A bill to suspend temporarily the duty on titanium dioxide.

I announce that the Senator from California (Mrs. Boxer), the Senator from West Virginia (Mr. Byrd), the Senator from Washington (Ms. Cantwell), and the Senator from New Jersey (Mr. Lautenberg) are necessarily absent.

I announce that the Senator from West Virginia (Mr. Byrd) is necessarily absent.

Madam President, I move to reconsider the vote and lay that motion upon the table.

The motion to lay upon the table was agreed to.

Madam President, I urge my colleagues to oppose the Sessions amendment. It does two things. First, it requires legal permanent residents in the United States to produce documentary proof of their legality. We tried this under Medicaid and found out that many people in our country, the elderly and others, found it difficult to produce documentation though they were clearly eligible and clearly legal and entitled to basic assistance.

Instead, our bill that we passed, health care reform, verifies that a person is legal by declaration of their Social Security number, which is verified. So we go through a good process here to make sure only those eligible will receive, and, secondly, what Senator Sessions' amendment does, is say to legal permanent residents paying taxes, they cannot use the Tax Code like other citizens for deductions and credits for 5 years. They are paying taxes under the Tax Code. They should be allowed the same tax credits as other Americans, other people living in this country.

I urge my colleagues to defeat it for those two reasons, and the fact that this is an attempt to derail this bill.

I move to table the Sessions amendment and ask for the yeas and nays.

I announce that the Senator from West Virginia (Mr. Byrd), the Senator from Louisiana (Ms. Landrieu), and the Senator from Colorado (Mr. Udall) are necessarily absent.

I announce that the Senator from Delaware (Mr. Kaufman), is necessarily absent.

I further announce that, if present and voting, the Senator from Delaware (Mr. Kaufman) would vote ``aye.''

I announce that the Senator from Indiana (Mr. Bayh) is necessarily absent.

Mr. President, our colleagues on the other side of the aisle have confused some statements made by the President and made by me regarding whether the new health law will cause premiums to go down.

The President has spoken forcefully about the impact of the new reform law on health insurance premiums. He has contrasted the effect of reform with the effect of doing nothing. He made it clear that if we passed a reform bill, premiums would go down compared to the status quo of not enacting a reform law.

A couple of weeks ago, I said on the Senate floor that no one claims premiums will go down tomorrow when we pass this legislation. I was speaking in absolute terms. Premiums have been rising at a high and unsustainable rate. With these reforms, premiums will rise more slowly.

The President and I were saying the same thing, using different words. The point is the same. With this new law, American families and businesses can have hope that their premiums will not rise as fast as they have been in the past.

The days of 39 percent premium increases, as we have seen in California, will be over once this law is fully implemented.

The days of 60 percent premium increases, as we have seen in my home State of Illinois, will be over once this law has been carried out.

And if we repeal this new law, as the Senators on the other side of the aisle advocate, premiums will continue to rise at an unsustainable rate with spikes like those we have seen this year.

Senators on the other side of the aisle are right to ask what will happen to premiums.

Every American wants to know, ``What is going to happen to the cost of my healthcare?'' And they are right to ask that question.

But the obstructionists and naysayers on the other side of the aisle are wrong when they oppose this bill and the new law based on the false claim that it will cause premiums to rise faster than the status quo. That is simply not true.

And you don't have to take my word for it. Just ask the nonpartisan Congressional Budget Office--the congressional ``umpire'' when it comes to questions of what legislation will cost or save.

Early in the health reform debate, throughout most of last year, we had useful data from the Congressional Budget Office--but it was not definitive. It was easily distorted by the opponents of reform and the defenders of the insurance companies, who want to stop all action and allow premiums to be increased by 10, 20, 39, 60 percent each year.

The initial CBO reports compared premiums in today's market with the cost of a more generous health plan that is likely to be offered in the insurance exchanges of a reformed market.

That is not a fair comparison, but it is all we had.

It showed that people would pay more if they chose better coverage. But it didn't clearly say that for coverage comparable to what is available today, premiums would be lower.

And so there was confusion.

In January, when no one was paying attention and the debate on the Senate floor had shifted to jobs, we received some important additional information from CBO.

The new data, from the people who know the numbers best at CBO, backs our conclusion that the Senate health reform bill will reduce the premiums people will pay for health insurance, compared to current law.

That clear answer came in response to a request from the senior Republican Senator from Maine, Ms. Snowe.

At the request of Senator Snowe, CBO estimated the premiums for a Bronze plan under the Senate reform bill.

Bronze plans will cover roughly the same proportion of an individual or family's total health care costs as the average plan sold in the individual market today.

So using Bronze plans to compare the Senate reform bill to current law provides an ``apples to apples'' comparison. It tells you what premiums you can expect if the bill passes, compared to what premiums you can expect for a similar policy if the bill is defeated. That is a fair comparison.

Here's what CBO tells us:

A Bronze plan in 2016 will cost an individual between $4,500 and $5,000 a year.

Earlier, CBO estimated that under current law, with no health reform in place, an average plan in 2016 will cost an individual $5,500.

So, under reform, the cost of a typical plan will be considerably less than the cost if we do nothing. In fact the savings will be roughly $500-$1,000 a year.

We see the same story for family coverage. According to CBO, under the Senate reform bill, a family can expect to pay between $12,000 and $12,500 for family coverage. If we do nothing, a family can expect to pay $13,100.

That is a savings of $600-$1,100 a year for American families.

So now we have the answer that many Senators, and many Americans, sought.

CBO's analysis provides a fair assessment of the effect of reform on the individual and family pocketbook.

And the answer is savings of $500 to $1,100 a year, from 2016 on.

But only if we preserve the reforms the President signed into law.

And that is just the direct effect on premiums. Millions of Americans will be eligible for subsidies that will dramatically reduce their costs beyond these basic reductions available to everyone.

But even people who don't receive subsidies will have lower premiums. Lower than if we don't implement the reform law.

Not because of assistance from the Federal Government, but because health reform legislation will give people buying power and will take the necessary steps to rein in health care costs.

The changes included in the new law will make a difference in the health care system and those changes will reap benefits for all of us.

This is confirmation that the reform bill represents an important victory for Americans struggling with the high cost of health insurance.

And now we can put a value on the savings: $500 to $1,000 a year for individuals and $600 to $1,100 a year for families.

The Senators on the other side of the aisle haven't been talking about this report, which was provided by the CBO to a member of their own party, because they don't want the American people to know that premiums will go down relative to doing nothing.

So instead, they try to find alleged discrepancies between the President and me that simply do not exist on this issue.

The evidence is clear. The Congressional Budget Office has weighed in. The facts are plain.

The health reform bill will reduce premiums compared to the do- nothing outcome pursued by the obstructionists.

Similarly, there has been some confusion about the magnitude of the tax cuts in this bill.

The tax cuts in the reform bill passed by the Congress and signed into law by the President are the largest middle-class tax cut for health care in the history of our Nation.

No Congress has provided greater tax assistance to American families and individuals and small businesses to help them afford the cost of health care.

There have been larger tax cuts unrelated to health care--not all of them wise.

But American businesses and families need help to deal with the high cost of health care, and this Congress has responded.

The new law, combined with the improvements in the reconciliation bill, will provide refundable tax credits to people with incomes up to 400 percent of the poverty level--around $88,000 for a family of four-- so that they can afford their health insurance premiums.

Ordinarily, a tax credit is provided when you file your tax return after the end of the year. The new law allows the credit to be paid to the insurer month by month, so that you can afford your monthly premiums. That is a good thing if you live month to month and can't wait until the end of the year to receive the tax credit and still pay your monthly premiums.

The new law also provides tax credits to small businesses--available starting right now--to help them pay for health insurance.

These provisions will give nearly $500 billion of tax cuts and cost- sharing assistance to middle-class Americans. That is what makes this the largest middle-class tax cut for health care in the history of our nation.

We received no help from the Members on the other side of the aisle in enacting these tax cuts. This Democratic Congress did it anyway. We provided the largest middle-class tax cuts for health care ever, and we are proud to have done so.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Mr. President, the reconciliation bill on the floor today realizes a dream of my friend and mentor, former Senator Paul Simon-- consolidation of the Federal student loan program entirely into direct loans.

The very first Federal student loans were direct loans provided under the National Defense Education Act of 1958--directly from the Federal Government to students.

In 1965, the Federal Government began guaranteeing student loans provided by banks and nonprofit lenders through the Federal Family Education Loan, FFEL, Program. Through this program, the Federal Government would pay banks a certain rate of return on student loans and guarantee those loans against default.

By the early 1990s, it was clear to Paul Simon that incentivizing banks through subsidies no longer made sense. The Federal Government could make loans more cheaply and more simply directly to students.

As he said: ``Are we in the business of helping banks and guarantee agencies, or are we in the business of helping students?''

Paul Simon became the leading Senate champion of a new direct college loan program, enacted in 1992 as a small pilot program. He and others hoped that the Direct Loan Program would be quickly expanded to replace the FFEL Program.

In 1993, during a budget reconciliation fight, lobbyists for the banks and Sallie Mae joined forces to try to defeat the effort to move the student loan system into direct loans. The result was our current system: the Direct Loan Program and the FFEL Program operating side-by- side.

This system hasn't worked. Private lenders like Sallie Mae have retained the majority of the student loan market through special deals with financial aid offices and have continued to make billions off of taxpayer-funded subsidies--$6 billion per year. Taxpayers are absorbing all the risk of student loan defaults, while private corporations bank all the profit.

Senator Kennedy, a longtime proponent of direct loans, once said: ``We

waste billions of dollars in corporate welfare every year on student loans, and we cannot afford it any longer.''

I agree with Paul Simon and Ted Kennedy. And so does Chairman Harkin, who led this bill through the HELP Committee. I join him in supporting this bill that would finally end corporate welfare in the Federal student loan program and put that money back in the hands of students.

The reconciliation bill will shift all loans into the Direct Loan Program that Paul Simon envisioned and use the $68 billion in savings to invest in education priorities.

We will put $36 billion over the next 10 years into the Pell Grant Program, a program that we know is essential for many poor families and struggling students.

For the first time, we will index the Pell grant to inflation. We will also avert a projected Pell grant budget shortfall caused by recent increased demand for Pell grants.

Without this investment, 8 million students could see their Pell grants cut by 60 percent next year, and 600,000 students could lose their scholarships completely.

The bill will cap monthly student loan payments at just 10 percent of discretionary income, so that college graduates can pursue careers in teaching or public service without the burden of student loan bills they couldn't keep up with.

We will also invest in historically Black colleges and universities, minority serving institutions, community colleges, and state-based college access programs that help students succeed in college.

And we will reduce the deficit by $10 billion over 10 years.

Families and students will benefit enormously from this bill and the realization of Paul Simon's vision. And who will suffer? Bank and lending executives who have grown rich off of unnecessary taxpayer subsidies for decades.

Paul Simon was right 20 years ago, and he is still right today. It is time to take the middleman out of the student loan industry and return our focus to students.

I would like to thank Senator Harkin for his hard work on the student loan reform provisions in this bill and for his tireless efforts on behalf of college students across the country.

I strongly support the student loan reform provisions that are included in the reconciliation bill and I look forward to seeing Paul Simon's full Direct Loan Program finally signed into law.

Madam President, we just now saw this amendment. We have to look at it. I suggest the absence of a quorum.

Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Madam President, as I said, we were just handed this amendment. We have now examined it. This is an amendment that is related to medical malpractice and tort reform. There are a lot of provisions already in the bill which cover this subject. However, the main point of this amendment is not the jurisdiction of the relevant committees.

I raise a point of order that the Ensign amendment would violate section 313(b)(1)(C) of the Congressional Budget Act.

Madam President, this is a health care reform----

This is a health care reform bill, and we should keep all amendments to that subject. When we were sworn in as Senators, we took an oath of office to support the Constitution of the United States, which clearly includes the second amendment. All of us have a strong belief in the second amendment to our Constitution. But whatever you think about second amendment rights and the application of the second amendment, whatever you think about veterans and the relationship to questions of competency, I think we all should agree that neither what anybody thinks about second amendment rights or what veterans' relations should be to that should be in this bill. This is a health care bill.

I note this bill already explicitly protects the rights of gun owners. Therefore, because this amendment is nearly entirely composed of matter outside the jurisdiction of the reconciled committees, I raise a point of order that the Coburn amendment violates section 313(b)(1)(C) of the Congressional Budget Act.

Madam President, this amendment is a thinly disguised attempt to kill health care reform. Let me explain why. I remind my colleagues that the Congressional Budget Office has told us that in the first 10 years the bill actually will reduce the deficit by a significant amount. CBO also informs us that health care reform will lower premiums for 97 percent of Americans, improve benefits for many who are underinsured, and health care reform will bend the growth curve of health care spending. The CMS Actuary also says that national health care spending will be lower under the law than it will be without reform. In 2019, health spending will be 6.7 percent, compared to 7.2 without reform.

To prohibit implementation unless all these projections bear out is just another attempt to kill the bill. For that reason, I urge colleagues to resist this amendment.

Madam President, I move to table the Cornyn amendment and ask for the yeas and nays.

Mr. President, I have the highest regard for my good friend from Iowa. We work very closely together. We want to make sure our States are fully incorporated, involved in the national health care delivery system; that is, rural States. We also want a balance between urban and rural. It is the only fair solution. This bill has that balance.

I might say, there are some--I chuckle a little bit--I have talked to some of my friends in the East who talk about rural America--rural New York or rural Illinois or rural Indiana--and I appreciate that very much. But we are talking here, with frontier States, with what is really rural: only about six people per square mile.

So I say to my friend from Iowa, we have the balance in the bill. We should maintain that current balance. I think this amendment is inadvisable, and I urge us to not support it.

Mr. President, I move to table the amendment, and I ask for the yeas and nays.

Madam President, I have a lot of sympathy with the amendment. We don't want to get into an AMT situation. The AMT was not indexed when the AMT was enacted. We are now paying the price today. It is very possible that if this level is not indexed, we may be paying the price later on, in several years' time, but this is not the time or place.

I might also say there are other provisions in the bill that are not indexed, such as the affordability provisions. That is not indexed. I don't think it is fair to index only for upper income and others whose incomes are below $20,000. But it is an issue, and we will address this at a subsequent date because it must be.

In the meantime, I move to table the amendment and ask for the yeas and nays.

Madam President, we have had all sorts of amendments this morning. We have had amendments on malpractice, we have had amendments on guns, we have had amendments on immigration. Even last night we had amendments on some very interesting subjects, but this is the return of the killer amendment. We had a few killer amendments yesterday, and this is the return of the killer amendment.

Why is it a killer amendment? Basically because this would suspend health care reform if certain arbitrary budget targets are not met. It is on again, off again, wondering about the other. It is clearly designed to kill the bill. Therefore, Madam President, I raise a point of order that the Vitter amendment violates section 313(b)(1)(c) of the Congressional Budget Act.

This is a motion to commit to the Finance Committee obviously designed to kill the bill. Clearly, there is inadequate competition among insurance companies in most of our States. In fact, in most States I think there are maybe just two major companies. We want to encourage much more competition.

Allowing them to sell across State lines is in concept a good idea, but it must be done responsibly. The underlying bill--the bill that passed, actually--does allow for interstate compacts. States can compact to sell across State lines. Once the exchange is open in 2014, insurance companies will automatically be able to sell across State lines. But to allow sales now would be irresponsible because it would encourage a race to the bottom. By that, I mean that irresponsible companies will be inclined to go to States with the lowest standards and then sell health insurance to other parts of the country, so people in other States will have virtually no remedies.

It makes sense to have health care reform provisions in place, and then we can sell across State lines with compacts through the exchanges.

I move to table the DeMint motion, and I ask for the yeas and nays.

Madam President, the whole premise, the theory of health care reform is that it is a shared responsibility--employers, employees, American citizens, companies, a shared solution here.

The bill already waives any criminal penalties. That is taken out of the bill. No criminal penalties. A person cannot go to jail. That is provided for in the bill that was signed a couple of days ago. The bill also limits collection activities. It is very sensitive to the points made by the Senator from Nevada. It has a good balance of responsibility and accountability. But there must be some consequence of somebody not living up to his or her shared responsibility. It is very sensitive to doing this in the right way. I think it is a good balance. Their amendment goes way too far by eliminating any consequences.

I move to table the amendment and ask for the yeas and nays.

Madam President, as I said on the Brownback amendment, there is much to be said for indexing this provision. It is true we don't want to get back into the situation we now face with the AMT because the AMT was not originally indexed. Unfortunately, the current amendment will be offset with unspent, unallocated mandatory spending of stimulus funds. Unemployment is still hovering close to 10 percent. There is growing evidence the recovery package is working. I don't think we want to stifle the stimulus now. Over the last 6 months of 2009, the economy grew at an annual rate of 4 percent. The fourth quarter grew at a higher rate, but that was due to an inventory situation. By and large, it is not proper to offset this with stimulus dollars. We will find some time at a later date to deal with this issue. I do think it is a serious issue.

I raise a point of order that the Murkowski amendment violates section 313(b)(1)(c) of the Congressional Budget Act.

Mr. President, in an effort to help small business, there are many provisions in this bill to accomplish that result. One is $37 billion in tax credits that are in this bill already for small business.

I do agree with the Senator from Texas, though, that it would be better if the credit, which is available for 2 years beginning in 2014 when the exchange is up and running, was extended. That would be my preference. But right now, in 2010, we are short on money, frankly, and we can't find all the money that is necessary to make that permanent to accomplish the wishes of the Senator from Texas. But I do say I am sympathetic with extending that 2 years, and we will work to try to find ways in the future to accomplish that.

In the meantime, I move to table the amendment, and I ask for the yeas and nays.

Mr. President, we all want to fight fraud, waste, and abuse. In fact, there are many provisions in this bill which so provide. To add to that, when we negotiated the bill, the White House came up with even stronger provisions. They have the screening, time to check for payments, and so forth.

I talked with the Senator from Florida, Mr. LeMieux, who also has good ideas. I pledge to him to do what we can to get some of that passed this year. However, the amendment before us is much too punitive. It is arbitrary in its numbers. I think it would be counterproductive, especially at a time when States are already struggling with their Medicaid Programs. I think it would be inappropriate for us to lay this arbitrary punitive measure on them.

And other measures.

I might reconfirm, this is the last amendment. There will be points of order raised and other business will transpire before we get to the points of order, which I understand will begin about quarter of 2. We are going to finish at 2 o'clock. We are right there. It is going to work.

Mr. President, I move to table the Cornyn amendment and ask for the yeas and nays.

Mr. President, that was the last vote on amendments. I wish to repeat that statement: That was the last vote on amendments.

That is right. Due to the Senator's leadership and hard work, we were able to make sure those here legally had a place to find affordable health coverage.

The Senator is exactly right. The health reform legislation that was signed into law allows immigrants who are here lawfully, who are otherwise ineligible for Medicaid to receive tax credits in the exchange. However, the size of those tax credits should be based on the families' actual income, not an artificial level of 100 percent of the poverty line. I expect this provision will be implemented as such. I look forward to working with Senator Menendez to ensure that these families receive access to affordable health insurance coverage.

I now ask unanimous consent that Senators Grassley and Conrad be permitted to engage in a colloquy and inquiries of the Chair for up to 5 minutes.

Mr. President, there are a flood of emotions going through all of us today as we pass this reconciliation bill which improves upon the bill the President signed 2 days ago. I would like to focus only on one part--a very important part but only one part--and that is to thank the people who have worked so hard, especially in this body, to help accomplish this result.

I thank especially my friends Senator Dodd, the chairman of the Banking Committee, who many times acted in the capacity as chairman of the HELP Committee, and Senator Harkin, chairman of the HELP Committee, working so hard with their staffs. As well, I thank Senator Conrad, especially for his acumen, his budgetary acumen. I don't know anybody who knows this stuff better than Senator Conrad. We all rely on him very much.

I thank Leader Reid for his strategic vision--he helped put the Finance Committee bill together; he saw a path forward--and his staff, who are so competent--Kate Leone, Bob Greenawalt, Randy DeValk--his top three staff.

I also thank my friend from New Hampshire, Senator Gregg, for his courtesy in managing this bill. He was very decent and a very good person to work with.

We all want to thank so many people. Once we start mentioning a couple or three names, we run the danger of offending people whose names are not mentioned. We all know that. There will be an appropriate time for us to make all the thanks, and I will make mine so sincerely because I am so grateful for all the hard work my staff has put into this.

I wish to single out one person, and that one person is sitting next to me. Her name is Liz Fowler. Liz Fowler is my chief health counsel. Liz Fowler has put my health care team together. Liz Fowler worked for me many years ago, left for the private sector, and then came back when she realized she could be there at the creation of health care reform because she wanted that to be, in a certain sense, her profession lifetime goal. She put together the White Paper last November--2008-- the 87-page document which became the basis, the foundation, the blueprint from which almost all health care measures in all bills on both sides of the aisle came. She is an amazing person. She is a lawyer; she is a Ph.D. She is just so decent. She is always smiling, she is always working, always available to help any Senator, any staff. I thank Liz from the bottom of my heart. In many ways, she typifies, she represents all of the people who have worked so hard to make this bill such a great accomplishment.

I will have printed in the Record the names of all my professional staff. There are more than I realized, so I can't name them all. I ask unanimous consent to have that list printed in the Record and just regret that I cannot thank everybody personally.

Mr. President, is it appropriate to ask for the yeas and nays?

I ask for the yeas and nays.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Mr. President, I wish to spend a couple of minutes to express my gratitude to a lot of people. I begin by thanking my colleagues here, both Democrats and Republicans. Obviously, all of us would have liked to have had a health care bill that was more than a partisan vote. It didn't turn out that way. I am glad we ended up with the result we did.

I thank the members of the HELP Committee on which I serve, both Democrats and Republicans. Although we didn't end up with a bipartisan vote on that committee, there was a very vibrant, active, civilized discussion over many days last summer regarding the HELP Committee's portion of this health care product. Obviously, having been the acting or temporary chair of the committee in the absence of our friend and colleague from Massachusetts who was obviously ill and could not be there, I begin by thanking Tom Harkin. You have heard people talk about him already. He has taken over the reins of that committee and has done an excellent job. I thank Barbara Mikulski, my long-time friend and colleague, who did a tremendous job in dealing with various aspects of the health care debate, as Tom Harkin did, Jeff Bingaman, Patty Murray--again, seasoned members of the committee and Members of this body who have contributed to many pieces of legislation over the years. Jack Reed, my neighbor and great friend from Rhode Island, was tremendously helpful on the committee, as well as Bernie Sanders of Vermont, Sherrod Brown of Ohio, who played a critical role working with people like Senator Hagan of North Carolina, working with Sheldon Whitehouse, who was on our committee at the time and played a critical role in fashioning our public option. Jeff Merkley and Bob Casey were very productive and serious members of the committee effort. Al Franken and Michael Bennet have since joined the committee, and Sheldon Whitehouse has moved on. But I want the record to reflect my deep appreciation for their work.

Let me also thank Mike Enzi and the people such as Tom Coburn and others, Judd Gregg, from the committee. I can't go down the whole list, but the Republicans on the committee, while they don't necessarily like to admit it, made a contribution to the bill. One hundred sixty-one amendments--I know they are tired of hearing me talk about over the last several months--were their additions to the HELP Committee final product.

I have talked about Max Baucus, my friend. We have served together, along with Tom Harkin in this Chamber and the other, for 35 years together. The work of the Finance Committee, which bore a tremendous share of this responsibility, dealing with very complicated issues that are within the jurisdiction of that committee, was tremendously important. I won't go down and list all the members of the Finance Committee. In fact, we had several on our committee who served both on Finance and on the HELP Committee: Jeff Bingaman on the Democratic side; I know there were several Republicans as well who filled a dual role by serving on both committees.

I thank my friend from Montana as well for his work. He has been recognized and acknowledged by many and deservedly so over the last number of days.

I commend, if I may, the staff members of the Finance Committee, beginning with Liz Fowler and the group I ask unanimous consent to include for the Record. They did a wonderful job. Senator Baucus has referred to them already, but I also wish to thank them this afternoon for their work.

On the Budget Committee, again you have heard Senator Kent Conrad talk about the Budget Committee staff. I ask unanimous consent that their names be printed as well at this juncture in the Record, if I may.

I want to make particular reference to the members of my staff, beginning with Jeremy Sharp and Tamar Magarik Haro who did a wonderful job. Jeremy Sharp's father is former Congressman Phil Sharp. He was part of the class with Max Baucus and Tom Harkin and me, Henry Waxman and George Miller, who played a critical role in the debate in the House. Both Tamar and Jeremy were tireless in this effort, going back many months. I am deeply grateful to them. Jim Fenton is my legislative director and played a very important role as well in those efforts.

Then, of course, there are the other members of the HELP Committee, many of whom, of course, were staff members of Ted Kennedy. I inherited their expertise, their knowledge, their great abilities when Ted was laid up. They continued to work with us, beginning with Carey Parker who is, of course, legendary in this institution, having served with Senator Kennedy since the day he arrived 47 years ago. While not directly on the HELP Committee staff, I can't tell you what a critical role Carey Parker played time and time again during the rough spots. Michael Myers, Pam Smith, Connie Garner, Stacey Sachs, David Bowen--all were tremendously influential in the process. Mark Childress, who worked with Tom Daschle before, was at the White House for a while, came back up and stayed with us on that effort. Mark was invaluable in understanding the rhythms of the Senate, understanding the White House, and we are deeply grateful. Jenelle Krishnamoorhty, who worked with Tom Harkin, I have gotten to know her very well, and the members of Tom's staff. I want Jenelle to know how much I appreciate her work. She did a tremendous job for us as well.

I want to thank the leader's staff as well, who were so valuable to us: Kate Leone, obviously; Carolyn Gluck; Bob Greenawalt; Bruce King; Randy Devalk; Jacqueline Lampert; and Gary Myrick, who we see here all the time pacing this Chamber at all hours of the day and night, keeping an eye on the movements of the Senate and what is occurring, keeping the leader well informed, about as knowledgeable as

anyone you will meet in understanding exactly what is happening at all moments. To Gary and the leader's staff, I apologize if I left anybody out, but I thank them for their work as well.

This bill also included the work on education issues. There were a number of people who played a very important role in that. In my office: Maddy Gitomer, Averi Pakulis, Joe Caldwell, and Anna Staton were all part of our efforts in that regard. I should have mentioned earlier Tom Kraus, Topher Spiro, and Andrea Harris who worked on HELP Committee efforts as we moved forward on the bill.

Those were a lot of names I have just recited. I said them so quickly that they may fly by. It hardly reflects the recognition they deserve for the time and effort they have put in. They will never be standing before a bank of microphones or getting their picture taken, probably won't have articles written about them and what they did or didn't do during their tenure in the Senate. But this place only functions and runs, the floor staff who are here and the respective cloakrooms who do the work every single day that make this institution work as well as it does, spending the hours, the weekends crafting ideas and compromises that allow us to move forward.

While there are a lot of people deservedly, in a very public way, getting credit for the work that has transpired over these many months, I didn't want this moment to pass without at least expressing my gratitude to them and others whose names I, unfortunately, have not mentioned, who have made this day possible.

To them, to my colleagues, to Senator Reid, Speaker Pelosi, House Members who valiantly took up a Senate-passed bill that they had strong reservations about and yet understood the value of the moment.

And to President Obama, who understood the importance of this issue and insisted it come up. I remember Daniel Patrick Moynihan. Max Baucus and I served with Dan Moynihan, and Max had served with him on the Finance Committee when he chaired that committee, a very wise man who understood the movements of the executive branch and the legislative branch. He once told me that American Presidents, whether they get one or two terms, only get somewhere between 18 and 24 months to do anything really meaningful. It is those first days from January 20, Inauguration Day, to maybe as late as Election Day of the midterm elections in their first term. If they are going to do anything really important, that is the window in which they have to try. After that, it gets harder. You campaign for reelection. If you are reelected, you are a lame duck. Your ability to affect huge issues narrows.

I thank our President. Whether you agree or disagree with his politics or his policies, the fact that he took on a major issue that had been crying out for decades for resolution is testimony to his willingness to put a political administration, a political campaign on the line. For those who work with him, from his chief of staff to his advisers on these various matters, history will be and should be deeply grateful to President Barack Obama for having the courage to take up a big issue that deserved and needed resolution by the Congress for the American people. Whatever else transpires in the remaining tenure of his office, whether he serves one term or two, in large measure he will be defined by his willingness, his courage to raise this issue, when many others suggested this was a worthless task to take on, we couldn't succeed, he would be wiser to follow a course where less significant issues might be at stake.

So to the President, I thank you immensely for having the courage to take this on. I believe in the long call of history the American people will thank you as well for having the courage to bring up this important issue.

With that, again, this is one of those very few rare days we get in this institution historically, but it is one in which I am deeply proud to have been involved. I thank all who made it come to pass.

I yield the floor.

Mr. President, I have always wondered if this day would come, when I could stand on the Senate floor before my colleagues and say those words:

We did it. We passed comprehensive health care reform.

Many have come before us and we have worked together for years. We took on a monumental task and faced obstacles at every corner.

It wasn't easy--nothing that is worth doing is easy. But we put aside our own differences and came together to pass meaningful legislation that will transform the way health care works in our country.

And it was worth every minute and every hurdle. It was worth every setback and every step forward.

Because for all those challenges, for all our debates and negotiations, I know that any trouble we faced was nothing in comparison to the daily struggle millions of Americans face everyday without health insurance. Millions that are without coverage who live everyday in terror of becoming sick--parents powerless to provide care for a sick child, workers unable to change jobs and pursue a new opportunity, families forced to choose between seeing a doctor and paying their mortgage.

When I think about the cause of reform, I think about those people and their stories.

And I want to tell you about some of them today.

I want to tell you about the Bord family of West Virginia.

The Bords are two dedicated school teachers--with health insurance, through their employer--whose son Samuel had Leukemia and needed treatment well beyond the onerous annual insurance limits, they didn't even know they had. Samuel's parents were desperate and feared for the worst. When he hit his million dollar cap, my office helped his parents find more resources.

But, the Bords were left with two heart-wrenching suggestions-- consider getting a divorce so that Samuel would qualify for Medicaid and stop taking their other children--Samuel's twin brothers--to the doctor altogether, even if they got sick, in order to save every penny for Samuel.

That's right. Get a divorce and choose one child's health care needs over another's.

Those are the choices our Nation offered to these caring, hard- working parents with a sick child?

They did everything in their power but, this fall, Samuel passed away.

It breaks my heart to think of what his parents went through: not only the pain of watching their son fight a terrible disease, but also the uncertainty of paying for his treatment when the coverage they counted--on and paid for--abandoned them.

And so now, we are creating a more secure and reliable health care system that works for every American: where those who are uninsured finally have someplace to go for care; where those with health insurance know that the coverage they count on--and pay for--will be there when they need it; and where a profit driven insurance industry cannot play mercilessly with people's lives or steal their hope for a healthy future.

This new law is for all those countless people we have lost to a broken system. This is Samuel's law. We will never be able to bring him back--but we can make sure no one's health is ever left to the whims of annual and lifetime caps or pre-existing conditions or arbitrary rate hikes.

In the course of my Senate Commerce Committee investigations into the health insurance industry, I met a wonderful woman named Susan Pearl.

You see, we knew in the committee that health insurance companies were not being straightforward about how much money they were spending on actual medical care. Too many people were not getting the care they needed, yet health insurance industry profits continued to soar.

So Susan came to us. Her husband owns his own business, and they had coverage--good coverage. And they were glad to have it--their son Ian was born with muscular dystrophy, but was doing well with medical treatment.

Unfortunately, Susan's insurance then decided that her son's care-- including the round-the-clock nursing necessary for advanced muscular dystrophy--was getting just too expensive for them to continue paying.

So with the full knowledge of the devastating and fatal effects of dropping coverage--Guardian Insurance abruptly rescinded, not just Ian Pearl's coverage, but the entire family policy, replacing it with another plan that was, quite simply, inadequate.

With Ian's life-saving care costing upwards of $1 million a year, Susan did everything she could to reinstate Ian on his original plan-- the one she had paid into faithfully for years.

Thankfully, Susan Pearl was able to recover Ian's old coverage--but only after Guardian's deplorable practices drew worldwide media attention.

This new law means health insurance companies can no longer gamble with people's lives and rescind coverage because it's hurting their bottom line.

You shouldn't need the full focus of a Senate investigation, just to be treated fairly by your insurance company.

I think of small business owners like Kate from my home State of West Virginia who shared her story on the White House Office on Health Reform's public website www.healthreform.gov. Her 2-year-old son is the only person with health insurance coverage in her household.

Many of us know that it is often hard for small businesses to find affordable coverage for themselves and their employees.

She and her husband are small business owners and they simply could not find an affordable policy. Today, small businesses pay up to 18 percent more than large firms for the same health insurance policy, so many just don't even offer it. While small businesses make up 82 percent of businesses in West Virginia, only 37 percent of them offered health insurance coverage to their employees in 2008.

Kate wished she even had the security of catastrophic coverage. She

knows she is risking her home and economic security without health coverage, but, basic health insurance is a luxury she and her husband simply can't afford.

When it comes to health care, small business owners have been facing higher administrative costs, lower bargaining power, greater price volatility and fewer pooling options. These are not minor details. They are major problems and health care reform includes concrete solutions to begin solving them.

Now, with this new law, West Virginia businesses will have access to far more affordable coverage options. In 6 months, as many as 20,000 small businesses in West Virginia like Kate's will have access to tax credits for up to 35 percent of the cost of health coverage for their employees.

And new State-based health insurance exchanges will be designed to help small businesses cover their employees in the small group market. By expanding the pool and spreading risk across every individual in the State exchanges, we can significantly decrease premiums for small businesses and lower administrative costs for small business coverage by as much as 30 percent.

Many people have heard about Sarah Wildman, a woman who purchased insurance on the individual market right here in Washington, DC.

Sarah was an informed consumer and specifically chose a policy she believed included good maternity coverage--one of the few policies on the individual market that cover maternity care at all.

Of course, her so-called ``Maternity'' coverage didn't cover labor, delivery, or even her stay in the hospital. And as a result, Sarah was left with a $22,000 bill.

And, because she gave birth by cesarean section--she now has a ``preexisting'' condition and can no longer get coverage elsewhere.

Sarah's situation would seem absurd, if it were not so deadly serious. And it begs the question: What is the value of health insurance that offers no coverage when it's needed?

But soon she won't have to worry. This new law will mean the elimination of preexisting condition exclusions--right away for our children and as soon as the exchanges are up and running for adults.

Both the House and the Senate have spent more than a year working on a meaningful plan to move our health system forward.

For many of us this journey started in earnest three years ago in our effort to reauthorize the Children's Health Insurance Program. Protecting that program--which will cover more than 14 million children by 2013--represents yet another of this new law's enormous achievements.

But today's achievement is built on more than 50 years of effort and incremental change--some quite meaningful, but none truly comprehensive.

At last, our work has brought fundamental changes to a broken health care system, and takes an enormous step to begin making people's lives better.

I was so proud to be there with the President when he signed the Patient Protection and Affordable Care Act into law--after spending my entire career in public service committed to this cause, it was a chance to witness history in the making.

I want to thank my colleagues in the House and Senate who did the right thing for the American people. I know we are walking on the right side of history. I know many wanted to do even more, and go further. I know this bill is not perfect, but it will be transformative and that is a good thing.

I particularly want to thank two courageous colleagues on the House side--Congressmen Allan Mollohan and Nick Rahall who took a stand for the American people and voted to pass this legislation.

I want to thank Harry Reid for his leadership, and his unwavering vision which helped deliver a final bill to the President's desk.

And finally, I want to thank the President who came to the White House as a champion of change. And now, he has delivered.

We knew it would not be easy to change our health care system, but we persevered. All of us have stories like the ones I told.

I am enormously proud to have supported this legislation, which, more than anything, means a better health care system. It means a better America and a better life for families everywhere.

Mr. President, in addition to important improvements to the health reform bill President Obama signed into law this week, the reconciliation measure before the Senate also provides a significant investment in higher education.

I have always strongly believed in the importance of a college education. Unfortunately, in recent years, average college tuition rates have increased faster than inflation, and have far outpaced student financial aid. Skyrocketing tuition is making it increasingly difficult for families to afford higher education. Many students are forced to take on significant debt, and too often are not able to complete college because of soaring costs.

Especially during these difficult economic times we need to be doing more to address the rising costs of higher education and the growing need for student financial aid. I am glad to see that the measure in front of us today streamlines our student lending system and no longer subsidizes banks to lend to students risk free. By requiring that all future student loans be made directly to students through the Federal Government, this bill will save $61 billion over 10 years. Not only will this provision save the government money,

but the Direct Loan Program is projected to save students millions of dollars in fees and interest payments.

A portion of the savings from this bill will be used to fund the Pell Grant Program, which is facing a significant shortfall this year. The measure provides $13.5 billion in mandatory appropriations for Pell grants, and will provide additional mandatory funding to the program by tying increases to inflation. Combined with the investment in Pell grants in the American Recovery and Reinvestment Act last year, which I was proud to support, the maximum Pell grant award will double as a result of this bill. Unfortunately, Pell grants cover less than half as much tuition at a public college or university as they did just a few decades ago, so a significant investment in the program's growth is necessary to help the more than 8 million students who participate. I met with students who attended school in Vermont this week and they shared their stories about how important this program was to them, and how it was critical to their ability to attend college. No student should be denied the opportunities of a college education because of financial burdens.

I am also pleased the changes to student lending in the reconciliation bill will help nonprofits to provide important loan servicing and counseling services to students and their families. Several States have established not-for-profit State agencies to administer financial aid and to provide their residents and students attending their schools with quality counseling services and low-cost loans. Vermont pioneered this movement by creating the Vermont Student Assistance Corporation, VSAC, more than 40 years ago. Since then, VSAC has worked hard to establish and maintain strong and longstanding working relationships with Vermont's higher education institutions as well as K-12 schools to provide outreach programs critical to the economic vitality of Vermont.

The reconciliation bill will prohibit anyone other than the Federal Government from originating new Federal loans, but unlike the lending measure the House passed in July, the reconciliation package will help nonprofits continue to provide important college access and completion activities. This measure will double the funding directed to Vermont, which will help VSAC continue to counsel students and their families about entering and completing college. Additionally, the reconciliation legislation will allow non-profits to contract with the Federal Government to continue to service loans at a competitive market rate.

I have heard from countless Vermonters about the invaluable services VSAC provides to help students attend and complete college. Just recently, a father of twins attending college in Vermont contacted my office to share with me the support that VSAC provided. If not for VSAC, he said, he did not think he could have made it through the paperwork or learned about the scholarships that were available.

I am glad that Congress has recognized the importance of these services in States across the country and will allow for a continued role to help more students access and complete college. I look forward to continuing to work with VSAC to ensure their place as an important part of students' college experience.

Mr. President, today's final passage of this Health Care and Education Reconciliation Act marks the culmination of a decades- long struggle to make health insurance affordable to hard working Americans. This has been an arduous process, but it has proven that change truly is possible. America again has risen to meet one of its foremost challenges.

Still, there is more work to be done to introduce competition into the health insurance industry. Today, health insurers do not play by the same rules of competition as do other industries. Benefiting from a 60-year-old special interest exemption, the business of insurance is not subject to the Nation's antitrust laws. These laws promote competition, which ensures that consumers will pay lower prices and receive more choices. We can surely agree that health insurers should not be allowed to collude to set prices and allocate markets.

Last fall, I introduced legislation to repeal the health insurers' antitrust exemption. I held a hearing to examine the merits of this repeal, and worked to build bipartisan support. A few weeks ago, repeal of the antitrust exemption for health insurers became the first stand- alone part of the health reform package to pass the House, in a strong bipartisan vote of 406-19. Today I want to renew my call for the Senate to take up and pass this legislation to repeal the antitrust exemption for health insurance companies.

As they begin to implement the measures included in the Patient Protection and Affordable Care Act, the Department of Health and Human Services, other Federal agencies, and the States can all greatly benefit from the competitive analysis provided by both the Department of Justice's Antitrust Division and the Federal Trade Commission, FTC. The Justice Department and the FTC have the knowledge and experience to provide informed assessments of whether a marketplace is functioning properly, and when there may be warning signs that competitive abuses are taking place. Their expertise will ensure that the basic rules of fair competition apply to those reforms included in the new health insurance reform law.