 50 or more people and
construction companies employing 5 or more people--that is 5,000
construction companies in Tennessee--will pay higher health ObamaCare
costs because of new government mandates.
Then here is the other one. This is the one that was just added over
the weekend: 200,000 Tennessee students including--I checked--11,000 at
the University of Tennessee-Knoxville where I was this week, will be
overcharged by $1,700 to $1,800 over the next 10 years on their student
loans in order to help pay for the health ObamaCare bill and other
programs.
Let me say that again. Over the weekend, without any debate in the
Senate, they have stuck in this bill--they are going to overcharge 19
million students in America, 200,000 in Tennessee, $1,700 or $1,800
more than it costs the government to borrow the money, because the
government is taking over the student loan program.
They borrow the money at 2.8 percent, they loan it out at 6.8
percent, they take the difference, they spend it, $8.7 billion of it to
help pay for the health ObamaCare program. So that is 200,000 Tennessee
students. These are not Wall Street financiers. This is a mom with a
child and a job going to school to get a better job. That is 200,000
Tennessee students. And $1.1 billion in costs will be forced on the
Tennessee government. That is according to our State Democratic
Governor, who said that is the cost of the Medicaid expansion and what
happens to the State after the physicians reimbursement expires in 2
years for Medicaid. This will force States, Tennessee for sure, and
many other States, to raise taxes, cut services, or increase college
tuition.

According to an Oliver Wyman study, 30 percent of young people will
pay up to 35 percent more in premiums as premiums go up in the
individual market.
Then finally, of course, the bill does add in Tennessee about 200,000
people to our TennCare or Medicare rolls. But

[[Page S1980]]

that is not health ObamaCare reform because nationally only about half
of doctors will see new Medicaid patients.
So we are saying to people, we are giving you health ObamaCare, but
it is like saying, we are giving you a bus ticket to a bus line where
the bus only runs half the time. When you put these low-income
Americans into this program in such large numbers, what that
additionally does is create more opportunities for physicians, for
hospitals, and for drugstores to say, we cannot serve Medicaid patients
any more.
That is why we feel this is the wrong course and an historic mistake.
What we would do instead is replace this bill with a different bill
that focuses on costs. We have said it over and over again. We said it
at the health ObamaCare summit. We would start with allowing people to
buy health care across State lines; with allowing small businesses to
combine their resources to offer insurance to more people at lower
costs; with reducing the number of lawsuits against doctors for
malpractice.
We would step up efforts against waste, fraud, and abuse, expand
health savings accounts. All of these were proposals made before the
Senate, basically ignored. But the fundamental mistake and the reason
we have such a difference of opinion between that side of the aisle and
this side of the aisle is that that side of the aisle, which has the
majority, is expanding a health ObamaCare delivery system that we all
know is too expensive, and we think instead what we should be doing is
focusing on reducing health ObamaCare costs so that more Americans can
afford to purchase health ObamaCare insurance.
I yield back my time to the Senator from New Hampshire.
Mr. GREGG. I would yield for 30 seconds to the Senator from Kansas to
put in order a couple of amendments.
The PRESIDING OFFICER. The Senator from Kansas.

Amendment No. 3577

Mr. ROBERTS. I ask unanimous consent to temporarily set aside the
pending motions and amendments so that I may offer an amendment, No.
3577, which is at the desk.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will report.
The bill clerk read as follows:

The Senator from Kansas [Mr. Roberts] proposes an amendment
numbered 3577.

Mr. ROBERTS. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To protect Medicare beneficiary access to hospital care in
rural areas from recommendations by the Independent Payment Advisory
Board)

At the end of subtitle B of title I, insert the following:

SEC. __. PROTECTING MEDICARE BENEFICIARY ACCESS TO HOSPITAL
CARE IN RURAL AREAS FROM RECOMMENDATIONS BY THE
INDEPENDENT PAYMENT ADVISORY BOARD.

(a) In General.--Section 1899A(c)(2)(A) of the Social
Security Act, as added by section 3403 of the Patient
Protection and Affordable Care Act and amended by section
10320 of such Act, is amended by adding at the end the
following new clause:
``(vii) The proposal shall not include any recommendation
that would reduce payment rates for items and services
furnished by a critical access hospital (as defined in
section 1861(mm)(1)).''.
(b) Expansion of Affordability Exception to Individual
Mandate.--Section 5000A(e)(1)(A) of the Internal Revenue Code
of 1986, as added by section 1501(b) of the Patient
Protection and Affordable Care Act, is amended by striking
``8 percent'' and inserting ``5 percent''.

Motion to Commit

Mr. ROBERTS. Mr. President, I ask unanimous consent now to
temporarily set aside the pending motions so that I may offer a motion
to commit, which is at the desk.
The PRESIDING OFFICER. Without objection, it is so ordered. The clerk
will report.
The bill clerk read as follows:

The Senator from Kansas [Mr. Roberts] moves to commit the
bill (H.R. 4872) to the Committee on Finance with
instructions to report the same back to the Senate within 3
days with changes to repeal the Patient-Centered Outcomes
Research Institute, the Center for Medicare and Medicaid
Innovation, any new functions of the United States Preventive
Services Task Force, and the Independent Payment Advisory
Board and adds an offset.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, how much time remains?
The PRESIDING OFFICER. There is 24 minutes 40 seconds.
Mr. BAUCUS. I yield half that time to the distinguished chairman of
the Banking Committee, former acting chairman of the HELP Committee,
and one of the most valuable and productive Members of this body, the
Senator from Connecticut.
Mr. DODD. I thank my colleague and commend him for his leadership on
this issue, along with, of course, our distinguished majority leader so
many others, including the wonderful staff we don't often mention--the
remarkable work being done by the individual staff of Members and the
committee staff of the Health, Education, Labor, and Pensions
Committee. I see my good friend, Tom Harkin, who now chairs that
committee, along with Max Baucus, and so many others of the leadership
staff who have brought us to this moment.
I rise to discuss the Health Care and Education Reconciliation Act.
Although none of us are ignorant of the historic nature of the health
care portion of our work this past week, I wish to take a few moments
to talk about the significance of the education portion of the bill. I
listened intently to my friend from Tennessee talk about this part of
the bill as well. I have great admiration for him, having served as the
Secretary of Education and as Governor of Tennessee. He has a wealth of
knowledge on the subject matter. I commend him for it. However, we
disagree with this particular portion.
I rise to express a different point of view about why I believe what
we have included in this bill has great value. Obviously, the major
attention has been focused on the health aspects of what we are doing.
That in itself is a major achievement. The reconciliation portion of
this bill before us now strengthens a good bill and makes it even
better.
Last evening I discussed portions of the bill that I think add
tremendous value to our efforts to provide health care once and for all
for all Americans. But the education portion of this bill also has
great significance.
Since the Pell grant was established in the 1970s, as all of us know,
it has made college a possibility for millions and millions of young
Americans. I had the great pleasure of serving with Claiborne Pell as a
Member of this body. He served in the 1960s up until only a few years
ago. We lost him a number of months ago; he passed away. But it is
incredible to think of what a difference that individual, that one
Senator made in the lives of millions of our fellow citizens. In years
to come, some may not know who Claiborne Pell was, but I would like the
record to reflect he was a remarkable Senator. He authored legislation
creating the Northeast Corridor, wrote the legislation that banned the
testing of nuclear weapons on the ocean floor. He was the author, along
with Jacob Javits, of the National Endowments for the Arts and
Humanities, and he was the author of Pell grants. Unique and remarkable
contributions, each and every one of them, but he should long be
remembered for making education an opportunity that would not be denied
because one lacked the resources to afford it.
Those millions of young Americans are now leaders in our Nation. They
are innovators, some of our most productive and successful citizens.
This bill is not unlike the GI bill at the end of World War II, when we
recall men who came back from the theaters of the Pacific and Europe
who were able to receive an education under the GI bill, who would tell
us what a remarkable investment it was.
It has been repaid millions of times over by those who today make
contributions to our country because they got an education because
there was a creative Congress, because there was an administration that
understood the value of an education in the midpart of the 20th
century. Here we are now into the second decade of the 21st century
facing a similar issue.
There should be no doubt in anyone's mind about the value not only of
making us a healthier country by the adoption of the health care
provision of this bill, but a better educated country--

[[Page S1981]]

not only to advance our own needs--but to make sure individuals have
the opportunity to maximize all of their potential. Today that wouldn't
be the case without Pell grants. What they have done to and for our
society has been remarkable. Countless individuals would not have had
the opportunity to attend college without Pell grants.
Since then the importance of a college education has only grown, not
only for the individual students who want to achieve their full
potential, but our Nation as well. America's ability to compete in the
global economy depends on having a well-educated workforce in the 21st
century. Today, that means a college-educated workforce. Unfortunately,
while the urgency of opening the door to college has grown, the support
provided to our most important college aid program has slipped. In
fact, it has gone further--it has fallen off a cliff. In 1975, the
maximum Pell grant covered 80 percent of the average student's tuition,
fees, room and board at a 4-year public university. Today it covers
less than one-third at a public university.
Our failure to keep pace with the exploding cost of college threatens
to slam the door on a generation of Americans, making college
impossible for many and leaving those who do find a way to further
their education with a debilitating burden of overwhelming debt.
Make no mistake, allowing the Pell Grant Program to wither, as would
be the case without the adoption of the language in this bill, isn't
just a slap in the face to low and middle-income hardworking American
families. It is a serious threat to America's competitiveness in the
21st century. Fortunately, the legislation in front of us presents an
opportunity to revitalize the Pell Grant Program and to unlock the
opportunity of higher education for millions of Americans.
The bill invests $13.5 billion to fill the shortfall in the Pell
Grant Program and ensures that such a shortfall doesn't develop again,
as the cost of college continues to increase in the years ahead. For
instance, if we fail to act, the maximum Pell grant award could be a
paltry $2,100 for the year 2010. Never before has the effectiveness of
this program been at such risk. The legislation before us protects the
maximum award at a level of $5,500 and increases to almost $6,000 by
2017, 7 years from now.
We all know that in 7 years the cost of education will have continued
to skyrocket. I would be the first to admit that while we are putting
tremendous resources into this program, we can imagine in 2017 what
college education will be like, even at public universities. This Pell
grant assistance, as important as it is, is not going to come close to
meeting the needs of families, so we will continue to work to increase
aid. But in this legislation, we also peg these increases to inflation
in order to try to keep up with the cost of higher education.
In my home State of Connecticut, this would enable more than 4,300
additional students to go to college. In addition, this legislation
makes important investments in Historically Black Colleges, community
colleges, and the College Access Challenge Grant Program, which fosters
partnerships between government and the nonprofit sector that helps
low-income kids get a chance to go on to a higher education.
It invests in programs that help students determine what college is
best for them, as well as prepares them not only to get into those
schools but to graduate from them. When those students do graduate,
they will no longer be faced with that mountain of debt we have heard
about over and over again that puts so many of their own careers and
contributions to society on hold while they have to pay off these
debts, seeking jobs and opportunities that may not be what they need
for their future growth and potential.
To help with this, our legislation caps repayment of Federal loans at
10 percent of discretionary income and forgives payments after 20
years. This represents an important investment not only in our
children's future but in the future of our country. It will pay
enormous dividends.
This investment isn't just smart, it is fully paid for. In fact, the
Congressional Budget Office estimates this legislation will reduce the
national debt and deficit by $10 billion over the next 10 years. We
accomplish that by eliminating what amounts to billions of dollars in
wasteful spending within the Federal student loan program.

Let me explain. Currently, some Federal student loans are made
through the Direct Loan Program, while others are made through the
Federal Family Education Loan Program, the so-called FFEL Program. This
program overpays banks for servicing these Federal loans. The result is
that money intended to help students go on to a higher education ends
up instead helping to pad the profits of those lenders. That is a waste
of money.
What is more, banks in the FFEL Program get their loan guarantee and
interest subsidy entitlements regardless of how they treat the student
borrowers. While they bank the profits when the loans are repaid,
taxpayers end up shouldering the risk of defaults. So our legislation
converts all future Federal student loans to direct loans.
This doesn't cut the private sector out of the student loan industry.
What it does is as American as apple pie. It makes them compete. It
ends these unnecessary payments and force banks to compete for the job
of servicing student loans. When institutions have to compete,
consumers benefit.
For students and parents, it means better customer service and the
same good rates that have always been the hallmark of Federal student
loans.
As for taxpayers, it means a savings of $61 billion over 10 years,
money that now flows into the coffers of banks, but under this
legislation will be used to help more kids go on to college and bring
down our national deficit.
In short, what we have here is a win-win, a fully paid for and much
needed investment in equal opportunity and American competitiveness. I
would be remiss if I did not note that we could and should be doing
more. It comes as a serious disappointment to me and to education
advocates across the country that funding for a new early childhood
learning initiative was not included in this package. I desperately
wanted it to be there, as did my friend Tom Harkin from Iowa who has
worked with me, along with others, for years on early education. As
important as it is to enable a high school student to graduate and
attend college, it is just as critical that we prepare every child to
be a viable candidate for their next step in the education process. The
achievement gap that robs too many American children of their
opportunity begins very early, before the age of 3, according to
everything we know about child development. You know the statistics, as
most of us do. Investments in early childhood education pay off tenfold
when we consider the decreases in crime, the reduced need for special
education and welfare services, and improved health of these children
who have access to early education.
Just as the increasingly competitive global economy calls us to
unlock the door to higher education, we must also do everything we can
to bring every American child to that threshold of maximizing his or
her potential. That important work requires a serious commitment to
early education. This legislation would have been a perfect opportunity
to follow through on that commitment. So the fight will continue,
unfortunately, without the strength this bill would have provided. But
for now we have the chance to do some real good for young people and
for our Nation.
I urge my fellow Senators, both Democrats and Republicans, to support
this commonsense measure, save the Pell Grant Program, and make a real
difference in the lives of countless young Americans for years to come.
I remind my colleagues this is just part of what is at stake in this
debate. The amendments being offered, on too many occasions by our
friends on the other side of the aisle, are doing nothing more than
trying to stop this legislation from going forward. I hope that will
stop. Let's pass this bill. We have a chance to not only change the
quality of health in America but also to open the doors of opportunity
for American students.
For those reasons, I urge adoption of this package.
I yield the floor.
Mr. GREGG. I yield to Senator McCain such time as he may use.
The PRESIDING OFFICER. The Senator from Arizona.
Mr. McCAIN. Mr. President, I read a lot about what has been going on
in the

[[Page S1982]]

health care debate, and all of us have. Americans are very aware of it.
I keep hearing the word ``historic'' this, ``historic'' that,
``historic.'' I agree. It is historic. This is a historic vote, and I
think we are pretty aware of what the outcome will be sometime tonight,
tomorrow, or the next day. It is the first time in history, the history
of this country, that a major reform has been enacted on a purely
partisan basis, the first time.
Every major reform throughout history has had significant--you can go
down the list--bipartisanship votes. In the 1970s--this one, purely
partisan, rammed through from beginning to whatever this end is.

It is historic, and it is the first time that a process called
reconciliation has ever been used to affect one-sixth of the gross
national product. I know the response will be: Well, Republicans did
it--et cetera, et cetera. It will be the first time that 51 votes has
been the measure of a decision on so-called reconciliation. Now, that
is historic. That is historic because we have basically broken down the
60-vote tradition of the Senate when we address it in this fashion--an
issue of this magnitude.
Let me tell you, when the President of the United States was still a
Senator--another time we were doing reconciliation--what he said:

You know, the Founders designed this system, as frustrating
[as] it is, to make sure that there's a broad consensus
before the country moves forward. . . . And what we have now
is a president----

He was referring to former President Bush--

who . . . [h]asn't gotten his way. And that is now prompting,
you know, a change in the Senate rules that really I think
would change the character of the Senate forever. . . . And
what I worry about would be you essentially have still two
chambers--the House and the Senate--but you have simply
majoritarian absolute power on either side, and that's just
not what the founders intended.

That is what Barack Obama, the Senator from Illinois, said.
So here we are. Yes, it is historic. It is historic. And it is
historic what we have seen take place from the beginning. We have seen
the special interests. We have seen the votes, the provisions in these
bills that carve out special deals for special interests and special
States, such as the ``Louisiana purchase,'' the $100 million inserted
in this 2,733-page document that builds a hospital in Connecticut. Why
Connecticut? Why $100 million? Why is it that there are these special
provisions for certain locations in the country?
It is historic in the special deals that have been cut--for PhRMA,
for the American Medical Association, for the hospital association, for
the unions in the taxation of Cadillac plans. Everybody has a deal but
the American citizen--the average American.
How many Americans, how many ordinary Americans who are, say,
enrollees in Medicare Advantage in my State, who are going to see the
Medicare Advantage program cut drastically--how many of them were
allowed in the majority leader's office? How many of them were allowed
in the Speaker's office? How many of them were allowed in the White
House as the special interests' representatives went in and out?
So there are winners and losers. That is what is being judged. The
winners will be those who live in favored States who will have special
deals. There will be those who are winners--PhRMA, the hospital
association, the unions. Again, my congratulations to PhRMA. They are
running $100 million-some worth of ads favoring this deal because they
got a deal that is worth billions--worth billions.
As I have quoted on the floor several times, their head lobbyists, or
$2 million-a-year lobbyists, said: A deal is a deal. We expect the
White House to keep it.
So who are the losers? Who are the losers? Well, the first loser is
the Senate because, as I said before, this reconciliation, requiring
only 51 votes, is a radical departure from anything we have done in the
past. I do not accept the statement that it has been done in the past--
not when it affects one-sixth of the gross national product, and as a
direct result of the vote in the State of Massachusetts that gave this
side 41 votes. If they still had 60 votes, we would not be doing this
on reconciliation. We would be doing it in the regular way we address
legislation--legislation through the House, legislation through the
Senate, a conference committee, and then, obviously, a final vote. But
they cannot afford a final vote because there are 41 votes now, not 60.
So the Senate is a major casualty of this process.
But the biggest losers probably are average citizens--average
citizens who were told the Congressional Budget Office judged this to
be deficit-neutral, and it would not cost the taxpayers additional
money. I just had a conversation with the Senator from Montana who said
clearly we are not going to cut physician payments by 21 percent; so,
therefore, the assumption they gave the Congressional Budget Office is
false--is false. So before we go any further, it is already a $150
billion deficit because everybody knows we are not going to cut
physicians' payments by 21 percent.
So the American people are the ones who never had access to get a
special deal. And 330,000 citizens of my State who have enjoyed and
chosen the Medicare Advantage program are now going to see those
benefits slashed. But the average citizen who thinks today there is a
huge disconnect between their lives and that of the life that is led
here and the way we do business here--last Saturday, I was in my own
home State of Arizona. I did two townhall meetings, one in Prescott and
one in East Valley Phoenix, and people are hurting. People are hurting,
people are angry, they are frustrated, and they feel there is a huge
disconnect between themselves and Washington. I come back the next day,
and they are drinking champagne in celebration of a ``historic''
victory. Americans do not get it. Americans do not get it. They are
angry. They are frustrated.
I want to assure them--I want to assure them--this fight is not over.
We will take it, as I mentioned before, to the towns and cities of
America. We will have townhall meetings all over the country. We will
register voters. We will urge them to turn out. We will urge them to
take part in one of the most seismic elections in the history of this
country.
I know the liberal media is saying: The American people are going to
move on. Well, they are not going to move on. They are not going to
move on because they are sick and tired of the spending and the
generational theft we have committed on future generations of
Americans. This is only one part of their frustration. It is a big
part, but it is only one part.
So I know I speak for my colleagues when I say this fight is far from
over. This struggle to regain control of this body and this institution
in Washington, DC, and give it back to the people of this country will
go on.
I have great faith in this country and its future. That is why I am
confident that over time, sooner or later, we will be back and we will
repeal and we will replace--we will replace--this huge government
takeover with medical malpractice reform, with going across State lines
to get insurance of your choice, to reward wellness and fitness, to
establish risk pools that insurance companies will bid on in order to
treat people with preexisting conditions. We have a long list we will
replace this mortgaging of America's future with that will be what all
Americans want; that is, to maintain the quality of health care in
America and, at the same time, bring costs under control.
I thank the Senator from New Hampshire for his leadership. I thank
the Senator from Montana for his courtesy during this debate over these
days and weeks and even months, on days and nights and weekends. I want
to assure my colleagues this debate is far from over.
I yield the floor.
Mr. GREGG. Mr. President, I just want to thank the Senator from
Arizona for his excellent summation of where this issue lies and its
impact on the American people. I hope that statement will be read
across this country because it was a reflection of the concerns which
are legitimate and which are being expressed by vast amounts of
Americans. It is not unusual it should be expressed by the Senator from
Arizona because he is so much a personality of this Nation and a force
within our political process.
I would reserve the remainder of my time.
The PRESIDING OFFICER. The Senator from Montana.

[[Page S1983]]

Mr. BAUCUS. Mr. President, I yield to the distinguished chairman of
the HELP Committee, who has been so involved in health legislation,
education legislation. Might I ask, how much time do we have left?
The PRESIDING OFFICER. There remains 11 minutes 48 seconds.
Mr. BAUCUS. Mr. President, I yield as much time to the Senator as he
wishes to take, including 11 minutes 48 seconds.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. HARKIN. Mr. President, I thank my friend from Montana, the
chairman of the Finance Committee. I thank him for all of his great
leadership, and also Senator Dodd, who just spoke.
If I might just add a little historical footnote. Senator Baucus,
chairman of the Finance Committee; Senator Dodd, who led the effort
through the HELP Committee; myself, as now chairman of the HELP
Committee; Chairman Miller on the House side, chairman of the Education
and Labor Committee; and Chairman Waxman, the chairman of the
House Commerce Committee--all of whom had big parts of the whole health
care bill to develop--a historical footnote: We were all sworn in on
the same day in January of 1975. It was a great class, and our
classmates, as history would have it, survived to be able to put
together this great health care bill.

I again want to thank my longtime friend and colleague from Montana,
Senator Baucus, for his extreme patience and his endurance in getting
us to this point.
Mr. President, we are in the midst of a historic week in this
Nation's Capital. Health care reform is no longer a bill; it is the law
of the land. It has been signed.
Just as the history books remember 1935 as the year FDR signed Social
Security into law, and 1965 as the year when Lyndon Johnson signed
Medicare into law, they will now remember the year 2010 as the year
President Barack Obama signed comprehensive health reform into law.
Each of these three bills marked a giant step forward for the
American people. Each was stridently opposed by the special interests
and defenders of the status quo. But in the end--in 1935, in 1965, and
now in 2010--a critical mass of Senators and Representatives rose to
the historic occasion. They voted their hopes, not their fears. They
created a better, fairer, more compassionate America for all of our
citizens.
As a Nobel Prize-winning economist recently put it, the new health
reform law is a ``victory for America's soul''--a ``victory for
America's soul.'' At long last, we are realizing Senator Ted Kennedy's
great dream of extending access to quality, affordable health insurance
to every American. We are ending the last shameful bastion of legal
discrimination and exclusion in our country.
Think about it: Over the decades, we have outlawed discrimination
based on race, color, and national origin. We have outlawed
discrimination based on gender and religion. We have outlawed
discrimination based on age and disability. But until now, it has been
perfectly legal to discriminate against our fellow Americans because of
illness--because of illness--and to exclude tens of millions of our
citizens from decent health care simply because they could not afford
insurance or afford health care--blatant discrimination.
When President Obama signed health care reform into law on Tuesday,
he set in motion a series of changes that will tear down these last
barriers of discrimination and exclusion. That truly is a great moral
victory. It is, indeed, a victory for America's soul.
But our work is not done. The reconciliation bill now before us
includes a number of modifications to strengthen the new health care
reform law. It also includes reforms in the student lending program
that in their own way are also profound and historic. I regret these
landmark education reforms have not gotten the attention they deserve.
Senator Dodd--I just listened to his speech--outlined in great detail
what these reforms are and what they will mean for our families and for
our students.
This bill in front of us now eliminates $61 billion in wasteful
subsidies to banks and redirects most of that money to low-income
college students in the form of increased Pell grants. The status quo
in student lending is a bizarre Rube Goldberg process that makes no
sense. The Federal Government pays private banks to make entirely risk-
free loans. The banks then sell the loans back to the Federal
Government and pocket hundreds of millions of dollars in fees. This is
a brazen case of corporate welfare--a huge government giveaway to
bankers. This bill at long last will put a stop to it.
Mr. President, I want to state forthrightly I am not antibanker. I am
not antibank. I have family members in the banking business and they do
a great job. But who does not like free money? If you give the banks
free money, they love it. But if we have money we want to give away, I
say do not give it to the banks. Give it to low-income students so they
can go to college. Banks have lots of ways in which they can make
money. A low-income student has no other way to go to college but that
we provide him and her access to meaningful Pell grants. I am
disappointed our Republican colleagues are doing everything in their
power to delay and obstruct and to kill this bill. Reportedly, they now
plan to offer dozens and dozens of largely meaningless amendments to
try to stretch the process out and delay a final vote. One might call
this the Republican version of March madness. They know it is going to
end; they just want to drag it out.

Let's be clear what is at stake. A vote against this bill is a vote
against eliminating the doughnut hole in the Medicare prescription drug
plan for seniors. A vote against this bill is a vote against parents'
rights to keep their kids on health insurance plans until age 26. A
vote against this bill is a vote against a tough new crackdown on fraud
and abuse in Medicare and Medicaid Programs. A vote against this bill
is a vote against ending discrimination against rural areas in Medicare
reimbursement rates. A vote against this bill is a vote against ending
tens of billions of dollars in corporate welfare for banks, a vote
against redirecting that money to more generous Pell grants for needy
college students.
I might add, a vote against this bill is a vote against a very
important provision. I know an amendment has been offered to do away
with what is called the CLASS Act. The CLASS Act is now the law of the
land. Here is what it is. It is a voluntary program. No one has to join
it. It is fiscally solvent for 75 years. All it says is that an
individual during their working years can set aside some money. If
they, God forbid, become disabled, they can have some income to be able
to live in their own homes and not be put in a nursing home. That is
the law of the land right now, and there is an amendment before us to
do away with that. Over 275 groups representing people with
disabilities and seniors support the CLASS Act, and we ought to keep it
in the law and not repeal it with an amendment.
In short, those who are determined to kill this reconciliation bill
need to decide whose side they are on. Are they going to continue their
die-hard defense of the health insurance companies and the banks or are
they going to stand with ordinary Americans who want access to quality,
affordable, reliable health coverage and with needy young people who
need Pell grants in order to go to college? It is time to choose.
We are going to have a whole series of amendments. Oh, some of them
will sound nice. Some of them I would probably like to vote for myself
if they weren't to this bill. But we can't be lured into this by the
siren song of amendments that sound good but only have one purpose;
that is, to kill this bill, to delay it, to kill it, to make sure it is
not enacted into law. That is the only purpose of these amendments,
make no mistake about it. So when an amendment comes up that I like and
I might want to support, I will vote against it because it is that
important to make sure this reconciliation bill gets passed and sent to
the President for his signature.
So I say to all of my friends on this side of the aisle: Don't be
lured. Don't be lured by the siren song of amendments that may sound
good. Don't be afraid that somehow they are going to use it against you
in a campaign. Hey, they can use anything against you in a campaign. We
all know that by now. Let's stand united. Let's stand strong. Let's say
no to these amendments designed only to kill this bill.

[[Page S1984]]

I urge my colleagues to support passage of the Health Care and
Education Reconciliation Act of 2010, to defeat all of the amendments.
Let's get this bill to the President, let's help our students get to
college, and let's help the people of this country have better health
care.
Mr. President, one of the arguments raised by my Republican
colleagues regarding the landmark new health reform law just signed
into law by President Obama is that it is unconstitutional. Well, I
strongly disagree. One example of the strong constitutional basis of
the new law is outlined by the American Constitution Society in a paper
released at the end of last year.
I commend this paper to my colleagues and ask unanimous consent its
conclusions be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

[From the American Constitution Society for Law and Policy, Dec. 2009]

Mandatory Health Insurance: Is It Constitutional?

(By Simon Lazarus)

VI. Conclusion: mandatory insurance is neither burdensome nor
unprecedented.

A major reason why all opponents' legal arguments fall
short is that they share a common factual foundation, which
itself is a fallacy. Their root assumption, or assertion, is
that requiring Americans to carry health insurance is both
extraordinarily novel--``unprecedented''--and extraordinarily
burdensome. But this endlessly repeated assertion is
specious, for several reasons:
To begin with, experience demonstrates that mandatory
health insurance is neither unprecedented nor burdensome.
Hundreds of millions of millions of individuals live under a
variety of mandatory health insurance regimes, with very high
rates of compliance and no record of discontent with the
requirement, in other advanced economies and, indeed, as
noted above, in Massachusetts.
As noted above, the overwhelming majority of Americans
already carry health insurance that satisfies the terms of
the mandate, so they will not be affected by the mandate at
all. Of the approximately 46 million Americans who currently
lack health insurance, the majority are in this state only
because it is unavailable or unaffordable, and they of
course, will welcome the opportunity presented by the
legislation to gain coverage.
For those currently uninsured Americans who would prefer to
forego the cost of coverage, even with whatever level of
subsidy they will be in a position to claim, the mandate is
no more a burden than the requirement to pay Social Security
and Medicare taxes--indeed, it is less, since the coverage
they receive in return is available immediately, not when
they reach eligibility in their 60s.
By conceding that social and health insurance taxes are
constitutionally valid restrictions on individual liberty,
while condemning functionally equivalent contributions to
private insurers, opponents effectively contend that a
single-payer, government-run program like Medicare is the
only type of universal health insurance system Congress may
establish. The Constitution surely does not impose such an
arbitrary strait jacket on Congress.
The great majority of Americans live in jurisdictions that
require the purchase of automobile insurance. Health care
reform opponents claim that these state mandatory auto
insurance regimes are not ``precedents'' for federal
mandatory health insurance, for a variety of essentially
legalistic reasons. For example, they assert that auto
insurance is a voluntary payment in exchange for a
``privilege,'' permission to drive on public roads. But for
most people, driving is an economic necessity. In terms of
its actual impact on people, mandatory auto insurance is a
common-sense indicator of whether the public would find novel
or inherently burdensome a mandate to purchase health
insurance from the private insurance industry.
If, as opponents claim, the burden of mandatory health
contributions was--in principle--oppressive and unfair,
Medicare, and for that matter Social Security taxes would
raise constitutional questions no less than if these landmark
statutory programs were cast as regulations of interstate
commerce. In fact, of course, since 1937, such questions have
never been raised either in the courts or in Congress. The
reason is simple: most people regard these mandatory
contributions--in light of what they expect to receive in
exchange--as a bargain not a burden.

Mr. HARKIN. Mr. President, this bill makes unprecedented investments
to expand high-quality educational opportunities for all Americans. It
invests in the Pell grant scholarship award, strengthens historically
Black colleges and universities and other minority-serving
institutions, and provides more resources to States for college access
and other supports for students through the college access challenge
grant program.
Further, these investments are paid for without increasing our
Nation's deficit, through key reforms in the Federal student loan
programs designed to provide a stronger, more reliable, and more
efficient student loan system. The legislation directs more than $10
billion of the savings generated under this legislation to paying down
the country's deficit.
The education provisions of this legislation will convert all new
Federal student loans to the Direct Loan Program starting in July 2010,
saving $61 billion over the next 10 years. These changes will also
upgrade the customer service borrowers receive when repaying their
loans. The legislation will also maintain jobs by ensuring a robust
role for the private sector, allowing lenders and not-for-profits to
contract with the Department of Education to service Direct loans.
The legislation significantly increases the Federal Pell grant award;
the cornerstone of need-based Federal student assistance since its
creation in 1972. Investments in this program are essential to ensuring
access to higher education and making college more affordable for
students and families. Both the House and Senate authorizing and
appropriating committees have made significant investments in
increasing the maximum Pell grant award in the past few years--32
percent since 2006. This legislation includes $36 billion to help
address the Pell grant shortfall in fiscal year 2011 and to increase
the maximum Pell grant to $5,550 in 2010 and to $5,975 by 2017.
Starting in 2013, the grant will be linked to match rising costs of
living for 5 years by indexing it to the Consumer Price Index.
The legislation includes $750 million to bolster college access and
other supports for students. It will more than double funding for the
college access challenge grant program to fund programs in every State
that focus on informing students about college options and financing,
increasing financial literacy and helping students persist from year to
year and graduate.
While this legislation seeks to ensure increased access and success
for all students, we intend for the Secretary to work with States to
address the unique access issues faced by underserved communities,
including: low-income individuals, individuals with disabilities,
homeless and foster care youth, disconnected youth, nontraditional
students, members of groups that are traditionally underrepresented in
higher education, individuals with limited English proficiency,
veterans, including those just returning from active duty, and
dislocated workers.
The legislation also includes a continuation of funding for
investments in historically Black colleges and universities, Hispanic-
serving institutions, tribal colleges and universities, institutions
serving Alaska and Hawaiian Natives, predominantly Black institutions,
institutions serving Asian American and Pacific Islanders, and
institutions serving Native Americans, first made under the College
Cost Reduction and Access Act of 2007, recognizing the critical role
these institutions play in serving the Nation's minority populations.
Minority serving institutions educate more than half 58 percent, of
minority undergraduate students. While Hispanic serving-institutions
(HSIs) comprise less than 8 percent of colleges and universities
nationwide, they consistently graduate approximately one-third of all
Hispanic students with degrees in science, technology, engineering and
mathematics. Similarly, even though historically Black colleges and
universities only make up 3 percent of all colleges and universities
they graduate 40 percent of African Americans with degrees in science,
technology, engineering and mathematics. These schools also produce 50
percent of African-American teachers and 40 percent of African-American
health professionals.
Concerning the servicing contracts with eligible not-for-profit
servicers, this legislation recognizes that not-for-profit servicers
play a unique and valuable role in helping students in their States
succeed in postsecondary education and that students should continue to
benefit from the assistance provided by not-for-profit servicers.
Including more high-quality servicers in the contracting process will
increase competition amongst servicers and deliver better customer
service for student borrowers. Under the bill, not-for-profit servicers
will be allocated a minimum of 100,000 borrower loan accounts as a
starting

[[Page S1985]]

point. The Secretary of Education has been given the authority to
increase or decrease that volume based on factors that include capacity
and customer service. With sufficient loan volume and competitive
servicing rates, eligible not-for-profit servicers can individually or
collectively generate sufficient revenue to continue the valuable
services they provide to borrowers. Because of the significant increase
in loan volume as all Federal loans are moved to the Direct Loan
Program, additional servicing capacity will be needed and is provided
for through the contracts provision. I encourage the Secretary to
implement these provisions in a timely manner so that many local not-
for-profit servicers will continue to play a role in the student loan
program.
The Department of Education should use the not-for-profit servicers
to increase competition and quality in the student loan programs. To
ensure that occurs, the Department must hold not-for-profit lenders to
the same high standards of quality, performance and integrity used for
other Department of Education loan servicers. This bill would require
that eligible not-for-profit servicers meet the same standards for
servicing Federal assets as apply to all other servicing contracts
under section 456. These standards relate to: information technology
security; financial reporting; collection and payment processing by the
Department of the Treasury; internal control management; and, Federal
accounting practices and debt management. The standards are derived
from a variety of statutory and other sources of guidance, including
the Federal Information Security Management Act of 2002 (44 U.S.C. 3541
et seq.); the Privacy Act (5 U.S.C. 552a); the Federal Financial
Management Improvement Act of 1996 (P.L. 104-208); the Debt Collection
Improvement Act of 1996 (P.L. 104-134);the Federal Managers Financial
Integrity Act (31 U.S.C. 3512); the Chief Financial Officers Act of
1990 (31 U.S.C. 901 et seq.); the ``Government Management Reform Act of
1994'' (P.L. 103-356); OMB Circulars A-123 (Management's Responsibility
for Internal Control), A-127 (Financial Management Systems), and A-129
(Policies for Federal Credit Programs and Non-Tax Receivables); and the
Treasury Financial Manual.
Critical amendments will be made in America's community colleges
through one additional important program that is funded in the Finance
Committee's title of this bill. Community colleges serve an
instrumental role in both our education and workforce systems. They
provide needed postsecondary education and job training, particularly
to individuals and families hardest hit by difficult economic times.
This includes workers eligible for training under the Trade Adjustment
Assistance for workers program, individuals who are, or may become
eligible for unemployment compensation, and other individuals who have
been impacted by the economic and employment crisis. To ensure that
these institutions have access to the resources they need to develop
and improve educational and career training programs designed to meet
the needs of the workers in the affected communities, the legislation
directs the Secretary of Labor to award community college career
training grants especially to struggling 2-year public community
colleges, (as defined in section 101 of the Higher Education Act of
1965. As the legislation ensures that all States benefit from these
resources with the inclusion of a State minimum, I also encourage that
the Secretary strive to ensure a diverse geographical representation of
community colleges in both urban and rural areas and to provide grants
to both large and small community colleges. Finally, in order to ensure
that these grants reach the institutions and students they are intended
to serve, I encourage the Secretary of Labor to consult with the
Secretary of Education in implementing grants provided under this
program. I also remind the Secretary of Labor in implementing this
program that community colleges are public 2-year degree-granting
institutions of higher education that offer associate's degrees; or
public 4-year institutions of higher education that offer associate's
degrees, are not located reasonably close to a community college, and
have an open enrollment policy for certificate or associate's degree
programs; or tribal colleges or universities. This should be the
universe of institutions awarded grants under the community college and
career training grants program.
Mr. President, I ask unanimous consent to have printed in the Record
a document entitled ``Constitutional Findings regarding the Individual
Responsibility Requirement.'' Furthermore, in support of this document,
I commend to my colleagues a list of the following studies and papers:

--<a href='http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-
KeyIssues.pdf
_http'>http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-
KeyIssues.pdf
_http</a>://content.healthaffairs.org/cgi/
content/full/27/5/w399
--<a href='http://www.familiesusa.org/assets/pdfs/hidden-health-
tax.pdf
_http'>http://www.familiesusa.org/assets/pdfs/hidden-health-
tax.pdf
_http</a>://download.journals.elsevierhealth
.com/pdfs/journals/00029343/PIIS0002934309004045.pdf
--<a href='http://www.newamerica.net/files/
NAF_CostofDoingNothing.pdf
_http'>http://www.newamerica.net/files/
NAF_CostofDoingNothing.pdf
_http</a>://<a href='http://www.urban.org/UploadedPDF/
411603_individual_mandates.pdf
_http'>www.urban.org/UploadedPDF/
411603_individual_mandates.pdf
_http</a>://<a href='http://www.nber.org/papers/w13758.pdf
_http'>www.nber.org/papers/w13758.pdf
_http</a>://content.healthaffairs.org/cgi/
content/full/28/6/w1079
--<a href='http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-
Premiums.pdf
_http'>http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-
Premiums.pdf
_http</a>://<a href='http://www.cms.hhs.gov/nationalhealthexpenddata/
downloads/proj2008.pdf
_http'>www.cms.hhs.gov/nationalhealthexpenddata/
downloads/proj2008.pdf
_http</a>://<a href='http://www.cbo.gov/ftpdocs/108xx/doc10868/12-19-
Reid_Letter_Managers_Correction_'>www.cbo.gov/ftpdocs/108xx/doc10868/12-19-
Reid_Letter_Managers_Correction_</a>
Noted.pdf

There being no objection, the material was ordered to be printed in
the Record, as follows:

Constitutional Findings Regarding the Individual Responsibility
Requirement

The individual responsibility requirement provided for in
the Patient Protection and Affordable Care Act, and amended
by Section 1002 of the Health Care and Education
Reconciliation Act, is commercial and economic in nature, and
substantially affects interstate commerce in many ways,
including as a result of the following aggregate effects:
(1) The requirement regulates activity that is commercial
and economic in nature, involving the distribution and
consumption of health care services throughout the national
economy, and in particular economic and financial decisions
about how and when health care is paid for and when health
insurance is purchased. Some individuals currently make an
economic and financial decision to forego health insurance
coverage and self-insure, paying for charges for services
directly to the provider and relying on uncompensated care.
The decision by individuals not to purchase health insurance
has many substantial effects on the national economy, the
national marketplace for health insurance, and interstate
commerce. Individuals who fail to purchase health insurance
have a diminished capacity to purchase health care services,
and increase overall health care costs. When such individuals
inevitably seek medical care, the costs of that caremust
often be paid for by providers, insured individuals and
businesses through higher premiums, or Federal, State, and
local governments. The requirement encourages prepayment for
services, and affects an individual's decision whether or not
to purchase health insurance by imposing penalties on
individuals who remain uninsured. Congressional Budget
Office, Key Issues in Analyzing Major Health Insurance
Proposals, December 2008.
(2) The uninsured receive about $86,000,000,000 in health
care, of which about $56,000,000,000 is uncompensated.
Private spending on uncompensated care is $14,500,000,000,
and includes profits forgone by physicians and hospitals.
Government spending on uncompensated care is $42,900,000,000,
and is financed by taxpayers at both the State and Federal
levels. Jack Hadley et al., Covering the Uninsured in 2008:
Current Costs, Sources of Payment, and Incremental Costs,
Health Affairs, August 25, 2008.
(3) Health care received by the uninsured is more costly.
The uninsured are more likely to be hospitalized for
preventable conditions. Jack Hadley, Economic Consequences of
Being Uninsured: Uncompensated Care, Inefficient Medical Care
Spending, and Foregone Earnings, Testimony before the Senate
Subcommittee on Labor, Health and Human Services, Education,
and Related Agencies, May 14, 2003. Hospitals provide
uncompensated care of $35,000,000,000, representing on
average 5 percent of hospital revenues. Health Affairs,
August 25, 2008.
(4) Those who have private health insurance also pay for
uncompensated care. Medical providers try to recoup the cost
from private insurers, which increases family premiums by on
average over $1,000 a year. Families USA, Hidden Health Tax:
Americans Pay a Premium, May 2009.
(5) The decision to self-insure increases financial risks
to households throughout the United States. 62 percent of all
personal bankruptcies are caused by illness or medical bills,
and a significant portion of medically bankrupted families
lacked health insurance or experienced a recent lapse in
coverage. David U. Himmelstein et al., American Journal of
Medicine, Medical Bankruptcy in the United States, 2007:
Results of a National Study, 2009.
(6) The national economy loses up to $207,000,000,000 a
year because of the poorer health and shorter lifespan of the
uninsured. Elizabeth Carpenter and Sarah Axeen, The Cost of
Doing Nothing, New America Foundation, November 2008.

[[Page S1986]]

(7) A large share of the uninsured are offered insurance at
low or zero premiums, but choose to forego coverage. New
America Foundation, December 6, 2007. According to one
estimate, the absence of a requirement from health reform
would leave 50 percent of the uninsured without coverage.
Linda J. Blumberg and John Holahan, Do Individual Mandates
Matter?, The Urban Institute, January 2008. While generous
subsidies alone would not achieve universal coverage, the
requirement further expands coverage. Congressional Budget
Office, December 2008. The requirement improves budgetary
efficiency by significantly lowering the federal cost per
newly insured. Jonathan Gruber, Covering the Uninsured in the
U.S., National Bureau of Economic Research, January 2008. In
Massachusetts, where a similar requirement has been in effect
since 2007, the share of uninsured declined to 2.7 percent in
2009. Massachusetts Division of Healthcare Finance and
Policy.
(8) By regulating the decision to self-insure, and
expanding coverage, the requirement addresses the problem of
free riders who rely on more costly uncompensated care,
shifting costs to medical providers, taxpayers, and the
privately insured. It will also reduce the cost to the
national economy of the lower productivity of the uninsured.
(9) The requirement is necessary to achieve near-universal
coverage while maintaining the current private-public system.
It builds upon and strengthens private employer-based health
insurance, which covers 176,000,000 Americans nationwide. In
Massachusetts, a similar requirement has strengthened
employer-based coverage: despite the economic downturn, the
number of workers offered employer-based coverage has
actually increased. Sharon K. Long and Karen Stockley,
Massachusetts Health Reform: Employer Coverage from
Employees' Perspective, Health Affairs, October 1, 2009.
(10) Under the Patient Protection and Affordable Care Act,
if there were no requirement, many individuals would wait to
purchase health insurance until they needed care. Higher-risk
individuals would be more likely to enroll in coverage,
increasing premiums and costs to the government. The Urban
Institute, January 2008. The requirement will broaden the
private health insurance risk pool to include healthy
individuals, which will spread risk, stabilize the market,
and lower premiums. Congressional Budget Office, An Analysis
of Health Insurance Premiums Under the Patient Protection and
Affordable Care Act, November 30, 2009. It is necessary to
create effective private health insurance markets throughout
the country in which improved health insurance products that
are guaranteed issue and do not exclude coverage of pre-
existing conditions can be sold.
(11) Administrative costs for private health insurance,
which were $90,000,000,000 in 2006, are 26 to 30 percent of
premiums in the current individual and small group markets.
Congressional Budget Office, December 2008. The requirement
is necessary to create effective private health insurance
markets throughout the country that do not require
underwriting, eliminating its associated administrative
costs. By significantly increasing health insurance coverage
and the size of purchasing pools, which will increase
economies of scale, the requirement, together with the other
provisions of the Patient Protection and Affordable Care Act,
will significantly reduce administrative costs and lower
health insurance premiums.
(12) Health insurance and health care services are a
substantial part of the national economy. National health
spending is projected to increase from $2,500,000,000,000, or
17.6 percent of the economy, in 2009 to $4,700,000,000,000 in
2019. Centers for Medicare & Medicaid Services, Office of the
Actuary, National Health Expenditure Projections, 2008-2018.
Private health insurance spending is projected to be
$854,000,000,000 in 2009, and pays for medical supplies,
drugs, and equipment that are shipped in interstate commerce.
Centers for Medicare & Medicaid Services, Office of the
Actuary. Since most health insurance is sold by national or
regional health insurance companies, health insurance is sold
in interstate commerce and claims payments flow through
interstate commerce.
(13) The requirement, together with the other provisions of
the Patient Protection and Affordable Care Act, will add more
than 30,000,000 consumers to the health insurance market.
Congressional Budget Office, Patient Protection and
Affordable Care Act, Incorporating the Manager's Amendment,
December 19, 2009. In doing so, it will increase the demand
for, and the supply of, health care services. According to
one estimate, the use of health care by the currently
uninsured could increase by 25 to 60 percent. Congressional
Budget Office, December 2008.
(14) Under the Employee Retirement Income Security Act of
1974, the Public Health Service Act, and the Patient
Protection and Affordable Care Act, the Federal Government
has a significant role in regulating health insurance. The
requirement is an essential part of this larger regulation of
economic activity, and the absence of the requirement would
undercut Federal regulation of the health insurance market.
(15) Payments collected from individuals who fail to
maintain minimum essential coverage will contribute revenue
that will help the Federal government finance a reformed
health insurance system that ensures the availability of
health insurance to all Americans.
The preceding 15 points cite numerous studies and papers
which illustrate the extensive evidence that the Patient
Protection and Affordable Care Act, as amended by Section
1002 of the Health Care and Education Reconciliation Act,
substantially affects interstate commerce. These citations
are included as hyperlinks or in their written entirety for
the record.

Mrs. HAGAN. Mr. President, today I rise in support of a bill that
builds upon the health care reform legislation that was signed into law
yesterday.
The new--and historic--law combined with the bill the Senate is now
considering, will reform our health care system to reduce costs and
improve patient care for North Carolina families and families across
America.
In 1996, the average family premium was $6,000. Today it is $12,000.
Without health care reform, premiums would skyrocket to $24,000 by
2016--or half of the average North Carolina family income.
Without reform, health care costs were projected to reach 20 percent
of GDP, or $4.3 trillion, by 2017. This trajectory was simply
unsustainable.
After decades of working to fix a broken health care system,
President Obama yesterday signed into law a reform bill that controls
exploding costs, increases access to health care and reduces our long-
term deficit by as much as $1.2 trillion within 20 years.
By passing this bill, we will reduce the deficit, for a total savings
of $143 billion by 2019.
In addition to containing costs, health care reform will improve
access and quality of health care for millions of Americans. 1.7
million North Carolinians without insurance will now have access to a
family doctor.
It will provide immediate benefits to small businesses, middle class
families, and seniors in North Carolina.
While small businesses make up 98 percent of North Carolina's private
sector employers, in 2008, only 38 percent offered health insurance.
Small business owners I talk to want to provide coverage for their
employees, but costs are prohibitive. This month, I received an e-mail
from a small chiropractic practice in eastern North Carolina that had
to drop its health insurance plan for employees because rates were
doubled over 2 years. Most of the practice's employees are young women
under 30.
But starting today, 112,000 North Carolina small businesses will be
eligible for tax credits to provide health care to employees.
Within the next 6 months, hard-working, middle-class families will be
able to add their children up to age 26 onto their health plans. This
will benefit about 877,000 young adults in North Carolina.
This year, insurance companies will no longer be able to deny
coverage to a child for a preexisting condition, like asthma or
diabetes.
Health care reform means people can access preventive care without
being saddled with copays or deductibles. This includes well-child
visits and seasonal flu immunizations.
I recently heard a story about a North Carolinian who, as a junior in
college, had terrible stomachaches. But he could not afford a
colonoscopy. He learned of his colon cancer too late for the doctors to
save him. Health care reform means this young man would have had a
chance.
Health care reform means people with chronic illnesses will no longer
have to fear losing their insurance because of an arbitrary, insurance
company-set lifetime cap.
And it means insurance companies will no longer be able to drop your
coverage because you get sick or file too many claims.
Seniors also will see immediate benefits. In North Carolina, 1.4
million seniors will receive preventive services with no additional
costs, and 247,000 seniors will have their drug costs in the ``donut
hole'' immediately reduced and eventually eliminated.
I am proud of these immediate benefits and our efforts to reform the
health care system for the long term.
This reform effort contains provisions that I have championed since
coming to the Senate. In the United States, 23 million adults and
children suffer from diabetes, and in North Carolina, diabetes costs
our State $5.3 billion per year in medical interventions, lost
productivity, and premature mortality.
Given these dire numbers, I added to the health care reform bill the
second

[[Page S1987]]

piece of legislation I introduced as a U.S. Senator--The Catalyst to
Better Diabetes Care Act. The Senator from Texas, Mr. Cornyn,
cosponsored the bill last July. It creates a national and State-by-
State level diabetes report card to track progress at beating the
disease. It also requires the promotion of physician education on
properly completing birth and death certificates, and requires that
recommendations be made on appropriate levels of diabetes medical
education that should be completed prior to medical licensing and board
certification.
I also worked with the Senior Senator from Colorado, Mr. Udall, to
add a section to health care reform to improve access to health care in
rural areas. The section we added will help medical schools establish
programs designed to increase the number of graduates who practice in
rural areas. It will give schools resources to recruit students from
rural areas who have an interest in practicing medicine in their
communities, and it provides for additional training in pediatrics,
emergency medicine, obstetrics and behavioral health.
I also want to take this opportunity to discuss how the bill the
Senate is currently considering will help make college affordable for
our families.
One of the most significant provisions for our students in this
legislation is the over $2.5 billion investment over the next 10 years
in historically Black colleges and universities.
There are 10 outstanding HBCUs in North Carolina. HBCUs graduate 40
percent of African Americans with degrees in science, technology,
engineering and mathematics; 50 percent of African-American teachers;
and 40 percent of African-American health professionals.
North Carolina A&T, an HBCU in my hometown of Greensboro, graduates
more African Americans with PhDs in engineering than any other school
in the country.
This is a milestone week for the State of North Carolina. I am
working with my colleagues to send this bill to the President's desk to
further reduce costs for North Carolina's families and small
businesses.
This health care reform effort would not have been possible without
the work of some tenacious Capitol Hill staff, and I want to personally
thank my two incredible health care staffers, Michelle Adams and Tracy
Zvenyach, who worked countless hours for reform in our country.
Mr. CARDIN. Mr. President, I rise today in full support of the Health
Care and Education Affordability Reconciliation Act of 2010. I assert
that the investment we make in education with this bill is an
investment in America's economic future.
For too long, we have allowed America to lag behind other nations in
education, specifically in the number of college graduates we produce.
No more. Now is the time to train our workforce to compete in the
global economy. Now is the time to provide affordable, accessible,
quality educational opportunities so that America will shine as a
beacon of ingenuity and prosperity once again. This bill answers the
call by making college more affordable and accessible.
Perhaps most significantly, the bill invests in and protects the Pell
grant scholarship. It provides $36 billion over 10 years for this
program which allows so many to attend college who would not otherwise
have the opportunity. This includes funding to cover a shortfall due to
demand. The failing economy has spurred a dramatic increase the number
of those students who are eligible for Pell grants. In 2007, there were
5 million Pell grant recipients. In 2009-2010, there were 8.3 million.
The bill also provides an increase in the maximum annual award which
will ultimately be indexed to the Consumer Price Index and thus linked
to increases in the cost of living.
In Maryland, over 85,000 students depend on Pell grants to help them
attend college. With the additional funding, that number is expected to
rise to 100,000. That is 15,000 additional students who have the
opportunity to share in the American dream! Students like Morris
Johnson from Baltimore. Morris is a double major in sociology and
communications at Goucher College with a 3.5 grade point average.
Morris credits those who believed in him and his academic promise for
keeping his dream of attending college alive. But without financial
aid, including a Pell grant, that dream would have been out of reach.
For those who find it necessary to borrow to finance their education,
the bill solidifies a mechanism for obtaining high-quality student
loans. The direct loan program is a reliable lender and cost-effective
mechanism for taxpayers. Beginning in July of this year, all new
student loans will be originated through the direct loan program. This
will bring an end to the costly federally-guaranteed student loan
program that generated billions of dollars in subsidies for banks--at
the expense of additional financial aid for more deserving students.
Instead, direct loans will be serviced by contracted private lenders.
Further, direct loans can only be serviced in the United States,
thereby preserving American jobs.
The bill also makes it easier for new borrowers after 2014 to repay
Federal loans by lowering the existing cap on monthly Federal student
loan payments from 15 percent to 10 percent of discretionary income.
The legislation provides $1.5 billion for this income-based repayment
program.
Just paying for college, however, isn't enough. We need to make sure
our students succeed in college and graduate. To that end, the bill
supports additional key investments:
The bill dramatically increases funding for the College Access
Challenge Grant program. This program funds innovative financial
literacy and retention projects. This will increase the number of low-
income students who are adequately prepared for the financial
challenges of paying for college and related expenses.
The bill underscores the role of minority-serving institutions in
educating the Nation's low-income and minority students by providing
$2.5 billion to support these institutions. This funding represents a
significant investment in Maryland where we have four outstanding
Historically Black Colleges and Universities. The bill also recognizes
the role of community colleges and provides $2 billion for a
competitive grant program to develop and improve career training
programs.
I said the time for making college more accessible and affordable has
come and I believe that. But we also have to be fiscally responsible.
This bill is both. It makes historic investments in Federal financial
aid and yet comes at no cost to the taxpayers. This is possible by
switching all Federal loans to the direct loan program. Doing so saves
taxpayers a huge amount in subsidies that were going to the banks.
According to the Congressional Budget Office, this savings will amount
to $61 billion over 10 years. Even with the improvements, these
education provisions in the legislation will reduce the deficit by $10
billion over 10 years, at least.
The education provisions in this legislation make college more
affordable and accessible. It's necessary for America's students and
for America's future.
Ms. MIKULSKI. Mr. President, I am proud today to support the student
loan reform provisions in the Health Care and Education Affordability
Reconciliation Act of 2010. I've said this often, we in this country
enjoy many freedoms: the freedom of speech, the freedom of the press,
the freedom of religion. But there is an implicit freedom our
Constitution doesn't lay out in writing, and its promise has excited
the passions, hopes, and dreams of people in this country since its
founding. The freedom to take whatever talents God has given you, to
fulfill whatever passion is in your heart, to learn so you can earn and
make a contribution--the freedom to achieve.
When I was a young girl at a Catholic all-girls school, my mom and
dad made it clear they wanted me to go to college. But, right around
graduation, my family was going through a rough time because my dad's
grocery store had suffered a terrible fire. I offered to put off
college and work at the grocery store until the business got back on
its feet. My dad said, ``Barb, you have to go. Your mother and I will
find a way because no matter what happens to you, no one can ever take
that degree away from you. The best way I can protect you is to make
sure you can earn a living all of your life.'' My father gave me the
freedom to achieve. And the provisions in this bill will give millions
of

[[Page S1988]]

Americans that same freedom without adding a dime to the deficit.
For too long, banks have gotten a free ride from the U.S. Department
of Education by offering federally guaranteed student loans. The
provisions in this bill will stop wasteful and unnecessary subsidies to
lenders and put that money where it is needed most--in students'
pockets. By reforming the Federal student loan program, we will save
over $60 billion in the next 10 years. Many of those savings will go to
increase the Pell grant, which has made college a reality for students
of modest means for nearly half a century. But we also make critical
investments in institutions that help our most underserved students:
community colleges and Minority Serving Institutions, particularly
Historically Black Colleges and Universities, HBCUs.
I have fought alongside my colleagues for years to increase funding
for these programs and there was a point where Democrats had to fight
tooth-and-nail just to keep Pell funding from being cut. Now we are in
a position where we can guarantee increases in the Pell grant, which
helps more than 90,000 students in my home State of Maryland. My
colleagues have spoken eloquently about the importance of the much-
needed investments in this bill, but I would like to take a moment to
highlight the investments in HBCUs. I am the only senior Democrat on
the HELP committee that has HBCUs in their State, and I have been a
long-standing champion for these schools in both my work as an
authorizer on the HELP committee and as an appropriator through my
chairmanship of the Commerce, Justice, and Science Appropriations
Subcommittee.
I am proud that Maryland has four public HBCUs which provide an
incredible benefit to African-American students and the communities
they serve. Few people know, but HBCUs produce nearly a quarter of our
Nation's African-American public school teachers. They also produce
almost 40 percent of African-American graduates in physics, math,
biology, and environmental sciences.
Some of my colleagues might argue that HBCUs shouldn't be getting
Federal funding based primarily on the racial makeup of their student
bodies and, further, that there is no longer any place for these
institutions in this day and age. What I would tell them is that
Congress has been providing direct Federal support for HBCUs for more
than 50 years mainly for two reasons. First, Congress recognizes the
historical and cultural importance of HBCUs and their benefit to
students who are often the first in their families to go to college.
Second, the emergence of these institutions was a direct result of
Federal action permitting the segregation of students in public
education based on race.
During those dark days, HBCUs were often the only pathways to college
for African Americans; they were able to open the doors of opportunity
that were so often shut. But these institutions are historically under-
resourced, and their students are by and large underserved. For that
reason they have had to fight for representation, respect, and
recognition since they were established. They've had to urge lawmakers
to act ``now'' on behalf of their students when so many have told them
to ``wait.'' So I am here to make sure that the more than 20,000
students at Maryland's HBCUs get the resources they deserve by
supporting the $850 million investment in HBCUs over 10 years enabled
through this reconciliation bill. Maryland is slated to get $65
million, and I am confident that the presidents of Morgan State
University, Coppin State University, the University of Maryland Eastern
Shore, and Bowie State University will be good stewards of this
landmark Federal investment.
Our work isn't done when it comes to equity in access for higher
education, but this bill helps us get there.
Mr. KAUFMAN. Mr. President, after decades of efforts and a year of
extensive debate, Americans will finally have a health care system that
controls costs, reduces the deficit, improves access, adds more
protections for seniors and curbs insurance company abuses. The
President has signed meaningful health care reform into law that will
extend immediate benefits to millions of American families and small
businesses.
In implementing this comprehensive legislation, the Department of
Health and Human Services will be called upon, as will other Federal
agencies, and the States, to make assessments in a variety of contexts
as to whether the marketplace is functioning properly, or whether
abuses are occurring. In making these assessments, and in deciding on
appropriate steps to address any abuses or dysfunction, the Federal
agencies and the States can benefit greatly from competitive analysis
provided by the Department of Justice's Antitrust Division and the
Federal Trade Commission.
One example where this advice would be particularly beneficial is in
implementing the mandate to establish State and/or regional health
exchanges. At present, many State health insurance markets are
characterized by their extreme concentration. According to the American
Medical Association, in 2007, at least one insurer had a combined HMO/
PPO market share of 50 percent or greater in 64 percent (200) of the
local markets (or Metropolitan Statistical Areas) of the United States.
And the two top insurers accounted for at least 60 percent of
enrollment in almost 75 percent of these markets. High concentration
and barriers to entry reduce price competition and customer choice.
The law just passed contains an antitrust savings clause, which
clarifies that Congress did not intend health care reform to erode the
reach of the antitrust laws in any way. To restore true competition
however, more than a savings clause is needed.
I am pleased that the law vests in State exchange regulators the
power to address competition failures in the market, including the root
causes of industry concentration. This means curbing anticompetitive
practices designed to keep prices high and choices low, and also
encouraging new market participants by mitigating barriers to entry.
Obvious market abuses, such as tying agreements, predatory practices
and the like, must be stopped. But success also requires that the
regulators get the more delicate issues right: does a preferred rate
agreement constitute a de facto boycott? Will a regulation or exchange
adversely impact the ability of a new participant to gain public trust?
How does a proposed rule impact the ability of young insurance
companies to develop a comprehensive network of health care providers?
These are difficult questions and we should not expect State
regulators to develop an expertise in them overnight. But our Federal
antitrust agencies, have, through years of experience, developed just
this expertise. I urge the exchange regulators, as well as the
Department of Health and Human Services and other responsible agencies,
to make full use of their assistance.
Mr. NELSON of Florida. Mr. President, I rise today in support of two
amendments, S.A. 3574 and S.A. 3575, offered by the junior senator from
Florida. I am concerned the student loan reforms in the bill will lead
to a substantial loss of jobs in my State. That is why I recently led a
group of six Senators in asking Majority Leader Reid to consider
alternative ways to reduce the cost of student loans. Unfortunately,
that has not happened. The provisions in this bill could prove
detrimental to thousands of employees who serve in the student loan
industry throughout this country, about 700 who are located in Panama
City, FL. Therefore, Mr. President, I urge the Senate to pass this
amendment.
Mrs. FEINSTEIN. Mr. President, I rise in support of the education
provisions in the reconciliation legislation that reforms Federal
student loan programs and will help our Nation's neediest students
afford college by providing $35.5 billion for the critical Pell grant
program.
Nearly 700,000 students in California right now receive Pell grants
of up to $5,550 out of over 8 million students nationwide. The majority
of these students come from families where the average income is less
than $40,000.
The Pell grant funds in the bill will help prevent cuts to students'
grants of up to 60 percent and prevent nearly 600,000 students from
losing their grant entirely.
It will also help 63,000 more students in California receive a Pell
grant so they can afford to go to college during this tough economic
time.
Specifically, the legislation will allow the current Federal Direct
Loan

[[Page S1989]]

Program, backed by the U.S. Treasury, to be the sole originator of all
federal student loans; save $61 billion over 10 years by eliminating
the Federal Family Education Loan Program, FFELP, which provides
unnecessary subsidies to private lenders and banks for originating
student loans.
Of the $61 billion in savings, it directs $10 billion to help reduce
the Federal deficit, and the remainder towards important education
programs, such as $35.5 billion for Pell grants to help students afford
college; direct $22.5 billion of the total $35.5 billion in new Pell
Grant funds to increase the maximum award amount--from the current
$5,550 to about $6,000 to help with rising college costs.
The economic downturn has resulted in increased enrollment at
colleges and universities, and increased eligibility in Federal student
aid, with the number of Pell grant recipients increasing by 1 million
students in the past two years alone.
In my home state of California, these important provisions are
supported by the University of California, UC, California State
University, CSU, and California's public community college system--
which together serve approximately 500,000 Pell grant students.
I urge my colleagues to support these provisions that are critically
important to our Nation's students.

puerto rico

Mr. MENENDEZ. Mr. President, I want to thank the chairman and his
staff for taking the time and effort to ensure the 4 million residents
in Puerto Rico are treated fairly in our health care system.
Throughout my time in Congress, first in the House, and now here in
the Senate, I have worked to see the people of Puerto Rico are not
forgotten. The health care reform package we are debating today has
several outstanding provisions for Puerto Rico. It is an example of the
good we can do for its nearly 4 million U.S. citizens--who pay Social
Security and Medicare taxes.
But there is one issue I want to raise and that is the Medicare
Advantage program on the island. Approximately 83 percent of the
eligible Medicare beneficiaries in Puerto Rico participate in Medicare
Advantage, compared to 25 percent in the States. This can be tracked to
the fact that eligible seniors in Puerto Rico are not automatically
enrolled in Medicare Part B when they turn 65. As a result, it is more
beneficial for seniors in Puerto Rico to enroll in Medicare Advantage
to receive all of their Medicare services.
However, the fee-for-service, FFS, cost calculation for Puerto Rico
is inaccurate and under counts expenditures per Medicare beneficiary.
Last year the Medicare Payment Advisory Commission, MedPAC, alerted
Congress to this and recommends that the Centers for Medicare &
Medicaid Services, CMS, should expeditiously use its authority to
employ an alternative calculation method . . .'.
The fee-for-service cost calculation is important because it will
soon be the basis for Medicare Advantage rates throughout the country
and Puerto Rico. I strongly believe CMS should take a look at the under
count. If there is validation that the FFS expenditures are too low, I
believe the HHS Secretary and CMS should use current authority and
adjust the calculations appropriately.
I am asking HHS and CMS to look at the under count because there is a
very real chance we could do harm to Medicare Advantage in Puerto Rico
if we don't get the FFS costs accurate. I hope the chairman agrees with
me.
Mr. BAUCUS. I thank the Senator for bringing attention to this issue.
He is a true champion for Puerto Rico and a constructive member of the
Finance Committee.
I share his concern about the possible under count of fee-for-service
costs in areas like Puerto Rico. That is why we included a provision in
the Medicare Improvements for Patients and Providers Act of 2008 to
have MedPAC study the accuracy of the calculation and report to
Congress. As he points out, MedPAC recommends that CMS alter the FFS
cost calculation so that such under counts do not exist, particularly
in areas like Puerto Rico where Medicare Advantage provides benefits to
over 80 percent of its seniors.
I strongly agree with him that CMS should promptly use its authority
to correct any and all under counts that might exist in areas like
Puerto Rico. The island has unique circumstances that could affect
Medicare expenditures and spill over to Medicare Advantage. Moving
forward I will continue to work with the Senator closely to monitor and
correct this issue as expeditiously as possible.
Mr. MENENDEZ. I thank the Chairman for his leadership and commitment
on this issue.

PEOs

Mr. NELSON of Florida. Mr. President, I would like to ask the
chairman of the Committee on Finance and its ranking member a question
on the application of the legislation to Professional Employer
Organizations or PEOs.
As they know, there are millions of individuals throughout our
country who are working for small businesses which are in PEO
arrangements. The clear objective of this legislation is to create
incentives for health care coverage and not to provide disincentives. I
would like the chairman to clarify that, for purposes of the
application of section 2716 of the Public Health Service Act
(Prohibition on Discrimination in Favor of Highly Compensated
Individuals) and for purposes of Internal Revenue Code sections 45R
(Credit for Employee Health Insurance Expenses of Small Businesses) and
4980H (Shared Responsibility for Employers), to any health plans
sponsored by a Professional Employer Organization, PEO, or a PEO client
organization, the rules would be applied to each client organization
separately and eligibility for the small business tax credits and
employer shared responsibilities would also apply to each client
organization separately, and not at the PEO level.
Mr. BAUCUS. If the individual providing services to the PEO client
organization pursuant to the PEO arrangement continues to be an
employee of the PEO client organization, the Senator from Florida is
correct.
Mr. GRASSLEY. I agree with the chairman.
Mr. BAUCUS. Mr. President, I want to talk a moment about one of the
only retroactive tax provisions in the Patient Protection and
Affordable Care Act, Section 9016. This one deals with the special
deductions given to the many nonprofit Blue Cross Blue Shield
organizations which are no longer exempt from Federal income tax.
Under section 833 of the Internal Revenue Code, these organizations
receive a 25 percent deduction for claims and expenses and an exception
from the--otherwise applicable--20 percent reduction in the deduction
for unearned premium reserves. Effective January 1 of this year, these
non-profit Blue Cross Blue Shield organizations must now meet a medical
loss ratio of 85 percent or higher in order to take advantage of the
tax benefits of section 833. This provision was included to ensure that
recipients of this special deduction actually spend out most of their
premium income on the people they insure and not on administrative fees
or executive compensation.
But I want to clarify two issues here. First, it was our intention
that, in calculating the medical loss ratios, these entities could
include both the cost of reimbursement for clinical services provided
to the individuals they insure and the cost of activities that improve
health care quality. Determining the medical loss ratio under this
provision using those two types of costs is consistent with the
calculation of medical loss ratios elsewhere in the legislation. This
determination would be made on an annual basis and would only affect
the application of the special deductions for that year.
Second, it was our intention that the only consequence for not
meeting the medical loss ratio threshold would be that the 25 percent
deduction for claims and expenses and the exception from the 20 percent
reduction in the deduction for unearned premium reserves would not be
allowed. The entity would still be treated as a stock property and
casualty insurance company.
It is my understanding that the Joint Committee on Taxation scored
this provision consistent with the policy I just outlined. We intend to
clarify these two issues in a technical corrections bill as soon as
possible.
Mr. President, I want to speak concerning the accounting treatment of
one of the tax provisions that passed in the Patient Protection and
Affordable

[[Page S1990]]

Care Act, Section 9008, and that is proposed to be modified in the
Health Care and Education Reconciliation Act. This deals with the
annual fee on pharmaceutical manufacturers which, as passed, is to go
into effect this year. It is our hope that Congress will delay the
implementation of this fee by 1 year, to 2011, by passing the
reconciliation bill which we are discussing today on the floor. This
will give the government reporting agencies more time to establish
systems to report the drug sales to the Secretary of the Treasury as
required by health care reform.
As a reminder of how the fee works: our legislation sets an
aggregate, annual fee that is to be apportioned among the relevant
companies based on their market share of branded U.S. prescription drug
sales made to or funded by specified government programs. The U.S.
Treasury will allocate this annual fee to each company based on its
relative market share for the prior year.
Now, we understand that there have been questions about the nature of
this fee that are affecting how the fee should be treated for
accounting purposes. It was our intent that the fee is assessed in the
year that it is due. A fee is assessed on an entity in any given
calendar year only if the entity is engaged in the business of
manufacturing or importing branded prescription drugs and has sales to
the specified government programs in that calendar year. The reference
in the legislation to sales for the preceding calendar year is for the
sole purpose of providing the method of calculating market share. It
would be difficult to calculate market share and impose and collect the
fee in the same year, so we decided to look back to a completed year as
a proxy of market share. But it is not intended that a manufacturer or
importer would be assessed an annual fee in a calendar year in which it
had no branded prescription drug sales to the government programs. This
is regardless of whether the manufacturer or importer had any relevant
sales in the preceding year.
As an example, suppose a pharmaceutical company made sales in 2011
but in November 2011 shut down its U.S. operations and had no further
sales to the specified government programs. In 2012, that
pharmaceutical company would not be subject to the fee. Instead, the
2012 aggregate fee would be allocated among those companies selling
drugs in 2012 to the specified government programs.
These same accounting questions may also be raised under the annual
fee on health insurance providers--section 9010 of the Patient
Protection and Affordable Care Act, as amended. On these issues, our
intent as to the treatment of the fees is the same.
We anticipate that the Secretary of the Treasury will provide
guidance on how to determine the fees in situations involving mergers,
acquisitions, business divisions, bankruptcy, or other situations where
it may be difficult to account for sales taken into account in
determining market share. We intend to work with the IRS and the
affected groups to further clarify the law consistent with the policy I
have just outlined.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, how much time is remaining on our side?
The PRESIDING OFFICER. There is 1 minute 48 seconds remaining.
Mr. BAUCUS. First, I thank all of my colleagues on both sides of the
aisle. This has been a very civil discussion, very heartfelt feelings
on both sides, and I appreciate that.
Let me also say it is interesting that this is the first time in
recent memory that a reconciliation bill has all amendments on one side
only. These are clearly amendments designed to kill the reconciliation
and therefore kill health care reform. So I very much hope that all of
these amendments are defeated.
I note there are 23 amendments pending. It is going to take 7 or 8
hours, hopefully less. There will be many more amendments offered
tonight. It is our expectation that we will continue voting on all
amendments until we finally vote on all amendments and we can get
reconciliation passed, and therefore all of the measures surrounding
health care reform will be enacted and we can proceed.
Mr. GRAHAM. Mr. President, I rise today with great disappointment in
both the substance and process of this legislation.
We should be working from a long held medical premise; first, do no
harm. Instead, Americans know this government takeover of the health
care system is bad and the tactics that have been used to do it are
even worse. The policies contained in the recently passed health care
bill combined with this reconciliation package will raise costs, lower
the quality of care in our country, shift a new unfunded mandate onto
the States, and will result in health care rationing.
The reasons Democrats passed this bill on a party-line vote in the
Senate on Christmas Eve and late this past Sunday night in the House
are because of a slew of backroom deals and arm twisting to buy up last
minute votes. Now we take up the reconciliation bill to remove some of
these deals so the President can claim to have clean hands.
There are many other reasons to oppose this bill, aside from the
unsavory deals made to secure its passage. In both its scope and reach,
the combination of health care legislation and reconciliation is
unprecedented. It raises $644 billion in taxes and cuts $525 billion
from Medicare. The Democrats' bill contains accounting gimmicks that
would make Bernie Madoff proud.
The Congressional Budget Office found that savings generated from
Medicare will not be reinvested in the program, but rather will be used
to pay for new programs, putting even more strain on the long-term
viability of Medicare.
There is no guarantee this plan lowers health care costs for
consumers. What is sure is that 80 percent of Americans will find
themselves in some form of government-run, government-controlled health
care. The remaining 20 percent will soon be asked, if not required, to
follow.
Historically, large-scale social legislation has passed with great
bipartisan support. Social Security legislation passed in 1935 with 77
bipartisan votes. Medicare passed with 68 votes, and the Americans with
Disabilities Act passed with 76 votes. Never before have we acted in a
manner that would affect one-sixth of our economy on the whims of a
single political party. The combination of tactics used to pass the
health care bill and amend it through reconciliation moves us into
uncharted territory.
Even previous budget reconciliation measures cited by my colleagues
on the other side have passed with large, bipartisan margins. The law
that created the COBRA insurance program, often cited by my friends,
achieved final passage in the Senate on a voice vote in 1985. In
addition, welfare reform was supported by 78 Senators and SCHIP passed
the Senate with a whopping 85 votes.
While there are a number of things that Republicans and Democrats
agree on when it comes to reforming the health care system, Democrats
have chosen to pursue a winner take all strategy that leaves them in
the position of having to clean up a messy bill through the process of
reconciliation. They have adopted a hard-line ideological approach and
continue to push a plan that will put us one giant step closer to the
single-payer government run health care system they have long desired.
Speaking of a federal takeover; if you want a federal takeover of the
student loan industry, then your ship has come in. Every student in the
country who needs to borrow money for college will now have to come to
the Federal Government for a loan, which will make the United States
Department of Education one of the Nation's largest banks. A portion of
the proceeds from these loans, about $9 billion, will then be used to
finance new health care spending instead of being put back into
education programs. Students will be caught in the middle in terms of
health care financing. Not only will their loan interest go to finance
an unpopular health care proposal, but they will be paying higher taxes
when they graduate and get a job.
I am afraid that by dealing Republicans out of the game, Democrats
have done great harm to comity in the Senate. I have never hesitated to
work across the aisle on tough issues and try to reach consensus. After
this maneuver, I fear that bipartisanship may be a

[[Page S1991]]

thing of the past for the foreseeable future. While there may have been
the chance to work together on important topics, I believe Republicans
must now pursue a strategy of repeal and replace. Repeal this damaging
legislation and replace it with programs that promote fair tax
treatment of health care, encourage innovation, reward wellness, and
help those in need.
I will be voting against this reconciliation bill because I believe
that combined with the recently passed health care bill, it will do
more harm than good for health care and higher education in America.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mr. GREGG. How much time do we have on our side?
The PRESIDING OFFICER. There is 4 minutes remaining.
Mr. GREGG. Mr. President, a lot has been talked about here. A lot has
been discussed. I don't want to get in an expansive discussion of the
issue of the underlying bill. It has been fully aired. But this concept
to vote down every amendment, that you have to do that in order to save
this bill, seems to reject the concept of a constitutional process.
Think about this for a moment. The whole series of amendments here
are being offered to fulfill the statements made by the President of
the United States. For example, Senator McCain has offered an amendment
to take out the sweetheart deals. The President said the sweetheart
deals would be taken out. Senator Barrasso has offered an amendment
which says that if premiums go up, certain parts of this bill will not
go into force. The President said premiums will not go up on working
Americans. Senator Crapo has offered an amendment which says that if
there are taxes on people earning less than $200,000, those taxes won't
go into force. That is what the President promised. I have offered an
amendment which says that if there are Medicare cuts in this bill, the
cuts should go to Medicare and make Medicare more solvent--a promise
also made from the other side of the aisle.
All of these are amendments which are substantive and the purpose of
which is to put forward the policies which the other side of the aisle
represented they were going to have in their original bill. This is
called the fix-it bill. Well, we are suggesting you fix it so it meets
the conditions set out by the President and by the Democratic
leadership. Yet now we hear that every amendment should be voted down.
Why? Because the idea of sending the bill back to the House is anathema
to the Democratic Party. Did I miss something? Isn't the House of
Representatives controlled by the Democratic Party with a
supermajority? You mean they couldn't survive the idea of knocking out
the sweetheart deals, sending it back to the House, and coming back
here? That is going to somehow fundamentally undermine this bill? That
argument is absurd on its face. It is absurd on its face.
I think the only answer is that the other side of the aisle has
decided to proceed on this bill in a most arrogant process. From the
beginning of the core of this bill being put together in a hidden room
behind a hidden room behind a hidden door of the majority leader's
office suite, brought to this floor on a Saturday afternoon, the tree
was filled and we were told we had to vote on it on Christmas Eve. No
amendments were allowed. Then it was taken over to the House, and the
Speaker worked out the deals in the back rooms of her offices behind
hidden doors without any public input, without C-SPAN there, as was
represented it would be. And what happened? It passed the House without
any amendments being allowed.
Now, for the first time, we have a chance to offer amendments, and
the position on the other side of the aisle is no amendments allowed
even if they are good amendments.
So, I guess, obviously, they consider their promises to be an
inconvenience. Obviously, they presume the Republican Party is an
inconvenience. The Democratic process is an inconvenience. It also
appears, considering the opposition to this out in America, that the
American people are an inconvenience and that amendments which make
sense aren't going to be allowed to be passed because they don't want
to send it back to the House of Representatives. It makes no sense to
me, and I don't think it is going to make much sense to the American
people.
This bill is fundamentally flawed. It needs to be repealed and it
needs to be replaced. We have suggested a whole series of amendments
which will significantly improve this bill, and I hope some will be
supported by the other side of the aisle since they are the policies of
the other side of the aisle.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. BAUCUS. Mr. President, make no mistake----
Mr. GREGG. Mr. President, point of order. Is there time remaining on
the bill?
The PRESIDING OFFICER. There is 53 seconds remaining for the
majority.
Mr. BAUCUS. Mr. President, make no mistake, the intent of every
single one of the amendments offered on the other side of the aisle is
to kill health care reform. That is the sole purpose of each of those
amendments. That was the sole purpose of the amendments in the Finance
Committee last year--to kill health care reform. It was the sole
purpose in the HELP Committee, except for a few benign amendments--to
kill health care reform. It was the sole purpose on the floor of the
Senate when we took it up. Every amendment was to kill health care
reform.
A Senator on the other side of the aisle stood up and said that this
is hopefully the President's Waterloo. They want to kill health care
reform. It is clear they want to kill health care reform.
The other side has said repeatedly in campaign statements in the
other body that they want to repeal health care reform. They have
orchestrated legislatures to repeal health care reform.
Each amendment offered here is intended to kill health care reform,
and that is why each amendment should fail.
The PRESIDING OFFICER. The time of the Senator has expired.
Mr. REID. I note the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. REID. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. REID. Mr. President, I direct this comment through the Chair to
my distinguished colleague, the Republican leader. All time has
expired. Under the rules in the Senate, we start our vote-athon now, as
the Republican leader knows. I would ask my friend, is it the desire of
the minority that there be time before each amendment and a response to
that?
Mr. McCONNELL. Yes. I would say to my friend the majority leader,
since the voting will all occur during the so-called vote-arama, if we
could have a minute or so before each amendment simply to describe what
it is, that would be helpful.
Mr. REID. Mr. President, I say again through the Chair to my
colleague and those Members of this body, we do not have to agree to 1
minute, but we want everyone to understand we have tried to be as fair
as we can through this whole process. There are some who said: Why
should we waste--there would be 43 minutes or 46 minutes. I think there
are 23 amendments pending, so that would be 46 minutes. But we want to
be fair. In recent years, we have agreed by unanimous consent to have 1
minute to explain the amendment and 1 minute to disagree with the
amendment. I think that is the appropriate thing to do. We want to make
sure everyone is treated fairly.
But I alert everyone: The Chair is going to enforce--we are not
waiting for the Parliamentarian--the Chair is going to enforce that to
the letter of the law. Every time the Presiding Officer is here, there
will be 1 minute--if this consent agreement is agreed to--there will be
1 minute to explain the amendment and 1 minute to disagree with the
amendment.
Mr. McCONNELL. Would my friend yield for an observation?
Mr. REID. Yes.
Mr. McCONNELL. Even though allowing that, as the majority leader
suggested, is certainly optional, it has been the custom of both sides,
when we have been in these vote-arama situations in the past, to allow
the time on

[[Page S1992]]

each side, and I appreciate the willingness of the majority leader to
do that.
Mr. REID. Mr. President, I ask unanimous consent, as I directed, or
asked, that there be 1 minute to explain the amendment and 1 minute to
disagree with the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. REID. Mr. President, I also ask unanimous consent that after the
first amendment, on which we will do our normal 15 minutes with 5
minutes of time after that, all votes thereafter be 10 minutes. I ask
unanimous consent that prior to each vote there be 2 minutes of debate
equally divided and controlled in the usual form; that upon use or
yielding back of that time, the Senate proceed to vote in relation to
the amendments and the motions in the order they have been offered--I
think that is the fair way to go so we are not trying to catapult over
other amendments people may have offered at an earlier time--with no
intervening amendments or motions in order prior to a vote; further,
that after the first vote in this sequence, the succeeding votes be
limited to 10 minutes each.
The reason I suggest 10 minutes is I have been told by Senator
McConnell and others they want an opportunity to offer amendments, and
this will maybe allow them to offer a few more.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. REID. Mr. President, I also note that with just the amendments
that have been proposed, if we are fortunate, it will probably take 9
hours or so, maybe more than that, to get rid of those. There will be
continuous votes without any breaks. We are not going to have any
breaks unless something untoward happens. Senators should be advised
that they should remain close to the floor during this process. If
people are not here at the end of the time, we are going to close it
up. We need to move on. We have other things we have to do prior to the
recess. I have to work with the Republican leader. It has taken an
enormous amount of time to do this. Everybody stay here. It works a lot
better if my colleagues stay close to their seats and, hopefully, we
will have an orderly process as much as possible during the vote-arama.
The PRESIDING OFFICER. The minority leader.
Mr. McCONNELL. Mr. President, I am going to take a few minutes of my
leader time before we begin the vote.
The PRESIDING OFFICER. The leader has that right.
Mr. McCONNELL. Mr. President, the administration and some in Congress
wish this debate to be over. They want the American people to sit down
and quiet down. That has been their approach to health care for an
entire year.
Well, Republicans think Congress serves the people, not the other way
around.
We have fought on behalf of the American people this week, and we
will continue to fight until this bill is repealed and replaced with
commonsense ideas that solve our problems without dismantling the
health care system we have and without burying the American dream under
a mountain of debt.
That is what we have been doing all week in the Senate. While
Democratic lawmakers and staffers threw a party for themselves at the
White House yesterday, Republicans were here at the Capitol fighting a
150-page postscript that Democrats added at the last minute to the
health care bill. This add-on took a terrible health spending bill and
made it even worse.
If you thought the tax hikes in the original bill were bad, this bill
raised them even higher. If you thought the Medicare cuts were bad,
this bill made them even deeper. If you thought the first bill cost too
much, this bill made it even more expensive. If you did not like the
special deals in the first bill, they slipped more into this one. The
whole thing was one last slap in the face of Americans across the
country who have been howling at Democrats for the past year to stop
this bill and to work instead across party lines on reforms that would
actually drive costs down.
Today Republicans will give Democrats one last chance to reject the
horrible impact the underlying bill and this last-minute add-on will
have on our country. Unfortunately, we already know that they plan to
turn the other way.
We will offer an amendment to direct the Medicare cuts in this bill
back into Medicare, to preserve and strengthen it for future
generations. They will reject it.
We will offer an amendment to strike all the new sweetheart deals in
this bill. They will reject it.
We will offer an amendment that would have obliged the President to
keep his pledge that families earning under $250,000 will not see any
tax hikes as a result of this bill. They plan to reject it.
We will offer an amendment requiring HHS to certify that this bill
does not increase premiums. They will reject it.
We will offer an amendment to strike a job-killing mandate on
business. They will reject it.
While the White House is trying to sell this health spending bill to
a skeptical public, Senate Democrats today will speak loudly and they
will speak clearly about the things in this bill the White House does
not want people to know and vote to endorse them: massive cuts to
Medicare for seniors; job-killing mandates and business tax hikes;
higher insurance premiums; sweetheart deals; tax hikes on middle-class
families. This is the real story of health care reform.
Americans may not be hearing about it from the White House, but I
assure you, they will be feeling the pain. Americans know this and they
want to know that somebody is fighting for them in Washington to make
their voices heard. That is what Republicans have been doing on this
issue for the past year. That is what we have been doing this week.
That is what we will be doing tonight. And that is what we will keep
doing until those voices are heard. We are not giving up.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The majority leader.
Mr. REID. Mr. President, USA Today-Gallup reported that the people of
America, the citizens of America, favor what we did by a score of 49 to
40. That is a pretty significant majority. People support this
legislation. Why? Because they are tired of being treated by the
insurance industry the way they have been treated.
My friend talks about the mountain of debt of this bill. We have
rules and guidelines in this body, in this Congress, and one of them is
we have an independent body that has been set up, not by Republicans,
not by Democrats, but by us. It is independent. It is not partisan.
That agency, the Congressional Budget Office, determined this bill over
the first 10 years will save about $140 billion; over the next 10
years, $1.3 trillion. This is make-believe they talk about all these
things that are going to cost so much--$1.3 trillion.
I also have to comment on this. My friend, the Republican leader,
talks about how hard they were working yesterday when we were at a 45-
minute meeting at the White House while the President made history
signing for the first time in 100 years major health care reform in
this country. They were working so hard here. They were working so hard
today that they refused to let committees meet to hold sensitive,
important hearings for our country.
Carl Levin had to cancel a meeting because the Republicans refused to
allow that meeting to go forward, dealing with the safety and security
of this Nation. Claire McCaskill, with her subcommittee, had to cancel
a hearing dealing with having police officers trained in Afghanistan.
Canceled. Working hard, they are, to throw a monkey wrench in
everything we are trying to do for the American people.

To in any way denigrate, as has been done this afternoon, Chairman
Max Baucus and Chairman Chris Dodd and the work done by the man
replacing Ted Kennedy is an outrage. Max Baucus devoted his life to
this legislation for the last 2 years: the number of roundtable
discussions with Finance Committee members and invited guests, 3; the
number of papers outlining health care reform, significant, important
papers that were distributed to everybody around the country interested
in health care, 4; the number of meetings of the Gang of 6--three
Republicans and three Democrats--31 meetings; the number of member
meetings on health care reform, 141.
These are not back-room deals. This is how business is conducted in
the Senate.

[[Page S1993]]

The number of days in the Finance Committee the bill was available
before the markup even took place, 6; the total number of amendments
posted online before the markup, 564. They were public. Everyone in
America could read them. The number of amendments considered during the
markup, 135; the number of days the committee spent marking up the
bill, 8; the number of days the final bill was available before the
vote, 11.
There is more, but you get the picture.
Chairman Dodd conducted the longest markup in the history of the HELP
Committee. On what subject? Health care. Public meetings, many of them
on C-SPAN.
There is no bill anymore. It was signed into law yesterday. The work
that we did here on Christmas Eve, through the storms of 2010, is now
the law of this country. We are going to start in just a few minutes
making that law even better.
In my State of Nevada, 600,000 people will be able to have insurance
who have never had it before; 24,000 small businesses will be eligible
for a subsidy for people they employ to have health insurance. They did
not have health insurance because they were cheap or mean; they could
not afford it. If they would get a palsy, they would cancel when
somebody got sick or hurt.
Now someone who is 26 years old can go to college or do whatever they
want to do and not worry about losing their insurance until they
establish themselves.
This legislation extends Medicare for 9 years as a healthy entity.
Medicare is not a perfect program, but it is a good program.
My first elective job was a countywide job in Las Vegas, the
metropolitan areas Clark County. When I went on that hospital board,
the largest district in Nevada, 40 percent of seniors who came into
that hospital had no health insurance. Their sons, their daughters,
their mothers, their brothers, their cousins, their neighbors signed
for them that they would be responsible for that bill. We had a large
collection agency in that hospital. We went after those people.
Not anymore. Now everybody who is a senior citizen who comes into
that hospital is taken care of because of Medicare. We extend the life
of that program for about 9 years.
I had a letter written to me by a man from Nevada. He wrote to me and
he said: Senator, I have a son who has diabetes, but it has become more
complicated. Now he has Addison's disease. I lost my job. We have no
health insurance. When I go to bed at night and say my prayers, I don't
know whether to die or stay alive to help my son. That is how desperate
he is.
People such as this man from Nevada are no longer going to have to be
desperate. No longer are we going to have 750,000 people file for
bankruptcy, 70 percent of them because of health care costs and 80
percent of the 70 percent have health insurance.
The bill that is now the law of this country dealing with health care
is a wonderful bill, and we are going to improve it tonight.

Amendment No. 3567, as Modified

The PRESIDING OFFICER. There will be 2 minutes of debate equally
divided prior to a vote on the Gregg amendment, as modified. Who yields
time?
Mr. GREGG. Mr. President, this amendment fulfills the obligation to
our senior citizens. This bill reduces on its face $520 billion in
Medicare by cutting Medicare beneficiaries through reducing providers
and by eliminating or significantly reducing the Medicare Advantage
Program. That number actually, when fully implemented, is $1 trillion
over the first 10 years. That is $1 trillion of reductions in Medicare.
That money is then taken and used to create new entitlements for
people who are not seniors and who have, for the most part, not paid
into the Medicare trust fund. That is wrong. Medicare is in serious
trouble. We should use the Medicare savings in this bill for the
purposes of making Medicare more solvent.
That is exactly what this amendment does. It keeps Medicare savings
in the Medicare trust fund and uses them to make Medicare more solvent.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, without being dramatic, this is a killer
amendment, pure and simple. Why? Because it is basically designed to
prevent spending. That means it will take away tax credits to middle
Americans to help them buy insurance. This amendment would take it
away. It would kill the assistance to seniors for prescription drugs.
It would take that away. It would take away assistance to States. That
is why it is a killer amendment.
I proudly support this bill. Why? This bill reduces insurance costs
for working-class and middle-class Americans, expands Medicare
prescription drug coverage to more than 3 million seniors, provides
immediate tax credits for nearly 4 million small businesses, stops $6
billion in annual government subsidies for banks, and puts money into
college grants for students and their families.
In contrast, our friends on the other side do not want to do that.
They want to kill this bill. I think that is patently against the
wishes of the American people.
Mr. President, I move to table the Gregg amendment, and I ask for the
yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There appears to
be a sufficient second.
The question is on agreeing to the motion. The clerk will call the
roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 56, nays 42, as follows:

[Rollcall Vote No. 64 Leg.]

YEAS--56

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Whitehouse
Wyden

NAYS--42

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Webb
Wicker

NOT VOTING--2

Byrd
Isakson

The motion was agreed to.
The PRESIDING OFFICER. The majority leader.
Mr. REID. Mr. President, we are going to cut the votes off after 10
minutes. We are going to move these as quickly as we can. We want to
get through this series of votes as rapidly as we can, and it is going
to take hours to do that. People should stay close here. We are not
going to take time for fun and games. We have to move through this
process. It makes it so much easier if you are here to vote; otherwise,
some people are going to miss the votes.

Amendment No. 3570

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate, equally divided, prior to a vote in relation to
amendment No. 3570, offered by the Senator from Arizona, Mr. McCain.
The Senator from Arizona.
Mr. McCAIN. Mr. President, the amendment removes the following items
from the legislation: additional Medicaid funding for Hawaii hospitals;
additional Medicaid funding for Tennessee hospitals; provides special
Medicaid funding for Louisiana; special Medicaid funding primarily for
reclassified hospitals in Michigan and Connecticut; $100 million for a
Connecticut hospital; frontier funding provision provided in new
Medicare money for

[[Page S1994]]

Montana, South Dakota, North Dakota, and Wyoming; a provision allowing
for certain residents in Libby, MT.
I do not argue whether these are worthwhile or needed projects. I do
argue the method in which they were inserted in this legislation--the
one for Tennessee being as recently as yesterday or the day before--is
the wrong process.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I think it is important to recognize this
amendment for what it is. It is basically a political stunt at the
expense of a lot of victimized people. One is victims of Hurricane
Katrina, another is victims of asbestos in Libby, MT; it is at the
expense of rural Americans; it is an attempt to derail the bill and
force the House to have to vote again, therefore force, probably, the
Senate to go through another vote-arama, go back and forth. It makes no
sense whatsoever.
Let's not forget the underlying legislation passed recently and
signed by the President yesterday reduces insurance costs for working
and middle-class Americans. This amendment would have the effect of
taking that away if passed. If passed, it would take away Medicare
prescription drug coverage for more than 3 million seniors. If passed,
it would have the effect of taking away immediate tax credits for small
businesses, and I could go on and on.
I urge Members to support my motion to table. I ask for the yeas and
nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be.
The question is on agreeing to the motion to table.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from Alaska (Mr. Begich) and
the Senator from West Virginia (Mr. Byrd) are necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 54, nays 43, as follows:

[Rollcall Vote No. 65 Leg.]

YEAS--54

Akaka
Baucus
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--43

Alexander
Barrasso
Bayh
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--3

Begich
Byrd
Isakson
The motionm was agreed to.
Mr. BAUCUS. Mr. President, I move to reconsider the vote.
Mr. CARDIN. Mr. President, I move to lay that motion upon the table.
The motion to lay upon the table was agreed to.

Crapo Motion to Commit

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate, equally divided, prior to a vote in relation to the
motion to recommit offered by the Senator from Idaho, Mr. Crapo.
Mr. CRAPO. Mr. President, the two health care bills, the one the
President has already signed into law plus this one we are considering
will spend another $2.6 trillion over the next 10 years.
In order to pay for it, one of the things that these bills include is
over $600 billion in new taxes. The President has pledged there would
be no taxes on the middle class, and he defined that to be anybody who
makes less than $200,000 as an individual or $250,000 as a couple or a
family.
All this motion to commit does is say: Let's take those taxes out of
these bills. There are 73 million Americans who fall squarely in the
middle class who make less than $200,000 a year as an individual or
$250,000 as a couple who will pay the burden of these taxes if we do
not make this change.
It is time for this Congress----
The PRESIDING OFFICER. The Senator's time has expired.
Mr. CRAPO. To help the President keep his pledge.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I don't want to be dramatic about this,
but it is a fact that this amendment is a killer amendment. That is why
we cannot adopt it. I remind colleagues that the underlying bill the
President signed yesterday is a very large tax cut. It has tax credits
in the neighborhood of about $400-some billion. That is a big tax cut
for Americans who today are having a hard time buying insurance, a tax
credit that enables middle and lower income Americans to buy insurance.
I think we should keep that in mind. A vote for this amendment would,
in fact, prevent all the benefits this bill provides for forming a
health insurance market, stopping preexisting conditions. It would
prevent about $17 billion in tax credits that otherwise would go to
small business.
I strongly urge colleagues to support my motion to table this motion.
I move to table the motion to commit and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be.
The question is agreeing to the motion to table the motion to commit.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 56, nays 43, as follows:

[Rollcall Vote No. 66 Leg.]

YEAS--56

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--43

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Cantwell
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--1

Isakson

The motion was agreed to.
Mr. BAUCUS. I move to reconsider the vote.
Mr. LEVIN. I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Enzi Motion To Commit

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote in relation to the
motion to commit offered by the Senator from Wyoming, Mr. Enzi.
The Senator from Wyoming.
Mr. ENZI. Mr. President, this is not a killer amendment. This just
kills a bad part of the bill.
The reconciliation bill makes a bad employment situation even worse.
It imposes $52 billion in new taxes on employers who cannot afford to
provide health insurance to their workers. The

[[Page S1995]]

new employer tax will result in lower wages and lost jobs.
According to CBO:

Requiring employers to offer health insurance--or pay a fee
if they do not--is likely to reduce employment.

Low-income workers are particularly hard hit by the employer mandate
in the reconciliation bill. CBO says an employer mandate ``could reduce
the hiring of low-wage workers'' and would ``increase incentives for
firms to replace full-time workers with more part-time or temporary
workers.''
The Nation's unemployment rate is 9.7 percent, and in many States the
unemployment rate is well into the teens. We should be doing everything
possible to create new jobs, but the employer mandate in the
reconciliation bill does the opposite.
The job-killing taxes in the bill will slash wages and cut jobs.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. ENZI. I urge my colleagues to protect Americans' jobs by
supporting my motion.
The PRESIDING OFFICER (Mr. Begich). The Senator from Montana.
Mr. BAUCUS. Mr. President, sending the bill to committee sounds like
killing the bill to me. I have never heard of a motion to commit that
is not, in effect, a motion to kill the bill.
We are all in this together in America in enacting health care
reform--all groups: business groups, consumers, labor, and so forth. We
have consulted with business groups. They are an integral part of this.
Business groups want to work with us and have worked with us to get
health care reform passed.
I might also remind my colleagues there are tax credits in here for
small business to the tune of--I think it is $17 billion. Firms with
fewer than 50 employees are totally exempt from any penalty.
This clearly is a motion to kill the bill. Therefore, it would result
in taking away all these provisions enacted.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. BAUCUS. Mr. President, I move to table the motion to commit and
ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion to table the motion to
commit.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 58, nays 41, as follows:

[Rollcall Vote No. 67 Leg.]

YEAS--58

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--41

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--1

Isakson

The motion was agreed to.
Mr. CARDIN. Mr. President, I move to reconsider the vote, and I move
to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3582

The PRESIDING OFFICER. Under the previous order, there will be 2
minutes of debate, equally divided, prior to a vote in relation to
amendment No. 3582 offered by the Senator from Wyoming, Mr. Barrasso.
The Senator from Wyoming.
Mr. BARRASSO. Mr. President, my amendment protects families and
protects small businesses from dramatic increases in insurance
premiums. My amendment directs the Department of Health and Human
Services to certify that insurance premiums will not rise faster under
the new health care law than they would have if the law had not been
passed. If they find that premiums are higher, then the new law would
sunset.
This month in Pennsylvania, the President said the Senate bill would
reduce most people's premiums. I say to my friends on the other side of
the aisle, if you believe the President and you believe that this bill
lowers premiums, prove it. Vote for this amendment.
This is a reasonable, straightforward amendment. It holds the
President and it holds the Members of Congress accountable to the
American people for promises made.
Thank you, Mr. President.
Mr. BAUCUS. Mr. President, all things being equal, I choose to
believe the President. Second, I choose to believe the Congressional
Budget Office. The Congressional Budget Office has concluded that
premiums under this legislation will, all things equal, be reduced for
big business as much as 3 percent. Small businesses will see a decrease
of 11 percent if you factor in the small business tax credits for
coverage. Individuals who receive tax credits in the exchange will find
a 57-percent reduction in premiums; again, all things being equal.
Will someone find an increase in premium? Somebody might buy a very
expensive health insurance policy. Maybe that person's premiums might
go up.
Obviously, this is designed to kill the bill, and I strongly urge my
colleagues not to support it. It prevents passage of the bill. It
undermines the bill. It repeals the bill, in effect, that has already
been signed by the President.
So I move that this amendment be tabled, and I ask for the yeas and
nays.
The PRESIDING OFFICER. Is there a sufficient second? There is a
sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from Delaware (Mr. Kaufman)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 57, nays 41, as follows:

[Rollcall Vote No. 68 Leg.]

YEAS--57

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--41

Alexander
Barrasso
Bayh
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--2

Isakson
Kaufman

The motion was agreed to.
Mr. BAUCUS. I move to reconsider the vote.
Mr. LEAHY. I move to lay that motion on the table.

[[Page S1996]]

The motion to lay on the table was agreed to.

Amendment No. 3564

The PRESIDING OFFICER. Under the previous order, there will be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 3564, offered by the Senator from Iowa, Mr. Grassley.
The Senator from Iowa.
Mr. GRASSLEY. Mr. President, my amendment would require the
President, the Vice President, Cabinet members, and White House staff
to use exchanges created in this bill. It would also fix a loophole so
that the committee and leadership staff are also required to obtain
coverage in these exchanges.
Today, after seeing my amendment, the White House announced that
President Obama will voluntarily participate in the health insurance
exchange that starts in 2014.
This is a little presumptuous since he has another election before
2014, but it is still effectively an endorsement of my amendment to
make sure that political leaders live under the laws they pass for
everyone else. But the principle should not be voluntary for political
leaders. Congress and President Clinton confirmed that in 1995 by
enacting the Congressional Accountability Act that Senator Lieberman
and I sponsored. It is a matter of not having a double standard.
I urge my colleagues to support my amendment and make sure we are
living under the same laws.
The PRESIDING OFFICER. The time of the Senator has expired.
The Senator from Montana.
Mr. BAUCUS. Mr. President, I could be mistaken, but it is my
understanding that the underlying amendment, which also includes
Members of Congress in the exchange, is language that was drafted on a
bipartisan basis in the HELP Committee. I don't see Senator Dodd here.
It is an amendment Senator Coburn worked on and was agreed to in the
HELP Committee. It covered Members of Congress and who all should be
included.
Frankly, I don't think it is wise at this point to try to negotiate
who should additionally be covered in the exchanges and who should not.
It was agreed to before. I say to my good friend from Iowa--he has been
my very good friend--I don't think it is intended to embarrass the
President and the executive branch people, but I think it is
inappropriate.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. BAUCUS. I say to my friend, he can be happy when Northern Iowa
beats Michigan State this Friday. It will make him happy.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. BAUCUS. I make a point of order that the pending amendment
violates section 313(b)(1)(C) of the Congressional Budget Act of 1974.
Mr. GRASSLEY. Mr. President, pursuant to section 904(c) of the
Congressional Budget Act of 1974, I move to waive section 313 of the
Budget Act for the consideration of the pending amendment.
Mr. BAUCUS. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 43, nays 56, as follows:

[Rollcall Vote No. 69 Leg.]

YEAS--43

Alexander
Barrasso
Bayh
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NAYS--56

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NOT VOTING--1

Isakson

The PRESIDING OFFICER. On this vote, the yeas are 43, the nays are
56. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected.
The point of order is sustained, and the amendment falls.

Alexander Motion to Commit

The PRESIDING OFFICER. Under the previous order, we will have 2
minutes of debate equally divided prior to a vote on the motion to
commit offered by the Senator from Tennessee, Mr. Alexander.
The Senator from Tennessee.
Mr. ALEXANDER. Mr. President, this is an effort to stop the Federal
Government from overcharging 19 million college students to help pay
for the health care bill. It would reduce from 6.8 percent to 5.3
percent the interest on their loans. It would save $1,700 to $1,800 on
the average of a $25,000 loan over 10 years.
Why are we talking student loans during a health care bill? Because
we can't trust the other side with the Yellow Pages. If they find it in
there, they think the government ought to be doing it. They have taken
over the Federal student loan program, and they are running up the debt
$\1/2\ trillion to do it. They are firing 31,000 people by July 1. They
are going to borrow money at 2.8 percent and loan it to students at 6.8
percent and use the rest to help pay for health care and for the
government. CBO has said this is $8.7 billion of overcharging students
to pay for health care. So a ``yes'' means don't overcharge.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. ALEXANDER. A ``no'' means savings to students.
Mr. HARKIN. The last time we took up higher education, in 2007, we
lowered interest rates on student loans and crafted the interest-based
repayment program. In this bill, we lower that down even more--from 15
percent to 10 percent--and we make a historic investment in Pell
grants.
I would agree, I am all for lowering interest rates. I would just
note that my friend from Tennessee didn't take to the floor to complain
when Sallie Mae was charging over 20 percent interest on its loans to
students. I didn't see that.
This amendment is not about lowering interest rates. What it is about
is continuing a $61 billion subsidy to the big banks in this country.
We take that money and give it to students in Pell grants.
Mr. President, I move to table the motion to commit, and I ask for
the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There is a
sufficient second.
The question is on the motion.
The clerk will call the roll.
The bill clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 58, nays 41, as follows:

[Rollcall Vote No. 70 Leg.]

YEAS--58

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer

[[Page S1997]]

Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--41

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--1

Isakson

The motion was agreed to.

Amendment No. 3586

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes equally divided prior to a vote in relation to amendment No.
3586 offered by the Senator from Florida, Mr. LeMieux.
The Senator from Florida is recognized.
Mr. LeMIEUX. Mr. President, I have heard my friends on the other side
of the aisle talk about 30 million new people in America having health
care. What they are not talking about is 16 million of those folks are
going into Medicaid. Medicaid is a program that doesn't work. Forty
percent of physicians according to MedPac no longer will see Medicaid
patients. Pharmacies will not fill prescriptions. You cannot find a
specialist.
I have also heard our friends on the other side of the aisle come to
the Senate floor and say the people of America should have the same
great health care that we have in this body. The corollary should be
true as well. We should have the same health care that we are willing
to put 16 million new Americans in and 50 million Americans in total.
We should all be on Medicaid.
My amendment says 535 Members of Congress, as well as the Vice
President of the United States, will go into Medicaid. If it is good
enough for them, it should be good enough for us. We talk the talk
around here a lot, now let's see if we will walk the walk.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I don't think this is really a serious
amendment that requires all Members of Congress to withdraw from their
Federal health insurance plan, and it requires all Members of Congress
to be in Medicaid. Medicaid is a safety net for vulnerable Americans.
It should not be the subject for political gamesmanship like this
amendment. It is a slap in the face of vulnerable, poor Americans.
Ironically, this killer amendment will have the effect of reducing
payments to States which are in the underlying bill. It would take that
away. I don't think that is the intent of the author of the amendment.
Mr. President, I make a point of order the pending amendment violates
section 313(b)(1)(C) of the Congressional Budget Act of 1974.
The PRESIDING OFFICER. The Senator from Florida.
Mr. LeMIEUX. Pursuant to section 904 of the Congressional Budget Act
of 1974 and section 4(G)(3) of the statutory pay-as-you-go act of 2010,
I move to waive all applicable sections of those acts for purposes of
my amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There is a
sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The bill clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 40, nays 59, as follows:

[Rollcall Vote No. 71 Leg.]

YEAS--40

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NAYS--59

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NOT VOTING--1

Isakson

The PRESIDING OFFICER. On this vote, the yeas are 40, the nays are
59. 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 falls.

Hatch Motion To Commit

Under the previous order, there will now be 2 minutes of debate
equally divided prior to a vote in relation to the motion to commit
offered by the Senator from Utah, Mr. Hatch.
Mr. HATCH. Mr. President, I urge my colleagues to support my motion
to commit.
Simply put, this motion protects the 11 million Medicare
beneficiaries, both seniors and the disabled, currently participating
in the Medicare Advantage program.
If the HHS actuary certifies that the Medicare Advantage cuts
included in the health reform law would result in 1 million Medicare
Advantage beneficiaries losing current health benefits, those Medicare
Advantage cuts would not go into effect.
Medicare Advantage makes a tremendous difference in the lives of
beneficiaries. They have told me over and over again how important it
is for them to have lower deductibles, premiums, and copayments.
And what a difference it makes to have dental and vision benefits.
The Medicare Advantage cuts in the health reform law would take away
those benefits. For that reason, I strongly oppose these cuts and urge
my colleagues to support my motion to commit and do the right thing for
Medicare beneficiaries, seniors and disabled individuals, across
America.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, as a motion to commit, this clearly is
designed to kill the bill. All motions to commit have that intent and
effect. Let's remind ourselves, the underlying bill protects all
Medicare beneficiaries. All statutory benefits are guaranteed in the
underlying legislation. Second, the underlying bill reforms Medicare
Advantage which rewards high performance Medicare Advantage programs,
those providing value, whereas under current law that is not the case.
In addition, if this amendment passes, fee-for-service Medicare
beneficiaries would have to pay a $90-a-year penalty to pay for the
excess subsidy of Medicare Advantage plans. For lots of reasons, this
motion should not prevail.
I move to table the motion to commit and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion to table the motion to
commit.
The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 56, nays 42, as follows:

[Rollcall Vote No. 72 Leg.]

YEAS--56

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry

[[Page S1998]]

Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Whitehouse
Wyden

NAYS--42

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Webb
Wicker

NOT VOTING--2

Byrd
Isakson

The motion was agreed to.

Amendment No. 3556

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 3556, offered by the Senator from Oklahoma, Mr. Coburn.
The Senator from Oklahoma.
Mr. COBURN. Mr. President, this amendment saves $6.5 billion over the
next 10 years for what it does on fraudulent Medicaid prescriptions--
$6.5 billion--$650 million a year on fraudulent prescriptions. It also
creates a prohibition so that erectile dysfunction drugs are not paid
for by the American taxpayers to convicted rapists, those convicted of
sexual assault, and pedophiles in this country.
You can say a lot of things about a lot of amendments. This is not a
game amendment; it actually saves money. All the States are struggling
with Medicaid. This is a way to spread $650 million a year to the
States.
I reserve the remainder of my time.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, this legislation is about filling the
doughnut hole for seniors. It is about providing health care for
working families, for children. It is about reducing our national debt.
It is a serious bill. It deserves serious debate.
The amendment offered by the Senator from Oklahoma makes a mockery of
this Senate, the debate, and the American people. It is not a serious
amendment. It is a crass political stunt aimed at making 30-second
commercials, not public policy.
I urge my colleagues to oppose the amendment.
I move to table the amendment, and ask for the yeas and nays.
Mr. COBURN. Mr. President, do I have time remaining?
The PRESIDING OFFICER. The Senator from Oklahoma still has time.
The Senator from Oklahoma.
Mr. COBURN. I would make the following point: The vast majority of
Americans do not want their taxpayer dollars paying for this kind of
drug for those kind of people.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I move to table the amendment, and ask for
the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 57, nays 42, as follows:

[Rollcall Vote No. 73 Leg.]

YEAS--57

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--42

Alexander
Barrasso
Bayh
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--1

Isakson

The motion was agreed to.
Mr. CARDIN. Mr. President, I move to reconsider the vote, and I move
to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3608

The PRESIDING OFFICER. Under the previous order, there will be 2
minutes of debate, equally divided, prior to a vote in relation to
amendment No. 3608 offered by the Senator from Texas, Mrs. Hutchison.
Mrs. HUTCHISON. Mr. President, we are hearing from State leaders all
over our country begging Congress to abandon this bill that is an
unconstitutional preemption of States rights, State innovation, and
State prerogatives. Thirteen States have already filed suit against
this bill.
My amendment would restore the 10th amendment rights reserved to the
States by allowing State legislatures to pass legislation to allow them
to opt out of this bill, opt out of the job-killing taxes, opt out of
the cuts to Medicare, opt out of the unfunded Medicaid mandates, when
our States are hurting already. They are not balancing their budgets
right now. This is going to make it worse.
This is an easy ``yes'' vote, and I hope our colleagues will help our
States to opt out of this bill if they choose.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, this is another in a long series of killer
amendments. Clearly, allowing States to opt out of any or all
provisions of the underlying health care reform bill would have that
result. States could decide not to abide by health care market reforms,
preexisting conditions, provisions against rescissions, et cetera.
States could decide not to provide health care coverage to their
citizens. One State versus the national program. States could decide
they are not going to pay the fees, enact the fees that are required on
State pharmaceuticals or insurance industries. States could make all
kinds of decisions which basically would have the effect of killing
this bill.
So I urge my colleagues to not support the amendment of the Senator
from Texas.
I move to table the amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There is a
sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 58, nays 41, as follows:

[Rollcall Vote No. 74 Leg.]

YEAS--58

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--41

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi

[[Page S1999]]

Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--1

Isakson

The motion was agreed to.
Mr. INOUYE. I move to reconsider the vote.
Mrs. MURRAY. I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3638

The PRESIDING OFFICER. There will now be 2 minutes of debate prior to
a vote in relation to amendment No. 3638, offered by the Senator from
Maine, Ms. Collins.
The Senator from Maine.
Ms. COLLINS. Mr. President, just last week we passed the HIRE Act,
which included a tax credit offered by Senator Schumer and Senator
Hatch to encourage companies to hire unemployed workers. It makes no
sense for any of us to have voted for that bill and then not to support
the amendment that I have offered.
The amendment I am offering would waive the onerous fines that are in
this bill for small businesses that hire unemployed workers. If you
voted for the HIRE Act giving a tax credit, why in the world would you
support a policy of imposing penalties on businesses that hire
unemployed workers?
Mr. President, I urge support of the amendment.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, this amendment basically has the intent of
creating a group of second-class employees. It is very similar to the
issue of subminimum wage. It makes all the sense in the world to
distinguish the two, between the HIRE Act and this amendment.
The HIRE Act gave incentives for firms to hire new employees. This
amendment creates a group of second-class employees. It says you can
hire employees so long as they do not have health insurance. I think
that is wrong. I do not think we should have a second class of
employees, which is the effect of the amendment. I urge it be defeated.
I move to table the amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER (Mr. Casey). Are there any other Senators in
the Chamber desiring to vote?
The result was announced--yeas 58, nays 41, as follows:

[Rollcall Vote No. 75 Leg.]

YEAS--58

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Byrd
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--41

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--1

Isakson

The motion was agreed to.
Mrs. MURRAY. I move to reconsider the vote.
Mr. LEVIN. I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3639

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 3639, offered by the Senator from South Dakota, Mr.
Thune.
Mr. THUNE. Mr. President, this amendment gets at the issue of the
student loan program and what this bill would propose to do to that
program.
Under this bill, students in this country would have one option to
get a student loan--the Federal Government. Today, there are 2,000
lenders across this country that make student loans. A recent article
in the Wall Street Journal pointed out that the shift to government
lending would mean lending would now be operated by the Department of
Education, which is ``distinguished in its Soviet-style customer
service.''
There are 30,000 to 35,000 jobs in this country that are associated
with the student loan program. At a time of record-high unemployment
levels, we need to ensure that moving student lending to the Department
of Education does not place more Americans on unemployment. As our
economy recovers, we should be focused on ways to increase jobs in the
private sector, not ending those positions in favor of adding more
government bureaucrats in Washington.
This amendment would require the Secretary of Education to certify
that no State would experience a net job loss as a result of the
Federal Family Education Student Loan Program being terminated.
I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
Mrs. MURRAY. I move to table.
The PRESIDING OFFICER. A motion to table is not in order.
There is not a sufficient second at this time.
The Senator from Iowa.
Mr. HARKIN. Mr. President, this amendment is not about protecting
jobs, because the bill already does that. We carve out a role for
nonprofit lenders to service loans. We provided $50 million in this
bill to incentivize companies--private companies, too--to keep jobs in
the same towns and cities where they are now. Private lenders will
continue to service the $450 billion in outstanding private loan
volume.
Let me say this also about Sallie Mae. They took a couple thousand
jobs out of this country. Guess what. They are bringing them back
because they get to service the loans. Under Treasury rules, in order
for them to service the loans, it has to be done in this country. So
Sallie Mae is bringing jobs back to America.
This amendment is not about protecting jobs. It is about killing the
bill and leaving the subsidies to the big banks, where they are today.
I move to table the amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 55, nays 43, as follows:

[Rollcall Vote No. 76 Leg.]

YEAS--55

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

[[Page S2000]]

NAYS--43

Alexander
Barrasso
Bayh
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Nelson (FL)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--2

Byrd
Isakson

The motion was agreed to.

Amendment No. 3640

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate, equally divided, prior to a vote in relation to
amendment No. 3640, offered by the Senator from South Dakota, Mr.
Thune.
Mr. THUNE. Mr. President, this amendment would strike the CLASS Act
from the bill. The CLASS Act, as we all know, is a new entitlement
program. We have two entitlement programs that are already destined to
be bankrupt that have unfunded liabilities in the neighborhood of $60
trillion. It does not make a lot of sense to add a third one.
Here is what everybody said about this. One of our Democratic
colleagues has called the CLASS Act ``a Ponzi scheme of the first
order, the kind of thing that Bernie Madoff would be proud of.''
Even the Washington Post described it as a ``gimmick . . . designed
to pretend that health care is fully paid for.''
The administration's Chief Actuary said ``there is a significant risk
of failure, there is a significant risk that the problem of adverse
selection would make the CLASS program unsustainable,'' and the CBO
said the additional deficit increases would amount to ``the order of
tens of billions of dollars for each 10-year period'' after 2029.
We know what this is. This is a gimmick. It is a budgetary gimmick
used to make this bill look like it is paid for when it is not. We
ought to strike it from the bill, and I hope my colleagues will support
this amendment.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. HARKIN. Mr. President, the CLASS Act is a voluntary, self-funded
insurance program, with enrollment for people who are presently
employed. There are no taxpayer dollars involved whatsoever.
The statement that the Senator referred to was made before we made
sure it was paid for. It is all paid for. In fact, the Senator from New
Hampshire in our committee offered an amendment that made sure it was
fully funded for 75 years. The Congressional Budget Office has
certified this will be solvent for 75 years. Plus, it will save
taxpayers money.
By letting people put some money aside, so if they become disabled
they can stay at home rather than going to a nursing home, we save
Medicaid dollars. This saves taxpayer dollars from paying more into
Medicaid in the future.
Mr. President, I raise a point of order that the Thune amendment
violates section 310(D)(2) of the Congressional Budget Act.
The PRESIDING OFFICER. The Senator from South Dakota.
Mr. THUNE. Mr. President, pursuant to section 904 of the
Congressional Budget Act of 1974 and section 4(G)(3) of the statutory
Pay-As-You-Go Act of 2010, I move to waive all applicable sections of
those acts and applicable budget resolutions for purposes of my
amendment and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There is a
sufficient second.
The question is on agreeing to the motion. The clerk will call the
roll.
The assistant legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 43, nays 55, as follows:

[Rollcall Vote No. 77 Leg.]

YEAS--43

Alexander
Barrasso
Bayh
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lieberman
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NAYS--55

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NOT VOTING--2

Byrd
Isakson
The PRESIDING OFFICER. On this vote, the yeas are 43, the nays are
55. 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 falls.

Cornyn Motion To Commit

Under the previous order, there will now be 2 minutes of debate
equally divided prior to a vote in relation to the motion to commit
offered by the Senator from Texas, Mr. Cornyn.
The Senator from Texas.
Mr. CORNYN. Mr. President, mine is a motion to commit the
reconciliation bill back to the Finance Committee to report the bill
back without the brandnew, whopping 3.8 percent tax on investment and
savings. This is a $123 billion mistake. It will discourage savings and
investment and decrease the standard of living for millions of
Americans. Simply put, increasing taxes on investment income and
savings income is a job killer. It is just one of many job-killing
provisions of this bill, $100 billion of new taxes and fees on health
care consumers, an employer mandate that will kill jobs.
My motion will also make sure the bill does not break another one of
the President's promises when he pledged that everyone in America will
pay lower taxes than they would under the rates Bill Clinton had in the
1990s.
I ask my colleagues for their support.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, this is an honest, straightforward
amendment which is concerned about people making more than $200,000.
The effect of some amendments prior to this moment have been trying to
protect people making less than $200,000. This amendment is the exact
opposite; it is only concerned about people making more than $200,000
in income.
The bill itself also provides that people whose investment income is
above $200,000 should contribute to the Medicare trust fund. Currently,
they do not. Only taxes on wages contribute to the Medicare trust fund.
The thought is that people with unearned income should also contribute.
This tax only applies to those who make above $200,000. There is a
passthrough exemption, subchapter S. Other passthroughs are exempted.
Retirement income is exempted. It doesn't make sense that people making
over $200,000 should be exempt.
I move to table the motion to commit and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion to table the motion to
commit.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 52, nays 46, as follows:

[[Page S2001]]

[Rollcall Vote No. 78 Leg.]

YEAS--52

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Mikulski
Murray
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--46

Alexander
Barrasso
Bayh
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Cantwell
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Nelson (FL)
Pryor
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--2

Byrd
Isakson

The motion was agreed to.
Mr. DURBIN. I move to reconsider the vote.
Mr. REID. I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3579

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate, equally divided, prior to a vote in relation to
amendment No. 3579, offered by the Senator from Kansas, Mr. Roberts.
The Senator from Kansas.
Mr. ROBERTS. Mr. President, included in the new taxes in this health
reform is a tax hike of $20 billion on medical devices. The nonpartisan
Congressional Budget Office and Joint Committee on Taxation both
confirmed these excise taxes will not--will not--be borne by the
medical device industry but, instead, are passed on to patients in the
form of higher prices and higher insurance premiums.
Who are these folks who will bear the burden of this new tax? People
with disabilities, diabetics, amputees, people with cancer, just to
name some of the people--and more--who will see their costs go up
because of this tax. We do not want to do this. Why should we want to
do this on those who are most vulnerable?
This amendment would prevent this new tax from raising the already
high costs for this group and a tax that will stifle the Medicaid
device technology and innovation of this country.
I urge my colleagues to support this amendment. It is offset by an
amendment similar to that offered by Senator Schumer in the Finance
Committee so it must be bipartisan.
The PRESIDING OFFICER. The Senator's time has expired.
The Senator from Montana.
Mr. BAUCUS. Mr. President, how have Kansas and Kansas State done
lately?
This is a very simple amendment. This health care bill is premised on
the assumption that all groups should participate in finding the
correct health care solution for our health care system. That includes
hospitals, pharmaceuticals, and it also includes device manufacturers.
This amendment would exclude one section: device manufacturers.
How is it paid for? It is paid for by reducing the number of people
who would otherwise get tax credits to help pay for their health
insurance. I do not think that is what we want to do. We do not want to
reduce the number of people who have health insurance. This amendment
would reduce coverage for people who need help buying insurance.
So I move to table this amendment, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 56, nays 42, as follows:

[Rollcall Vote No. 79 Leg.]

YEAS--56

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--42

Alexander
Barrasso
Bayh
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--2

Byrd
Isakson

The motion was agreed to.
Mr. NELSON of Nebraska. Mr. President, I move to reconsider the vote,
and I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3588

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 3588 offered by the Senator from Oklahoma, Mr. Inhofe.
The Senator from Oklahoma.
Mr. INHOFE. Mr. President, we just heard from Senator Roberts about
the medical devices. I think he pointed out very clearly that there is
kind of another hidden tax in this legislation of some $20 billion on
medical devices. I think it is important to listen to what Senator
Roberts said, that it was not--it is not the device companies that will
be paying this; it will be the individuals who would be paying it.
Now, the difference between my amendment and Senator Roberts'
amendment is that mine excludes those devices for children and those
with disabilities. For example, some of our troops coming home have
lost limbs, and they have prosthetic devices. This is for them. This is
for the 8-year-old whose heart quit beating in the middle of the night
and they put a pacemaker in and it saved his life. It is for incubators
and this type of thing. It is the same thing. It is the same offset as
Senator Roberts and Senator Schumer had, and I would ask that you
seriously consider this amendment. This is for the children and those
with disabilities.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, two subjects. First, I wish to correct the
record. I mistakenly stated that the Kansas Wildcats were not in the
Sweet 16. That was an error. The Kansas State Wildcats are very much in
the Sweet 16, and my apologies to coach Frank Martin of the Wildcats. I
wish them very well in the tournament.
Mr. ROBERTS. Will the chairman yield?
Mr. BAUCUS. Well, I don't have much time, but I will do my very best.
Mr. ROBERTS. I am just so sorry that Montana lost in the first round.
Mr. BAUCUS. I would say to my good friend, he isn't nearly as sorry
as I am.
Basically, this is like the last amendment--two flaws. It exempts a
certain group from the shared responsibility in helping to finance
health care reform. The second flaw is that it reduces coverage by
changing the income threshold. This is not a way to do business.
I move to table the amendment and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There appears to
be a sufficient second.

[[Page S2002]]

The question is on agreeing to the motion.
The clerk will call the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 57, nays 41, as follows:

[Rollcall Vote No. 80 Leg.]

YEAS--57

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--41

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--2

Byrd
Isakson

The motion was agreed to.

Amendment No. 3644

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 3644, offered by the Senator from Utah, Mr. Hatch.
The Senator from Utah.
Mr. HATCH. Mr. President, there is a tax hike of $20 billion on
medical devices in this bill. These taxes are passed on to patients in
the form of higher prices and higher insurance premiums.
My amendment would prevent this new tax from raising costs or hurting
access for American soldiers and veterans by exempting medical devices
used by the TRICARE Program and the Veterans Health Program.
We need to protect our wounded warriors who rely on these medical
devices for recovery and to live a normal life.
I reserve the remainder of my time.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, this amendment is very similar to the past
two amendments we voted on. It seeks to exempt a sympathetic group of
individuals from the excise tax on medical device manufacturers. The
amendment is misplaced. We already exempt retail purchases of medical
devices, such as Band-Aids, glasses--all those kinds of items. The tax
only applies to large manufacturers. The government negotiates with the
large manufacturers. The government is large enough to exact a better
price. It does not pass that on to individuals, not on our military,
not on our vets who already receive prescribed health care coverage.
Second, this amendment is paid for by increasing the number of
uninsured. I do not think we want to increase the number of uninsured.
We want to decrease the number of uninsured.
I reserve the remainder of my 15 seconds so the Senator from Utah can
finish.
The PRESIDING OFFICER. The Senator from Utah.
Mr. HATCH. Mr. President, I feel deeply about this. I do not think we
should leave these wounded warriors without access to the best medical
devices, and I do not think we should be assessing them extra costs.
This is a simple amendment. This is one we all ought to vote for.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, very simply, this will not be passed on.
The government is a large payer. They will be able to negotiate for
better prices.
I move to table the amendment and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 54, nays 44, as follows:

[Rollcall Vote No. 81 Leg.]

YEAS--54

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Udall (CO)
Udall (NM)
Warner
Whitehouse
Wyden

NAYS--44

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hagan
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Tester
Thune
Vitter
Voinovich
Webb
Wicker

NOT VOTING--2

Byrd
Isakson

The motion was agreed to.
Mr. DURBIN. Mr. President, I move to reconsider the vote.
Mrs. MURRAY. I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3651

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 3651, offered by the Senator from New Hampshire, Mr.
Gregg.
The Senator from New Hampshire.
Mr. GREGG. Mr. President, this amendment addresses what is a core
problem we have with our health care system, which is the fact that
every year we cut our doctors' pay--those doctors who deliver Medicare
services. This year, it will be cut 21 percent. This amendment restores
that pay so that those cuts don't occur for a period of 3 years. This
is known as the doctors fix.
It should have been in the bill to begin with. The reason it wasn't
in the bill was because the other side wanted to not put it in the bill
because of its cost, because it scores at $280 billion over 10 years.
The other side didn't want to absorb that score because it would have
thrown the entire bill out of whack relative to the budget.
We have come up with a way to address this doctor problem that pays
for it for 3 years. Let's do it. Let's take care of these doctors who
are delivering these services so they can continue to deliver services
to Medicare recipients.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, the Senator from New Hampshire and I kid
each other about this. The fact is, this is another killer amendment,
and it is apparent it is designed to kill this bill. Why do I say that?
Because on October 21 of last year, the sponsor of this amendment, and
every other Senator on the other side of the aisle, voted against
invoking cloture on a bill to accomplish the very same thing they
profess to desire at this point.
Also, we have been advised by the Congressional Budget Office that it
is not paid for. According to CBO--they recently sent us a note--the
Gregg amendment would increase the deficit by $65 billion over the next
5 years.

[[Page S2003]]

We will solve the SGR problem at the appropriate time. This body will
then decide at that time the degree to which we want to pay for the
SGR. This is not the time or the place. This is a killer amendment.
According to CBO, it increases the deficit by $65 billion over the
next 5 years; therefore, I raise a point of order that the Gregg
amendment violates section 310(d)(2) of the Congressional Budget Act.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mr. GREGG. Mr. President, parliamentary inquiry: This amendment pays
for the doctors fix for 3 years, does it not?
The PRESIDING OFFICER. The Chair is unaware.
Mr. GREGG. I withdraw the inquiry.
Pursuant to section 904 of the Congressional Budget Act of 1974 and
section 4(G)(3) of the Statutory Pay-As-You-Go Act of 2010, I move to
waive all applicable sections of those acts and applicable budget
resolutions for purposes of my amendment, and I ask for the yeas and
nays.
The PRESIDING OFFICER. Is there a sufficient second? There is a
sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 42, nays 56, as follows:

[Rollcall Vote No. 82 Leg.]

YEAS--42

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NAYS--56

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NOT VOTING--2

Byrd
Isakson

The PRESIDING OFFICER. On this vote, the yeas are 42; the nays are
56. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected.
The point of order is sustained, and the amendment falls.
Mr. LEVIN. Mr. President, I move to reconsider the vote, and I move
to lay that motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3652

The PRESIDING OFFICER. There will now be 2 minutes, equally divided,
prior to a vote in relation to the amendment No. 3652, offered by the
Senator from North Carolina, Mr. Burr.
Who yields time?
Mr. BURR. Mr. President, my amendment is quite simple. In the rush to
finish this bill, there were some errors. One of the errors was
clarifying the status of some veterans programs, specifically the
TRICARE program, the VA spina bifida program--that is the children of
Agent Orange exposure from Vietnam--and the last one is the CHAMPVA
program.
What this amendment simply does is set the minimum essential coverage
as met on these programs, so the veterans' families, the children of
veterans, are not at risk of determining that their insurance does not
meet the minimum essential coverage, therefore, exposing them to fines.
Some might suggest it does not need to be fixed. The House went back
very quickly and fixed TRICARE but not CHAMPVA or spina bifida. It is
my belief we should act on that on the appropriate mechanism, which is
this fix-it bill.
The PRESIDING OFFICER. The Senator from Virginia.
Mr. WEBB. Mr. President, I would suggest to my colleague from North
Carolina and my colleagues on the other side of the aisle that if we
want to fix this problem, we can fix it right now and we should fix it
right now.
We should not allow things to be tied up in the separate melodrama of
the moment. I introduced a bill on Monday which passed the House
unanimously on Saturday to fix the TRICARE part of this. The chairman
of the Veterans' Committee introduced a bill today to fix the spina
bifida problem.
I ask unanimous consent that the Finance Committee be discharged from
further consideration of S. 3148, a bill to amend the Internal Revenue
Code to provide for the treatment of Department of Defense health
coverage as minimal essential coverage, sponsored by myself; further,
that the Senate proceed to its immediate consideration en bloc, along
with the bill introduced earlier today by Senator Akaka, S. 3162, a
bill to clarify the health care provided by the Secretary of Veterans
Affairs that constitutes minimum essential coverage; that all
Democratic Senators be added as cosponsors to this measure; that the
bills be read a third time and passed en bloc, and the motions to
reconsider be laid upon the table en bloc, with no intervening action
or debate.
The PRESIDING OFFICER. Is there objection? The Senator from Oklahoma.
Mr. COBURN. Reserving the right to object.
The PRESIDING OFFICER. The Senator from Oklahoma.
Mr. COBURN. We got this 1\1/2\ minutes ago to see the language. You
have an amendment on the floor that actually accomplishes everything
you want to do. Why are we doing this? Because you do not want to mess
up a package that is clean. It has every application, the Burr
amendment, to this.
With that, and the fact that this is exactly the kind of shenanigans
the American people do not want, I object.
Mr. WEBB. Let the American people understand, the Republicans
objected to a matter that could have been fixed by law tomorrow.
The PRESIDING OFFICER. Objection is heard.
The Senator from Hawaii.
Mr. AKAKA. Mr. President, I move that we table the Burr amendment,
and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There appears to
be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senator is necessarily absent: the Senator
from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 54, nays 44, as follows:

[Rollcall Vote No. 83 Leg.]

YEAS--54

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--44

Alexander
Barrasso
Bennett
Bond
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hagan
Hatch
Hutchison

[[Page S2004]]

Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Pryor
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--2

Byrd
Isakson

The motion was agreed to.
Mr. DURBIN. I move to reconsider the vote.
Mrs. MURRAY. I move to reconsider and to lay that motion on the
table.
The motion to lay on the table was agreed to.

Amendment No. 3553

The PRESIDING OFFICER. Under the previous order, there will now be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 3553 offered by the Senator from Louisiana, Mr. Vitter.
The Senator from Louisiana.
Mr. VITTER. Mr. President, this amendment is very straightforward. It
would repeal the ObamaCare bill. That bill is fatally flawed in terms
of its core, and we do need to repeal and replace it with a very
different, more targeted, focused, step-by-step approach. What is that
core? It is more than $\1/2\ trillion in Medicare cuts on our seniors,
which is wrong; over $\1/2\ trillion of tax increases, including on
middle-class families, which is wrong; increasing health care costs
rather than doing the opposite, decreasing them. That is what the CBO
says, nonpartisan. That will result in increased individual health care
premiums, 10 to 13 percent, and government getting even more involved
in our lives, including over 16,000 new IRS agents.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I give a prize to the Senator from
Louisiana. This is very transparent. It is very straightforward. It is
totally honest. It is not dressed up. It is not camouflaged. It is
straight repeal of health care reform.
Therefore, I move to table the amendment and ask for the yeas and
nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Georgia (Mr. Isakson) and the Senator from Missouri (Mr. Bond).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 58, nays 39, as follows:

[Rollcall Vote No. 84 Leg.]

YEAS--58

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--39

Alexander
Barrasso
Bennett
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NOT VOTING--3

Bond
Byrd
Isakson
The motion was agreed to.
Mrs. MURRAY. I move to reconsider the vote, and I move to lay that
motion on the table.
The motion to lay on the table was agreed to.

Amendment No. 3577

The PRESIDING OFFICER. There are 2 minutes now evenly divided before
a vote with respect to the Roberts amendment.
The Senator from Kansas.
Mr. ROBERTS. Mr. President, this amendment protects the rural health
care delivery system by exempting critical access hospitals from
dangerous payment cuts by the Independent Payment Advisory Board. This
board is an unelected and unaccountable body, nefarious to be sure,
with unprecedented power to set payment rates and make other Medicare
policy changes.
While most hospitals are exempt from the board's cuts by virtue of
the special deals they cut with the administration--for shame--critical
access hospitals, which are among the most vulnerable in the country,
are not exempt.
I do not know why critical access hospitals were let out of this
exemption--perhaps a drafting error; I do not know--but I can think of
no other more deserving providers than critical access hospitals
throughout our rural areas--in Montana and in Kansas--to be spared from
the Independent Payment Advisory Board's cuts. Save the rural health
care delivery system.
The PRESIDING OFFICER. The Senator's time has expired.
The Senator from Montana.
Mr. BAUCUS. Mr. President, I agree--Kansas, Montana, anywhere--
critical access hospitals should be treated the same way as other
hospitals. And when we get to that point, I say to my good friend from
Kansas, I will work with him, and I know he will with me, so we can
exempt critical access hospitals from this commission.
However, the Parliamentarian tells us it is not permissible to amend
programs subject to fast-track rules such as this commission in a
reconciliation bill. Critical access hospitals are not in. It is a
technical error, oversight--there are all kinds of reasons why it
should be in, but they are not, and I cannot, at this point, agree with
my friend to take them out now. I will at a later date, but we cannot
now.
Mr. ROBERTS. Surely, you are not going to raise a point of order?
Mr. BAUCUS. Mr. President, surely I have to do the right thing. The
right thing is to raise a point of order. I raise a point of order that
the Roberts amendment violates section 313(b)(1)(D) of the
Congressional Budget Act.
Mr. ROBERTS. Mr. President, I take it the chairman has raised the
point of order, so we are at regular order.
Mr. BAUCUS. We are, and the Senator can make his motion.
Mr. ROBERTS. I thank the Senator. Mr. President, pursuant to section
904 of the Congressional Budget Act of 1974 and section 4(g)(3) of the
statutory Pay-As-You-Go-Act of 2010, I move to waive all applicable
sections of those acts and applicable budget resolutions for purposes
of my amendment in saving rural hospitals, and I ask for the yeas and
nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
and the Senator from Maryland (Ms. Mikulski) are necessarily absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Missouri ( Mr. Bond) and the Senator from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 42, nays 54, as follows:

[Rollcall Vote No. 85 Leg.]

YEAS--42

Alexander
Barrasso
Bennett
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Webb
Wicker

[[Page S2005]]

NAYS--54

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Whitehouse
Wyden

NOT VOTING--4

Bond
Byrd
Isakson
Mikulski
The PRESIDING OFFICER (Mr. Brown of Ohio). On this vote, the yeas are
42, the nays are 54. Three-fifths of the Senators being 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 falls.
Mr. REID. Mr. President, I move to reconsider the vote.
Mr. PRYOR. I move to lay that motion on the table.
The motion to lay on the table was agreed to.

Roberts Motion to Commit

The PRESIDING OFFICER. There is now 2 minutes equally divided before
the vote with respect to the Roberts motion to commit.
The junior Senator from Kansas.
Mr. ROBERTS. Thank you, Mr. President.
This motion commits the bill back to the Finance Committee with
instructions to repeal ``the four rationers'' of health care reform.
These four horsemen of the rationing apocalypse are the Patient Center
Outcomes Research Institute, already conducting research that will be
used to deny coverage and ration care; the CMS Innovation Center, which
will grant new powers to CMS--that should be a pleasant thought by any
beleaguered hospital administrator--the U.S. Preventive Services Task
Force, which is given new powers--that is the outfit that said women
should not have mammograms until age 50--wonderful--and the Independent
Payment Advisory Board, vested with extraordinary power to set Medicare
payment rates and make policy decisions.
These rationers comprise the infrastructure for the ``Brave New
World'' of big government intrusion into health care decisions of all
Americans, and they must be repealed.
Start over. Put patient care first. Get them back in the corral.
Support the amendment.
The PRESIDING OFFICER. The Senator's time has expired.
The Senator from Montana.
Mr. BAUCUS. Mr. President, saying it doesn't make it so. It is not at
all as it has been described.
We very much in this country have to work to control health care
costs. Doctors and hospitals--especially doctors--want to practice
evidence-based medicine, even more than they do now. They want the
evidence. They want the information. They want to know which procedures
and medicine, et cetera, work better than others. These commissions
will help them get that information. Then, they make the decisions
alone, independently, with their patients as to what to do. But they
want more evidence so they can make more evidence-based decisions.
Second, I am not going to sugarcoat it. This independent advisory
board is very important to help improve quality of care and to control
costs. It does have some teeth in it. But I say to my colleagues, if we
really want to do something about health care costs in this country,
this is a start. CBO says this does score positively. I, therefore,
move to table the motion, and I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second? There appears to
be.
The question is on agreeing to the motion to table the motion to
commit.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
and the Senator from Maryland (Ms. Mikulski) are necessarily absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Missouri (Mr. Bond) and the Senator from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 59, nays 37, as follows:

[Rollcall Vote No. 86 Leg.]

YEAS--59

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Collins
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Snowe
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--37

Alexander
Barrasso
Bennett
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Risch
Roberts
Sessions
Shelby
Thune
Vitter
Voinovich
Wicker

NOT VOTING--4

Bond
Byrd
Isakson
Mikulski
The motion was agreed to.
Mr. REID. I move to reconsider the vote, and I move to lay that
motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The majority leader is recognized.
Mr. REID. Mr. President, we have finished the first tranche of
amendments and motions, some 23 in number, all of which were amendments
pending at the end of the 20 hours. I think it is time we pause for a
minute and find out where we are and where we need to go.
First of all, I congratulate the entire Senate. I think the decorum
of the Senate has been maintained in the highest standards. The debate
has been good. I especially appreciate the work of the staff, the
professionals they always are.
We have handled, as I indicated, 23 amendments and motions. Not a
single one has been adopted. All of the amendments and motions have
been offered by the minority, which is their right. The average,
according to CRS, number of amendments offered during this same type of
proceeding is 21. We are two over that now.
I want, of course, to congratulate my friend, Senator Gregg, who has
managed these budget-type proceedings on many occasions and is always a
gentleman, easy to work with. There could have been a lot of
controversy. There has been none. There has been no reading of
amendments. There has been agreement that time would be allowed to
speak on behalf of amendments.
I think, though--I am speaking to my chairs: Harkin, Baucus, Dodd,
Conrad--they agree unanimously we need to just continue. The House of
Representatives worked all weekend moving this issue along, and I think
we need to move this along and find out if they have to take any action
on this tomorrow, which is today.
I say to my colleague, my counterpart, the Republican leader, through
the Chair that I think we would like to know what the plans are. We are
not going to offer any amendments. We would like to know if there is
some indication from the Republican side as to how many more amendments
we are going to deal with this morning.
The PRESIDING OFFICER. The Republican leader is recognized.
Mr. McCONNELL. Mr. President, I say to my friend the majority leader,
I agree, I think the process has been well handled today. The top
number of amendments that have been offered on past reconciliation
bills is 53. We have offered 23.
We have had a number of discussions off the floor, I say for the
benefit of everyone in the Chamber, about some process to complete this
bill and to complete the next bill that will be brought up by the
majority after we finish this bill. I think there is a chance we might
be able to reach some agreement on the disposition of this bill and
that bill. I think we should

[[Page S2006]]

continue to discuss it. I will be happy to continue those discussions
with the majority leader. In the meantime, it strikes me we can either
continue voting tonight or we could set a reasonable time in the
morning after everybody has had a chance to get some sleep, continue
voting and discussing and see if we can't wrap up both this measure and
the next one in the not too distant future.
The PRESIDING OFFICER. The majority leader is recognized.
Mr. REID. Mr. President, my focus is on this legislation, and I know
there are other things we have to deal with before we leave, but I am
not concerned about those at this stage. I want to finish this
legislation, and I want to do that as quickly as we can.
So I would ask that we just proceed. I hope there aren't that many
more amendments, but we are here for the duration.
I would note--and I am certainly in no way trying to denigrate those
amendments that have been offered, but we have to understand that not a
single one has been adopted. I don't know what we are trying to
accomplish. We have listened intently. Most of the comments from our
side have been from the chairman of the Finance Committee because most
of these issues deal with the jurisdiction he has. But it is very clear
there is no attempt to improve the bill. There is an attempt to destroy
this bill.
We already have a law in place. It is the bill that we passed on
Christmas Eve 2009. That is the law of this land. This is a matter to
improve that, and I have to suggest that we are going to continue down
this road. I am not sure it is a good picture for the American people,
to have all these amendments and not a single one of them having enough
votes to pass, but that judgment is not mine. We are here to try to
move this along.
The House of Representatives is waiting for us to act, as we speak. I
think they have proven they are willing to work hard, as indicated this
past weekend and over the last several weeks. So let's continue forward
in the same spirit we have gotten this far. But I would hope that my
friends understand I think it would be to the benefit of most everyone
if we could get out of here at a decent hour today. If it is not, if we
are going to keep going, that is the way it is. I am an old marathoner,
and getting older every day.
The PRESIDING OFFICER. The Republican leader is recognized.
Mr. McCONNELL. I would just add that there are some obvious
disadvantages to the minority to be in a reconciliation contest, but
one of the advantages is that we have had more amendment votes today
than we had in the entire month of December on the previous health care
bill. So the majority leader may not think we are serious about
changing the bill, but we would like to change the bill. And with a
little help from our friends on the other side, we could improve this
bill significantly.
But rather than subject all of our Members to listening to the
majority leader and myself go back and forth, I would simply suggest it
might be a better use of his and my time for us to continue the
discussions we have been having off the floor, continue to offer the
amendments, and see if we can reach an accommodation that satisfies
both sides. Maybe the best way to do that would be for Senator Reid and
myself to continue our discussions while we will keep voting, if that
is what the majority would like.
The PRESIDING OFFICER. The junior Senator from Kentucky is
recognized.

Amendment No. 3681

Mr. BUNNING. Mr. President, I would like to call up Bunning amendment
No. 3681.
The PRESIDING OFFICER. The clerk will report the amendment.
The bill clerk read as follows:

The Senator from Kentucky [Mr. Bunning] proposes an
amendment numbered 3681.

Mr. BUNNING. Mr. President, I ask unanimous consent to dispense with
the reading of the amendment.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To allow individuals to elect to opt out of the Medicare part
A benefits)

At the end of subtitle B of title I, add the following:

SEC. __. ALLOWING INDIVIDUALS TO ELECT TO OPT OUT OF THE
MEDICARE PART A BENEFIT.

Notwithstanding any other provision of law, in the case of
an individual who elects to opt out of benefits under part A
of title XVIII of the Social Security Act, such individual
shall not be required to--
(1) opt out of benefits under title II of such Act as a
condition for making such election; and
(2) repay any amount paid under such part A for items and
services furnished prior to making such election.

The PRESIDING OFFICER. The Senator has 1 minute.
Mr. BUNNING. Mr. President, I rise to offer a very important
amendment to many of our seniors. My amendment would allow individuals
to voluntarily opt out of Medicare Part A benefits. Right now, if you
don't want to have Medicare Part A, you have to forego Social Security
checks and you also have to repay any Medicare benefits that have been
paid on your behalf. I don't think that is fair.
If a senior doesn't want Part A, they shouldn't be forced to take it.
My amendment says that anyone who opts out of Part A will not have to
give up their Social Security benefits and would not have to repay
Medicare payments that have already been made on their behalf. This
amendment does not allow anyone to opt out of paying their Medicare
taxes. Instead, it just allows them to not take Medicare benefits
without being penalized.
I think this is a fairness issue, and I hope Members can support it.
The PRESIDING OFFICER. The time has expired.
The senior Senator from Montana is recognized.
Mr. BAUCUS. Mr. President, since 1965, Medicare has provided security
and health to millions of seniors. Along with Social Security, it is
one of the two most successful and best social programs this country
has adopted. Now, after 45 years of success, what does this amendment
seek to do? It seeks to undermine the foundation of our social
insurance program.
It is a two-tiered system. The wealthy can take care of themselves.
Then, when they leave Medicare, it leaves a second-class seniors health
care system remaining in Medicare. It is unthinkable, frankly, that we
would have a two-tiered system for our seniors under Medicare. I
therefore move to table the Bunning amendment, and I ask for the yeas
and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The assistant legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
is necessarily absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Missouri (Mr. Bond) and the Senator from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 61, nays 36, as follows:

[Rollcall Vote No. 87 Leg.]

YEAS--61

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Collins
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Lautenberg
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Snowe
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Voinovich
Warner
Webb
Whitehouse
Wyden

NAYS--36

Alexander
Barrasso
Bennett
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Risch
Roberts
Sessions
Shelby
Thune
Vitter
Wicker

NOT VOTING--3

Bond
Byrd
Isakson
The motion was agreed to.

[[Page S2007]]

Mr. CONRAD. Mr. President, I move to reconsider the vote, and I move
to lay that motion on the table.

Amendment No. 3699

Mr. GRASSLEY. I send an amendment to the desk and ask for its
consideration.
The PRESIDING OFFICER. The clerk will report.
The assistant legislative clerk read as follows:

The Senator from Iowa [Mr. Grassley], proposes an amendment
numbered 3699.

Mr. GRASSLEY. I ask unanimous consent that reading of the amendment
be dispensed with.
Mr. BAUCUS. Mr. President, I object. I object.
The PRESIDING OFFICER. The Senator from Montana objects.
The assistant legislative clerk continued with the reading of the
amendment.
Mr. BAUCUS. Mr. President, I ask unanimous consent that further
reading of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide a temporary extension of certain programs)

At the end of the bill, insert:

TITLE III--TEMPORARY EXTENSION OF CERTAIN PROGRAMS

SEC. 300. SHORT TITLE.

This title may be cited as the ``Continuing Extension Act
of 2010''.

SEC. 301. EXTENSION OF UNEMPLOYMENT INSURANCE PROVISIONS.

(a) In General.--(1) Section 4007 of the Supplemental
Appropriations Act, 2008 (Public Law 110-252; 26 U.S.C. 3304
note) is amended--
(A) by striking ``April 5, 2010'' each place it appears and
inserting ``May 5, 2010'';
(B) in the heading for subsection (b)(2), by striking
``april 5, 2010'' and inserting ``may 5, 2010''; and
(C) in subsection (b)(3), by striking ``September 4, 2010''
and inserting ``October 2, 2010''.
(2) Section 2002(e) of the Assistance for Unemployed
Workers and Struggling Families Act, as contained in Public
Law 111-5 (26 U.S.C. 3304 note; 123 Stat. 438), is amended--
(A) in paragraph (1)(B), by striking ``April 5, 2010'' and
inserting ``May 5, 2010'';
(B) in the heading for paragraph (2), by striking ``april
5, 2010'' and inserting ``may 5, 2010''; and
(C) in paragraph (3), by striking ``October 5, 2010'' and
inserting ``November 5, 2010''.
(3) Section 2005 of the Assistance for Unemployed Workers
and Struggling Families Act, as contained in Public Law 111-5
(26 U.S.C. 3304 note; 123 Stat. 444), is amended--
(A) by striking ``April 5, 2010'' each place it appears and
inserting ``May 5, 2010''; and
(B) in subsection (c), by striking ``September 4, 2010''
and inserting ``October 2, 2010''.
(4) Section 5 of the Unemployment Compensation Extension
Act of 2008 (Public Law 110-449; 26 U.S.C. 3304 note) is
amended by striking ``September 4, 2010'' and inserting
``October 2, 2010''.
(b) Funding.--Section 4004(e)(1) of the Supplemental
Appropriations Act, 2008 (Public Law 110-252; 26 U.S.C. 3304
note) is amended--
(1) in subparagraph (C), by striking ``and'' at the end;
(2) by inserting after subparagraph (D) the following new
subparagraph:
``(E) the amendments made by section 2(a)(1) of the
Continuing Extension Act of 2010; and''.
(c) Effective Date.--The amendments made by this section
shall take effect as if included in the amendments made by
section 2 of the Temporary Extension Act of 2010 (Public Law
111-144).

SEC. 302. EXTENSION AND IMPROVEMENT OF PREMIUM ASSISTANCE FOR
COBRA BENEFITS.

Subsection (a)(3)(A) of section 3001 of division B of the
American Recovery and Reinvestment Act of 2009 (Public Law
111-5), as amended by section 3(a) of the Temporary Extension
Act of 2010 (Public Law 111-144), is amended by striking
``March 31, 2010'' and inserting ``April 30, 2010''.

SEC. 303. INCREASE IN THE MEDICARE PHYSICIAN PAYMENT UPDATE.

Paragraph (10) of section 1848(d) of the Social Security
Act, as added by section 1011(a) of the Department of Defense
Appropriations Act, 2010 (Public Law 111-118) and as amended
by section 5 of the Temporary Extension Act of 2010 (Public
Law 111-144), is amended--
(1) in subparagraph (A), by striking ``March 31, 2010'' and
inserting ``April 30, 2010''; and
(2) in subparagraph (B), by striking ``April 1, 2010'' and
inserting ``May 1, 2010''.

SEC. 304. EHR CLARIFICATION.

(a) Qualification for Clinic-Based Physicians.--
(1) Medicare.--Section 1848(o)(1)(C)(ii) of the Social
Security Act (42 U.S.C. 1395w-4(o)(1)(C)(ii)) is amended by
striking ``setting (whether inpatient or outpatient)'' and
inserting ``inpatient or emergency room setting''.
(2) Medicaid.--Section 1903(t)(3)(D) of the Social Security
Act (42 U.S.C. 1396b(t)(3)(D)) is amended by striking
``setting (whether inpatient or outpatient)'' and inserting
``inpatient or emergency room setting''.
(b) Effective Date.--The amendments made by subsection (a)
shall be effective as if included in the enactment of the
HITECH Act (included in the American Recovery and
Reinvestment Act of 2009 (Public Law 111-5)).
(c) Implementation.--Notwithstanding any other provision of
law, the Secretary of Health and Human Services may implement
the amendments made by this section by program instruction or
otherwise.

SEC. 305. ELIMINATION OF A SWEETHEART DEAL THAT INCREASES
MEDICARE REIMBURSEMENT JUST FOR FRONTIER
STATES.

Effective as if included in the enactment of the Patient
Protection and Affordable Care Act, section 10324 of such Act
(and the amendments made by such section) is repealed.

SEC. 306. EXTENSION OF USE OF 2009 POVERTY GUIDELINES.

Section 1012 of the Department of Defense Appropriations
Act, 2010 (Public Law 111-118), as amended by section 7 of
the Temporary Extension Act of 2010 (Public Law 111-144), is
amended by striking ``March 31, 2010'' and inserting ``April
30, 2010''.

SEC. 307. EXTENSION OF NATIONAL FLOOD INSURANCE PROGRAM.

(a) Extension.--Section 129 of the Continuing
Appropriations Resolution, 2010 (Public Law 111-68), as
amended by section 8 of Public Law 111-144, is amended by
striking ``by substituting'' and all that follows through the
period at the end and inserting ``by substituting April 30,
2010, for the date specified in each such section.''.
(b) Effective Date.--The amendments made by subsection (a)
shall be considered to have taken effect on February 28,
2010.

SEC. 308. SATELLITE TELEVISION EXTENSION.

(a) Amendments to Section 119 of Title 17, United States
Code.--
(1) In general.--Section 119 of title 17, United States
Code, is amended--
(A) in subsection (c)(1)(E), by striking ``March 28, 2010''
and inserting ``April 30, 2010''; and
(B) in subsection (e), by striking ``March 28, 2010'' and
inserting ``April 30, 2010''.
(2) Termination of license.--Section 1003(a)(2)(A) of
Public Law 111-118 is amended by striking ``March 28, 2010'',
and inserting ``April 30, 2010''.
(b) Amendments to Communications Act of 1934.--Section
325(b) of the Communications Act of 1934 (47 U.S.C. 325(b))
is amended--
(1) in paragraph (2)(C), by striking ``March 28, 2010'' and
inserting ``April 30, 2010''; and
(2) in paragraph (3)(C), by striking ``March 29, 2010''
each place it appears in clauses (ii) and (iii) and inserting
``May 1, 2010''.

SEC. 309. COMPENSATION AND RATIFICATION OF AUTHORITY RELATED
TO LAPSE IN HIGHWAY PROGRAMS.

(a) Compensation for Federal Employees.--Any Federal
employees furloughed as a result of the lapse in expenditure
authority from the Highway Trust Fund after 11:59 p.m. on
February 28, 2010, through March 2, 2010, shall be
compensated for the period of that lapse at their standard
rates of compensation, as determined under policies
established by the Secretary of Transportation.
(b) Ratification of Essential Actions.--All actions taken
by Federal employees, contractors, and grantees for the
purposes of maintaining the essential level of Government
operations, services, and activities to protect life and
property and to bring about orderly termination of Government
functions during the lapse in expenditure authority from the
Highway Trust Fund after 11:59 p.m. on February 28, 2010,
through March 2, 2010, are hereby ratified and approved if
otherwise in accord with the provisions of the Continuing
Appropriations Resolution, 2010 (division B of Public Law
111-68).
(c) Funding.--Funds used by the Secretary to compensate
employees described in subsection (a) shall be derived from
funds previously authorized out of the Highway Trust Fund and
made available or limited to the Department of Transportation
by the Consolidated Appropriations Act, 2010 (Public Law 111-
117) and shall be subject to the obligation limitations
established in such Act.
(d) Expenditures From Highway Trust Fund.--To permit
expenditures from the Highway Trust Fund to effectuate the
purposes of this section, this section shall be deemed to be
a section of the Continuing Appropriations Resolution, 2010
(division B of Public Law 111-68), as in effect on the date
of the enactment of the last amendment to such Resolution.

SEC. 310. USE OF STIMULUS FUNDS TO OFFSET SPENDING.

The unobligated balance of each amount appropriated or made
available under the American Recovery and Reinvestment Act of
2009 (Public Law 111-5) (other than under title X of division
A of such Act) is rescinded pro rata such that the aggregate
amount of such rescissions equals $9,200,000,000 in order to
offset the net increase in spending resulting from the
provisions of, and amendments made by, sections 2 through 10.
The Director of the Office of Management and Budget shall
report to each congressional committee the amounts so
rescinded within the jurisdiction of such committee.

SEC. 311. ELIMINATION OF ADVANCE REFUNDA-BILITY OF EARNED
INCOME CREDIT.

(a) In General.--Section 3507, subsection (g) of section
32, and paragraph (7) of section 6051(a) are repealed.

[[Page S2008]]

(b) Conforming Amendments.--
(1) Section 6012(a) is amended by striking paragraph (8)
and by redesignating paragraph (9) as paragraph (8).
(2) Section 6302 is amended by striking subsection (i).
(c) Effective Date.--The repeals and amendments made by
this section shall apply to taxable years beginning after
December 31, 2010.

The PRESIDING OFFICER. The Senator from Iowa is recognized for 1
minute.
Mr. GRASSLEY. This amendment is based largely on the extenders
package that passed the House last week. It includes a 30-day extension
for unemployment insurance, COBRA coverage, and the SGR Medicare
physicians payment fix. It includes provisions on Federal poverty
guidelines, national flood insurance, satellite television and
compensation for highway programs.
There is one very important difference between my amendment and the
House bill. My amendment is fully offset. We can do this without adding
to the deficit. I urge its passage and reserve the remainder of my
time.
The PRESIDING OFFICER. The senior Senator from Montana is recognized.
Mr. BAUCUS. Mr. President, there is discussion in progress on how to
deal with extenders that is ongoing with the majority leader and
minority leader. In fact, the minority leader referred to it when he
spoke just about a half hour ago. I think it is best to continue that
process. More important, I think, this amendment is a killer amendment
designed to send the reconciliation bill back to the House and let it
go all over again. It is paid for by repealing some stimulus dollars.
It is paid for by cutting back on the fundability of the EITC--clearly
nonstarters. I might say, too, there are other pay-fors in here that
are not going to fly, frankly.
I raise a point of order the Grassley amendment violates section
313(b)(1)(C) of the Congressional Budget Act.
Mr. GRASSLEY. Do I have time left?
The PRESIDING OFFICER. The Senator from Iowa has 20 seconds.
Mr. GRASSLEY. Yes? Mr. President, let's wake up. This has to be
passed. It has to be passed before the end. One of the problems we
always have is that it is not offset. It was included in the Baucus-
Grassley bill way back in February. The leader had the chutzpah to dump
his own chairman aside and go ahead with a partisan bill. Then the
other side complained about the Bunning filibuster, and we have an
opportunity now to avoid all that. We ought to avoid it and move on.
The PRESIDING OFFICER. The time of the Senator has expired.
Mr. BAUCUS. I raise the point of order that the Grassley amendment
violates section 313(b)(1)(C) of the Congressional Budget Act.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, pursuant to section 904 of the
Congressional Budget Act of 1974 and section 4(G)(3) of the statutory
pay-as-you-go act of 2010, I move to waive all applicable provisions of
those acts and applicable budget resolutions for purposes of my
amendment and ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There is a sufficient second. The question is on agreeing to the
motion. The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
and the Senator from New Jersey (Mr. Lautenberg) are necessarily
absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Missouri (Mr. Bond) and the Senator from Georgia (Mr. Isakson).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 40, nays 56, as follows:

[Rollcall Vote No. 88 Leg.]

YEAS--40

Alexander
Barrasso
Bennett
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Voinovich
Wicker

NAYS--56

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NOT VOTING--4

Bond
Byrd
Isakson
Lautenberg
The PRESIDING OFFICER. On this vote, the yeas are 40, the nays are
56. Three-fifths of the Senators duly chosen and sworn having not voted
in the affirmative, the motion is not agreed to, the point of order is
sustained, and the amendment falls.
Mr. REID. Mr. President, I move to reconsider the vote and lay that
motion upon the table.
The motion to lay upon the table was agreed to.
The PRESIDING OFFICER. The junior Senator from Utah is recognized.

Amendment No. 3568

Mr. BENNETT. I call up my amendment No. 3568.
The PRESIDING OFFICER. The clerk will report.
The bill clerk read as follows:

The Senator from Utah [Mr. Bennett], for himself, Mr.
Wicker, Mr. Brownback, Mr. Hatch, Mr. Roberts, Mr. Inhofe,
and Mr. Cornyn, proposes an amendment numbered 3568.

Mr. BENNETT. I ask unanimous consent that the reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To protect the democratic process and the right of the people
of the District of Columbia to define marriage)

At the end of subtitle B of title I, add the following:

SEC. ___. RIGHT OF THE PEOPLE OF THE DISTRICT OF COLUMBIA TO
DEFINE MARRIAGE.

(a) Findings.--Congress finds that--
(1) a broad coalition of residents of the District of
Columbia petitioned for an initiative in accordance with the
District of Columbia Home Rule Act to establish that ``only
marriage between a man and a woman is valid or recognized in
the District of Columbia'';
(2) this petition anticipated the Council of the District
of Columbia's passage of an Act legalizing same-sex marriage;
(3) the unelected District of Columbia Board of Elections
and Ethics and the unelected District of Columbia Superior
Court thwarted the residents' initiative effort to define
marriage democratically, holding that the initiative amounted
to discrimination prohibited by the District of Columbia
Human Rights Act; and
(4) the definition of marriage affects every person and
should be debated openly and democratically.
(b) Referendum or Initiative Requirement.--Notwithstanding
any other provision of law, including the District of
Columbia Human Rights Act, the government of the District of
Columbia shall immediately suspend the issuance of marriage
licenses to any couple of the same sex until the people of
the District of Columbia have the opportunity to hold a
referendum or initiative on the question of whether the
District of Columbia should issue same-sex marriage licenses.

Mr. BENNETT. Mr. President, with eight other cosponsors, we have
offered a bill that would allow the people of the District of Columbia
to exercise the same right that has been exercised by 31 States with
respect to the issue of whether there would be gay marriage in their
jurisdiction.
This bill does not take any position with respect to gay marriage,
simply allows the District to hold a referendum. The Home Rule Charter,
which is a constitution for the District, guarantees the people the
right to challenge acts passed by the District Council by referendum,
and the District Council has repeatedly ignored that right. It is in an
effort to restore that that we offer this amendment.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, no matter where you are on the issue of
marriage, no matter where you are on the issue of DC home rule, we
ought to be able to agree that neither issue has anything to do with
this bill, neither one. Therefore, I raise a point of order that the
amendment is not germane and thus violates section 305(b)(2) of the
Congressional Budget Act.

[[Page S2009]]

Mr. BENNETT. Pursuant to section 904 of the Congressional Budget Act
of 1974 and section 4(g)(3) of the statutory Pay-as-you-go Act of 2010,
I move to waive all applicable sections of those acts and applicable
budget resolutions for purposes of my amendment and ask for the yeas
and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be.
The question is on agreeing to the motion.
The yeas and nays have been ordered.
The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
and the Senator from New Jersey (Mr. Lautenberg) are necessarily
absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Missouri (Mr. Bond), the Senator from Georgia (Mr. Isakson), and
the Senator from Ohio (Mr. Voinovich).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 36, nays 59, as follows:

[Rollcall Vote No. 89 Leg.]

YEAS--36

Alexander
Barrasso
Bennett
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Risch
Roberts
Sessions
Shelby
Thune
Vitter
Wicker

NAYS--59

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Collins
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Snowe
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NOT VOTING--5

Bond
Byrd
Isakson
Lautenberg
Voinovich
The PRESIDING OFFICER. On this vote, the yeas 36, the nays are 59.
Three-fifths of the Senators duly chosen and sworn not having voted in
the affirmative, the motion is rejected. The point of order is
sustained, and the amendment falls.
The senior Senator from New Hampshire is recognized.
Mr. GREGG. Mr. President, just so people know, on our side the order
we are going to proceed on is that the next amendment will be by the
Senator from Idaho, followed by the Senator from Texas, followed by the
Senator from Louisiana, then the Senator from South Carolina, and then
the Senator from Oklahoma. That is the next group of five amendments.
The PRESIDING OFFICER. The junior Senator from Idaho is recognized.
Mr. RISCH. Oh, thank you so much, Mr. President.

Amendment No. 3645

I call up amendment No. 3645 and ask for its immediate consideration.
The PRESIDING OFFICER. The clerk will report the amendment.
The legislative clerk read as follows:

The Senator from Idaho [Mr. Risch], for himself, and Mr.
Crapo, proposes an amendment numbered 3645.

Mr. RISCH. Mr. President, I ask unanimous consent that reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To repeal the limitation on itemized medical expense
deductions)

At the end of subtitle E of title I, insert the following:

SECTION __. REPEAL OF LIMITATION ON ITEMIZED DEDUCTIONS FOR
MEDICAL EXPENSES.

(a) In General.--Section 9013 of the Patient Protection and
Affordable Care Act is hereby repealed effective as of the
date of the enactment of such Act and any provisions of law
amended by such section are amended to read as such
provisions would read if such section had never been enacted.
(b) Expansion of Affordability Exception to Individual
Mandate.--Section 5000A(e)(1)(A) of the Internal Revenue Code
of 1986, as added by section 1501(b) of the Patient
Protection and Affordable Care Act and amended by section
10106 of such Act, is amended by striking ``8 percent'' and
inserting ``5 percent''.
(c) Application of Provision.--The amendment made by
subsection (b) shall apply as if included in the Patient
Protection and Affordable Care Act.

The PRESIDING OFFICER. The Senator from Idaho is recognized for 1
minute.
Mr. RISCH. Thank you, Mr. President.
Fellow Senators, I cannot imagine anyone wanting to vote against this
amendment. Let me tell you what we have here. It is very simple.
Apparently, you made an error when you drafted the original bill
because what you did was you levied a tax on people who make less than
$200,000 a year. Very simply, what this amendment does is it corrects
that.
Right now, under the bill the President signed on Monday, it raised
the threshold to 10 percent from 7.5 percent at which you can deduct
medical expenses. That tax falls on the most vulnerable people in
America--mostly the elderly, mostly very low income. And it raises
taxes on 14.7 million people who make less than $200,000 a year. The
President of the United States said--he told us, he committed--he would
not raise taxes on people who make less than $200,000 a year. I am sure
he was just confused when he signed the bill on Monday.
Let's adopt this amendment and get the bill corrected.
Thank you, Mr. President. I reserve the remainder of my time.
The PRESIDING OFFICER. The Senator's time has expired.
The Senator from Montana.
Mr. BAUCUS. Mr. President, the goal of health care reform is to
increase coverage so more people have health insurance. That is the
goal of health care reform. What does this amendment do? It goes in the
opposite direction. Compared with the bill that was just signed by the
President, this amendment will cause many more people to lose health
insurance. Why? Because it lowers the income threshold from 8 percent
down to 5 percent. That is going to mean fewer Americans get tax
credits to pay for health insurance. That means fewer Americans are
going to have health insurance compared with current law. That is the
main reason we should vote against this amendment, because it expands
the number of people who are uninsured rather than expand the number of
people who would be insured.
The provision the Senator talks about, frankly, was changed under
current law because with health insurance people have less need for
that deduction and less need for catastrophic coverage because health
insurance will not pay for it.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. BAUCUS. Mr. President, I move to table the Risch amendment, and I
ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The bill clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
and the Senator from New Jersey (Mr. Lautenberg) are necessarily
absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Missouri (Mr. Bond), the Senator from Georgia (Mr. Isakson), and
the Senator from Ohio (Mr. Voinovich).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 55, nays 40, as follows:

[Rollcall Vote No. 90 Leg.]

YEAS--55

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Leahy
Levin
Lieberman
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (NE)
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester

[[Page S2010]]

Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NAYS--40

Alexander
Barrasso
Bayh
Bennett
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lincoln
Lugar
McCain
McConnell
Murkowski
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Wicker

NOT VOTING--5

Bond
Byrd
Isakson
Lautenberg
Voinovich
The motion was agreed to.
The PRESIDING OFFICER. The senior Senator from Texas.

Amendment No. 3635

Mrs. HUTCHISON. Mr. President, I call up amendment No. 3635 and ask
for its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Texas [Mrs. Hutchison] proposes an
amendment numbered 3635.

Mrs. HUTCHISON. Mr. President, I ask unanimous consent that the
reading of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To repeal the sunset on marriage penalty relief and to make
the election to deduct State and local sales taxes permanent)

At the end of subtitle F of title I, add the following:

SEC. 15__. PERMANENT TAX RELIEF PROVISIONS.

(a) Repeal of Sunset on Marriage Penalty Relief.--Title IX
of the Economic Growth and Tax Relief Reconciliation Act of
2001 (relating to sunset of provisions of such Act) shall not
apply to sections 301, 302, and 303(a) of such Act (relating
to marriage penalty relief).
(b) Permanent Extension of Election to Deduct State and
Local Sales Taxes.--Subparagraph (I) of section 164(b)(5) of
the Internal Revenue Code of 1986 is amended by striking ``,
and before January 1, 2010''.
(c) Rescission of Stimulus Funds.--Any amounts appropriated
or made available and remaining unobligated under division A
of the American Recovery and Reinvestment Act of 2009 (Public
Law 111-5; 123 Stat. 115) (other than under title X of such
division A), are hereby rescinded.

The PRESIDING OFFICER. The Senator from Texas is recognized for 1
minute.
Mrs. HUTCHISON. Mr. President, this is a very simple amendment. It
would just make relief from the marriage penalty and the sales tax
deduction permanent. If we don't act, people across our country are
going to start getting the marriage penalty tax once again. This was
corrected under previous tax law, but that is going out of existence at
the end of this year. Sales tax deduction is something that affects
eight States that do not have a State income tax. It just gives people
everywhere in America, if they have either an income tax or a sales
tax, the ability to choose what they deduct from their Federal income
taxes.
We need to make this law permanent, and I hope everyone will support
this amendment.
The PRESIDING OFFICER. The Senator's time has expired.
The Senator from Montana.
Mr. BAUCUS. Mr. President, I would remind my colleagues that the
Hutchison amendment uses as its offset rolling back the Recovery Act;
that is, rolling back stimulus funds. That is taking stimulus funds to
permanently pay for the marriage penalty relief as well as sales tax
relief.
With unemployment as high as it is, hovering around 10 percent, it
makes no sense to cut back stimulus dollars. Stimulus dollars are a
proven job creator. All mainstream economists and the CBO tell us that.
I think we should continue to create jobs by using the stimulus
dollars. I, therefore, urge my colleagues to not support the Hutchison
amendment.
In addition to that, there are funds not within the jurisdiction of
reconciled committees. For that reason, I raise a point of order that
the Hutchison amendment violates section 313(B)1(C) of the
Congressional Budget Act.
The PRESIDING OFFICER. The Senator from Texas.
Mrs. HUTCHISON. Pursuant to section 904 of the Congressional Budget
Act of 1974 and section 4(G)(3) of the Statutory Pay-As-You-Go Act of
2010, I move to waive all applicable sections of those acts and
applicable budget resolutions for purposes of my amendment, and I ask
for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
and the Senator from New Jersey (Mr. Lautenberg) are necessarily
absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Missouri (Mr. Bond), the Senator from Georgia (Mr. Isakson), and
the Senator from Ohio (Mr. Voinovich).
The PRESIDING OFFICER (Mr. Franken). Are there any other Senators in
the Chamber desiring to vote?
The yeas and nays resulted--yeas 40, nays 55, as follows:

[Rollcall Vote No. 91 Leg.]

YEAS--40

Alexander
Barrasso
Bayh
Bennett
Brown (MA)
Brownback
Bunning
Burr
Cantwell
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Wicker

NAYS--55

Akaka
Baucus
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Gregg
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

NOT VOTING--5

Bond
Byrd
Isakson
Lautenberg
Voinovich
The PRESIDING OFFICER. On this vote, the yeas are 40 and the nays are
55. Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected. The point of order is
sustained, and the amendment falls.
The Senator from Louisiana.

Amendment No. 3668

Mr. VITTER. Mr. President, I call up amendment No. 3668 and ask for
its immediate consideration.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Louisiana [Mr. Vitter] proposes an
amendment numbered 3668.

Mr. VITTER. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To increase women's access to breast cancer screenings)

At the end of subtitle F of title I, add the following:

SEC. 15__. REFUNDS OF FEDERAL MOTOR FUEL EXCISE TAXES FOR
FUEL USED IN MOBILE MAMMOGRAPHY VEHICLES.

(a) Refunds.--Section 6427 of the Internal Revenue Code of
1986 (relating to fuels not used for taxable purposes) is
amended by inserting after subsection (f) the following new
subsection:
``(g) Fuels Used in Mobile Mammography Vehicles.--Except as
provided in subsection (k), if any fuel on which tax was
imposed by section 4041 or 4081 is used in any highway
vehicle designed exclusively to provide mobile mammography
services to patients within such vehicle, the Secretary shall
pay (without interest) to the ultimate purchaser of such fuel
an amount equal to the aggregate amount of the tax imposed on
such fuel.''.
(b) Exemption From Retail Tax.--Section 4041 of such Code
is amended by adding at the end the following new subsection:
``(n) Fuels Used in Mobile Mammography Vehicles.--No tax
shall be imposed under this section on any liquid sold for
use in, or used in, any highway vehicle designed exclusively
to provide mobile mammography services to patients within
such vehicle.''.
(c) Effective Date.--The amendments made by this section
shall take effect on the date of the enactment of this Act.

[[Page S2011]]

Mr. VITTER. Mr. President, a short time ago the distinguished
majority leader urged there to be amendments to improve the bill, not
to do any harm to the broader ObamaCare bill. This is exactly such an
amendment.
This amendment would pass my Mobile Mammography Act, S. 2051. This
amendment would allow mobile mammography units to purchase fuel without
the Federal excise tax. This is exactly similar to an existing
exemption for blood centers. These units are very important to give
access to women for breast cancer screening. And this only scores $1
million, so there is no significant budget impact. This does improve
the bill. This does nothing to the underlying ObamaCare bill.

This reconciliation bill is already going back to the House, so I
urge a bipartisan vote in support of this good idea.
I reserve the remainder of my time.
The PRESIDING OFFICER. The Senator's time has expired.
Mr. VITTER. Mr. President, I ask unanimous consent to have printed in
the Record two letters relating to my amendment.
There being no objection, the material was ordered to be printed in
the Record, as follows:

LSU Health Sciences Center,

October 23, 2009.
Re Mobile Mammography Promotion Act

Hon. David Vitter: I am writing in support of the Mobile
Mammography Act which will eliminate the Federal Excise tax
on fuel for mobile mammography vehicles. At the LSU Health
Sciences Center in Shreveport, Feist-Weiller Cancer Center,
this year we have put our mobile mammography vehicle into
service. We perform free mammograms for the uninsured and
underinsured in North Louisiana. As you know this is an
expensive operation and fuel costs can be significant. Any
savings in fuel cost will allow us to reach more patients in
our service area.
Mobile Mammography is especially important in Louisiana,
which according to 2005 SEER statistics has the highest
breast cancer mortality of all the states. The rural areas in
Louisiana are particularly underserved as 40% of the parishes
in North Louisiana have no mammography facilities; and those
parishes with mammography are often unaffordable to our lower
income patients.
On behalf of the women in Louisiana. I applaud your efforts
and support for a vital resource--mobile mammography.
Sincerely,
Jerry W. McLarty, Ph.D.,
Professor of Medicine, Director,
Cancer Prevention & Control.
____

Mobile Health Clinics Network,

October 29, 2009.
Hon. David Vitter,
U.S. Senate, Hart Senate Office Building,
Washington, DC.
Dear Senator Vitter: We are writing to support for your
proposed amendment to the IRS Code of 1986 to allow refunds
of Federal motor fuel excise taxes on fuels used in Mobile
Mammography vehicles.
Most of the nearly 200 Mobile Mammography programs
throughout the U.S. are non-profits organizations; many
provide screenings for medically underserved women. In the
past year, non-profits have been struggling due to the
economic downturn, resulting in a decrease in donor dollars.
Because of the downturn, there are also more and more
Americans that need to access the services we provide, and it
is very difficult to predict when the benevolence of
Americans who can give will be restored to previous levels.
Thus, every cost savings that we can realize makes a
difference in our ability to continue the vital health
services that we offer. The change that you propose to the
tax code may be the difference between continued operations
and closing services for some programs, and with Mobile
Healthcare, our continuation gives us the opportunity to
further impact lives, and in some cases, saving lives of
Americans across the nation. We encourage the passage of this
important amendment, cited as the ``Mobile Mammography
Promotion Act of 2009''.
It is our sincere hope that the impact from this change
will be great enough to encourage you and your colleagues in
the Senate and the House to consider expanding the
application of the amendment to include all Mobile Healthcare
programs. There are approximately 2,000 Mobile Health
programs operating in the U.S., serving millions of women,
men, and children--many of whom have no other access to
affordable preventive and primary care, mammography
screenings, and oral healthcare. It is widely recognized that
Mobile Healthcare programs yield improved health outcomes for
the underserved and save the healthcare system billions of
dollars.
Mobile Health Clinics Network (MHCN) is a nationwide,
membership-based association of Mobile Health programs
primarily operated by non-profit entities such as community
health clinics, hospitals, and university schools of
medicine, nursing and dentistry. MHCN completed its Fifth
Annual Mobile Health Clinics Forum this past April, and we
are pleased to send you (under separate mail) a copy of the
official Program Binder. It will certainly offer you a view
toward the breadth and scope of Mobile Healthcare programs
that now operate in the U.S. and internationally.
On behalf of Mobile Mammography and Mobile Health clinics
across the nation, we thank you for your efforts toward
introducing the IRS amendment and for your continued
attention to making positive impacts that will support
continued operation of these unique healthcare delivery
systems. Early detection is the most effective method to
preventing and treating disease, and for Americans who rely
on Mobile Health services for these critical interventions,
this tax change could ensure many more years of access to a
healthcare system that provides potentially life-saving
services.
Sincerely,
Anthony Vavasis, MD,
Advisory Board Chair, Mobile Health Clinics Network,
Clinical Director, Health Outreach to Teens Program, New
York, NY.
Darien DeLorenzo,
CEO & Executive Director, Mobile Health Clinics Network.

MHCN Advisory Board Members

Melissa Lofton, Administrative Manager, Mobile Mammograph,
Breast Diagnostic Clinic, M.D. Anderson Cancer Center,
Houston, TX, Mammography Co-Chair, 2010 MHCN Annual Forum.
Candy Simbalenko, RN, BS, Manager, Breast Health Programs,
St. Joseph's Medical Center, Stockton, CA.
James Comeaux, LCSW, Chief Operating Officer, St. Charles
Community Health Center, Luling, LA.
Jennifer Bennet, Executive Director, The Family Van,
Harvard Medical School, Boston, MA.
Tina Hembree, MPH, Program Manager, Cancer Detection &
Early Prevention, Norton Healthcare, Cancer Institute,
Louisville, KY, Chair, MHCN Mammography SIG.
Shirley Hampton, RN, Development Director, Nevada Health
Centers, Inc., Carson City, NV.
Karen McInerney, RTRM, Director, Breast Imaging Services,
Swedish Medical Center, Seattle, WA.
Leah Berger, MPH, Director, Community Health Programs,
Planning & Development, Office of Community Affairs & Health
Policy, Tulane University School of Medicine, New Orleans,
LA.

The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I strongly support--I think every Member
in this Chamber does--prevention and treatment of breast cancer and
women's health generally. And the bill the President signed Tuesday
makes great strides to that end. For example, it prohibits gender
rating and eliminates the ability of insurers to limit coverage based
on preexisting conditions. In addition to the preventive services
available to everyone in the exchange, the health reform bill ensures
that women have access to the unique preventive services they need,
such as wellness exams.
I might also add that the amendment further drains dollars from the
highway trust fund. We don't want to go in that direction. Therefore,
Mr. President, I move to table the amendment, and I ask for the yeas
and nays.
The PRESIDING OFFICER. Is there a sufficient second? There appears to
be a sufficient second.
The question is on the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. DURBIN. I announce that the Senator from West Virginia (Mr. Byrd)
and the Senator from New Jersey (Mr. Lautenberg) are necessarily
absent.
Mr. KYL. The following Senators are necessarily absent: the Senator
from Missouri (Mr. Bond), the Senator from Georgia (Mr. Isakson), and
the Senator from Ohio (Mr. Voinovich).
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 56, nays 39, as follows:

[Rollcall Vote No. 92 Leg.]

YEAS--56

Akaka
Baucus
Bayh
Begich
Bennet
Bingaman
Boxer
Brown (OH)
Burris
Cantwell
Cardin
Carper
Casey
Conrad
Dodd
Dorgan
Durbin
Feingold
Feinstein
Franken
Gillibrand
Hagan
Harkin
Inouye
Johnson
Kaufman
Kerry
Klobuchar
Kohl
Landrieu
Leahy
Levin
Lieberman
Lincoln
McCaskill
Menendez
Merkley
Mikulski
Murray
Nelson (FL)
Pryor
Reed
Reid
Rockefeller
Sanders
Schumer
Shaheen
Specter
Stabenow
Tester
Udall (CO)
Udall (NM)
Warner
Webb
Whitehouse
Wyden

[[Page S2012]]

NAYS--39

Alexander
Barrasso
Bennett
Brown (MA)
Brownback
Bunning
Burr
Chambliss
Coburn
Cochran
Collins
Corker
Cornyn
Crapo
DeMint
Ensign
Enzi
Graham
Grassley
Gregg
Hatch
Hutchison
Inhofe
Johanns
Kyl
LeMieux
Lugar
McCain
McConnell
Murkowski
Nelson (NE)
Risch
Roberts
Sessions
Shelby
Snowe
Thune
Vitter
Wicker

NOT VOTING--5

Bond
Byrd
Isakson
Lautenberg
Voinovich
The motion was agreed to.
Mr. DURBIN. Mr. President, I move to reconsider the vote, and I move
to lay that motion on the table.
The motion to lay on the table was agreed to.
The PRESIDING OFFICER. The majority leader.
Mr. REID. Mr. President, it goes without saying we all appreciate
everyone's cooperation, having the Senate work so well, yesterday and
today. Therefore, after having had long discussions with my friend, the
distinguished Senator from Kentucky, I ask unanimous consent that we
are going to adjourn in a few minutes; that we will convene at 9:45
a.m. this morning, resume the bill, consider amendments up to 2 p.m.,
we will dispose of points of order that have been determined--and one
is still under review--by 2 p.m. There will be no further amendments
after 2 p.m., and the third reading will occur after points of order
are disposed of after 2 p.m.
I ask that in the form of a unanimous consent agreement.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mr. WHITEHOUSE. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

____________________