Mobile Mammography Promotion Act of 2009

Mr. President, I ask unanimous consent to temporarily

set aside the pending motion so that I may offer a motion to commit, which is at the desk.

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.

If I may consult with Senator Gregg, then respond. If you will make the request later, I would be grateful.

Thank you very much.

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.

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.

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

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

Mr. President, I withdraw my motion.

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.

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.

I will be glad to take the Senator's question.

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.

The Senator is correct.

I will be glad to have a question.

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.

I yield the floor.

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.

The Senator would withdraw the request and make the request later?

OK.

Mr. President, reserving the right to object.

Mr. President, I regret, I object.

Mr. President, reserving the right to object, what is the parliamentary situation at the moment?

Mr. President, who has the floor?

May I ask who has the floor?

I was going to ask the Senator from Tennessee a question.

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. 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.

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,

next, the Grassley amendment regarding executive personnel should be in the exchange.

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----

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.

That would be fine.

Mr. President, I yield 15 minutes to the Senator from Michigan, under the motion.

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.

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.

Mr. President, have Republicans used up their time?

I don't mean to be picky, but I assume they will yield back that minute.

I will yield 15 minutes to the Senator from Maryland.

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.

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

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.

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.

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.

Mr. President, that is a good introduction to the next speaker, the distinguished chairman of the HELP Committee, Senator Harkin.

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?

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.

Mr. President, is there an order providing for the next half hour?

I ask unanimous consent that the Republican side control the next half hour and that the majority control the half hour following that.

We won't worry about that yet.

Madam President, I think the half hour has now turned to our side.

I yield to the Senator from Michigan for a request.

Madam President, I yield to the distinguished senior Senator from California, Mrs. Feinstein, 10 minutes.

Madam President, I yield 10 minutes to the Senator from Virginia, Mr. Webb.

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.

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

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.

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.

Madam President, might I ask the Senator from South Dakota if he could identify his two amendments for the sake of clarity?

I thank the Senator.

Madam President, has the time on the Republican side expired?

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.

Madam President, I yield 6\1/2\ minutes to the Senator from Wisconsin.

Mr. President, I yield 7 minutes to the Senator from Florida, a very valued member of the Finance Committee.

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.

Mr. President, how much time remains on our half hour?

I yield 2 minutes 40 seconds to the Senator from Missouri.

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.

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.

Mr. President, I yield 5 minutes to the Senator from New Jersey, Mr. Lautenberg.

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.

I thank the Senator very much.

Might I inquire, Mr. President, how much time remains on this side for this block?

I thank the Chair.

Mr. President, I yield 10 minutes--5 minutes--to the Senator from Colorado.

Mr. President, I yield the remainder of the time to the Senator from Pennsylvania, Mr. Casey.

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

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,

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.

I ask unanimous consent for 1 additional minute.

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.

Madam President, I ask unanimous consent to temporarily set aside the pending motions and amendments to offer an amendment which is at the desk.

Madam President, I ask unanimous consent that reading of the amendment be dispensed with.

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.

Sure. I would ask the Chair, is there a number on those amendments?

Madam President, 3639 and 3640--one dealing with student loans, the other dealing with striking the CLASS Act from the underlying bill.

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

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.

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

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.

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.

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.