To delay the application of the Patient Protection and Affordable Care Act.

Mr. President, first let me thank Senator Boxer for putting into the Record the history of how we fought for Medicare, how we went through a lot of the health care fights, and what we have stood for in protecting the American public for affordable, quality health care. I applaud her and agree with the comments she has made.

I think it is very interesting to point out the contrast to the passage of the Affordable Care Act that has been law now since March 23, 2010. It went through hearing after days of hearings in the House and in the Senate. It went through days of markups in the committee, where hundreds of amendments

were offered in both the House and the Senate. We had a long debate on the floor of the Senate and the floor of the House. We reconciled the differences between the two Houses. It went through the regular process. We spent as much time on that bill, I think, as we have spent on any major bill. And yet there were differences. The bill was passed and signed into law.

When we expanded Medicare--and I was in the House at the time on Medicare Part D. I also voted against it. Most Democrats voted against it. We voted against it for the reason the Senator just said--the coverage gap, the doughnut hole, that we knew seniors would still not be able to afford coverage. There was no public option, as the Senator remembers.

It was all private insurance. They did not pool the total purchasing power to reduce the cost of prescription drugs--another matter that we felt very strongly that we were overpaying. And we are overpaying for prescription drugs, as a result of that change.

By the way, it was not paid for. It was estimated to cost $400 billion, and there was no offset of cost. So we were worried it would have an impact on the affordability of the Federal Government to pay the bill. So we all voted against it. Many of us did.

And it became law.

Senator Boxer is absolutely right: When that bill passed, we came together and said: Let's make it better. We lost the battle on the floor. It became the law. Let's try to make it work. And we did that, Democrats and Republicans.

We are now into 3 years under the Affordable Care Act, and all we get from the Republicans is repeal after repeal after repeal--no effort to deal with legitimate problems of implementation that we would like to work together to do.

What a difference. Instead, they are using the process of holding hostage the Federal Government from being in operation in order to advance their extreme agenda.

It has been nearly 20 years ago when the Government shut down because the Republicans decided it would be better to close government to prove their point. Well, they were wrong then. We recognized the cost of a government shutdown and the inconvenience to the American people and the damage to our economy. Yet Monday night we run the risk of another government shutdown because the Republicans are holding hostage the continuation of government to try to move forward their extreme agenda.

Let me talk a little bit about this. Let me talk about what it would mean if we were, in fact, to pass the continuing resolution that was passed by the House. We are not going to do that. We are not going to pass that. Everybody knows we are not going to pass that. But I think the American people need know what would happen if that did pass and we did defund the Affordable Care Act.

I could talk a lot about provisions that have already taken effect. I could talk about the fact that in my State of Maryland, 46,000 families have taken advantage of putting their children on their health insurance policies to age 26. If you repeal the Affordable Care Act, those 46,000 families will have to find another way to take care of the health insurance for their children.

I could talk about the fact that come January, we will eliminate lifetime caps on health insurance. How many families have had to go through bankruptcy because they cannot afford health coverage? They may have insurance, but their caps put them into bankruptcy. Well, that is gone. If you repeal the Affordable Care Act, we are back to the arbitrary limits.

How many families have told us about preexisting condition restrictions that are in their health insurance policies? We have already corrected that for children. That is already the law. Come January, there will be no further preexisting conditions. Women will not be discriminated against in health premiums. Pregnancies will no longer be considered a preexisting condition. Being a victim of domestic violence will no longer be considered a preexisting condition.

I could cite, and I am sure the Presiding Officer could too, examples in our own States where people have not been able to get full coverage. I have a family in Montgomery County that had to take out two insurance policies and pay two separate premiums for the family because of preexisting condition restrictions. That is history. If you pass the resolution that came over from the House, that is all gone, we are back to how it used to be.

I know we talk a lot about affordability. I want to talk a moment about that. Because before we passed the Affordable Care Act, we got letter after letter from individuals and businesses about their premiums going up. They had to cut back coverage, and they required the employee to pay more. The benefits were less, and the premiums were higher. We were seeing double-digit cost increases in health care.

Well, now we have a quality product, a guarantee that essential benefits are going to be in there. We have protection that at least 80 to 85 percent of the premium dollar must actually go to benefits. If it does not go to benefits, you get a rebate, you get a refund. In my State of Maryland, 44,000 Marylanders are getting rebates because their premiums were too high. The average rebate is $143 a family--$13 million in rebates.

With the House-passed continuing resolution, that is gone. Those protections are no longer in the law. We are back to how it used to be: no guaranteed coverage, no guaranteed benefits, no guaranteed value.

There is another aspect to this, one that I am very proud of. The United States will at last join the industrialized nations in the world and say that we are going to make affordable health care available to every person, every American in our country. I think that is an important point. I have 800,000 people in my State of Maryland who do not have health coverage today--800,000.

Now, come October 1, next Tuesday, they are going to be able to go to the Maryland Health Connection and get health coverage. But guess what. They are going to have a variety of plans they can choose from. They can make their decision. But a large number, over 85 percent--87 percent--of the people who will be going to the Maryland Health Connection, it has been estimated, are going to be entitled for help in paying for those premiums--87 percent.

We talked about the individual mandates. What we provided was an affordable option so everyone can be in the system. We want universal coverage because we think it is the right policy. Everybody should be covered. We want universal coverage because we think it is wrong for someone who has health insurance to pay for someone who does not have health insurance because they use the health facility and do not pay for it, and we pay more as a result of that. Hospital costs are more, physician costs are more. We think everybody should pay their fair share.

But we make it affordable. Eighty-seven percent will be entitled to help. Those who go through the Maryland Health Connection and are enrolled in Medicaid obviously are going to get their help. We have expanded that coverage. Those who go into the exchanges--and Maryland is one of those States that the State will be operating the exchanges.

The overwhelming majority will be entitled to some help in the payment of those premiums. If the House-passed resolution were to become law, and it is not going to become law--the purpose for sending it over here was to make it hostage in the closing of our government. If it became law, that help would be gone. These uninsured have no prospect of getting health coverage, and the inefficiencies of our system continue, the use of emergency rooms, the lack of preventive care continues.

The Senator from California Mrs. Boxer talked about the Medicare system. Let me take a moment about the Medicare system, because this is very important. The so-called doughnut hole, that prescription drug gap of coverage, is being closed as a result of the passage of the Affordable Care Act. How many seniors fell into that doughnut hole and literally could not afford their prescription drugs? We closed that in the Affordable Care Act. In my State of Maryland, 50,000 seniors benefited from that--50,000 seniors. If we

pass the bill that came over from the House, those 50,000 seniors would be calling our office every day finding out what happened to that coverage they lost. You better believe our phones would be ringing about why are we taking away their benefits.

It is even more who are benefiting from the preventive health care services. They do not have to pay copayments. About half a million Marylanders are eligible for that benefit--who are taking advantage, 34 million nationwide. They would lose that preventive health care service that they have today as a result of the passage of Affordable Care Act. That is gone if the House-passed resolution were to become law.

Probably even more serious than that, and Senator Boxer alluded to it, the passage of the Affordable Care Act improved the solvency of the Medicare system for a decade. You repeal the Affordable Care Act, you are back with whether Medicare itself will be a solvent program.

I could go on and on. We have provisions in the Affordable Care Act that are working to prevent fraud within the Medicare system, saving taxpayers dollars. That is gone. We help to make sure that the Medicare Advantage plans are properly paid. That is gone. All of that is repealed if the House resolution were passed, which it will not be. I will make it clear. It was sent over to us with a strategy to put the government operations in jeopardy. There are many on the other side who believe it is a good idea to close the government. That is their objective. Even the Republicans admitted this strategy would not work to actually defund the Affordable Care Act.

I think we should at least talk about what impact it would have. I hear my colleagues talk frequently about small business. I have had a lot of forums with small businesses in Maryland. I must tell you, yes, small businesses are concerned about whether they can afford the cost of their employees and health benefits. They are concerned about it. That is a legitimate issue. But let's talk about what are the circumstances without the passage of the Affordable Care Act. Well, they are on their own. They do not have large markets. They have to pay more than large companies have to pay. They do not have a lot of options.

Under the exchanges, under Maryland Health Connection, they will get different opportunities that they did not have before, more affordable coverage that they did not have before. There are credits available to help them pay for their health insurance. If you have less than 50 employees, there is not a single new mandate in this law for a small business. So this is good news for small companies. That is gone if the resolution that passed the House were to become law. It is not going to become law. My Republican colleagues know it is not going to become law.

I think it is important to point that out. What happens if we do not get to an agreement by Monday night? That is possible. That is possible. We are going to send back a continuing resolution to the House. We do not know whether they are going to accept it. What happens? Well, I can tell you this. I represent the State of Maryland. I represent a lot of Federal workers. I tell you something, they have been through furloughs, they have been through pay freezes, they have been put to the test. They have been asked to do a lot more work with less workers. We have less per capita workers than we have had in modern times on a per capita basis of Federal workers. They have been asked to do more with less. They have already contributed greatly to reducing the deficit.

Once again, come Tuesday morning, they are going to be asked in some cases to show up for work not knowing whether they will get paid, in other cases, to stay home not getting paid, trying to figure out again how they are going to pay their bills. They have rent payments and mortgage payments and food payments. Guess what. That is going to have a major impact on our economy. Make no mistake about it, it will hurt our economy. We have been through this. We have seen this movie before. It hurts our economy. It hurts our country. This is a self-inflicted crisis. This is totally avoidable. If that happens, yes, people will be terribly inconvenienced.

You ask the 10,000 people a day who elect to enroll in Medicare and there is no one there to enroll them in Medicare. What are they going to do? You ask the person who needs a passport and cannot get a passport, what are they going to do? I can go through a whole host of things. In 1995 and 1996, I think it was estimated 9 million people who had planned to go to national parks did not go to national parks.

It is a cumulative effect. Why are we doing this? To advance our agenda? No, it is not going to pass. Why are we not using regular order? This is costly to our economy, it is costly to American families. It is causing a slowdown in the recovery of our economy. An even greater concern is that in a couple of weeks, middle of October, we are talking about going through this again perhaps on whether we will pay our bills. The limit that we have deals with whether we can pay the expenses that have already been incurred. This is not about new spending. This is about money that has already been spent, will we pay the bill when the bill is received?

In the House-passed resolution, they said: Well, we will prioritize. We will pay some but not all. I do not know how you can do that. Administratively, I do not know how you can do that. You certainly are going to make it much more difficult to deal with those that are not in the priority category. So we become a selective deadbeat? We say we are not going to pay contractors, we are not going to pay doctors, we are not going to pay workers? I mean, who are we not going to pay? They have already done the work. They have already provided the services. They have responsibilities. They expect us to pay our bills.

It does not work. We have been through this before in the last Congress. We saw. It hurt America's reputation. We came close. We did not go over the cliff. But just coming close presented a huge problem for this country. If we actually go over the cliff and do not pay our bills, it will be very costly to the American taxpayers. Interest rates will go up on our national debt. It will go up. That will cost the taxpayers more money. For what? Another self-inflicted crisis by the Republicans to advance their extreme agenda.

We have the votes here to pass what we call a clean CR, a clean extension of paying our bills. We have the votes here. There is a majority of us prepared to vote for that. We have said that. We have shown that. But, instead, it is being held hostage to an extreme agenda and trying to shortcut the regular process. What is the regular process? The regular process is we do our work, they do their work, the House, the Senate go to conference, work it out.

Yes, there is a Republican-controlled House. Yes, there is a Democratic-controlled Senate. We do not have 60 votes but we have a majority. In the White House is President Obama. So that is what the voters gave us. Our responsibility is to work with that.

We did. The House passed a budget. I did not like the budget. I did not like their budget. But that is a democracy. They passed their budget. We passed a budget here. Our Republican friends said we probably will not do it. We did it. We did not pass that last week, we passed that months ago. And what we said is, okay, let's go to conference, work out the difference. It will not be everything I want, it will not be everything the Republicans want. That is how the process works.

Republicans will not sit down and talk with us. They will not let us go to conference. They will not let us work out a budget. So when you look at why we have not been able to reach a budget by October 1, it starts with the fact that we have not been able to sit around a table to work out our differences because the Republicans will not let us go to conference. That is a fact. So we have got to get to conference. We have got to get that done.

In the meantime, do not hold the government hostage, or paying our bills hostage, because all that does is create additional costs, hurts America's reputation, hurts our economic recovery. It does not at all advance a final resolution of an orderly process in which we work out the problems of this country.

I urge my colleagues to put America's interests first, stop the games we are playing and threats we are making. We are coming too close. Too many people we are again telling: We do not

know whether you are going to get a paycheck next week. What do you do if you are a worker or contractor and you do not know if you are going to get a paycheck next week?

You are already cutting back on your commitments. This is already hurting our economy. Every day we wait it hurts our economy. That is why a host of us are upset that we had to waste yesterday. It would have been nice to be able to use yesterday to resolve this issue. Every day we wait costs our economy, it costs our country. Let's pass the necessary legislation to keep government operating and pay our bills. Let's sit down as we should and work out the budget problems in a way that is befitting the tradition of the Senate.

I yield the floor.

Mr. President, I want to begin with a story about two young men, both 29, both married with a couple of kids, and both contracted cancer the same day--malignant melanoma, the kind of cancer that comes from a mole. Unfortunately, it is not uncommon in our society. One of those young men had insurance. In fact, he had an insurance policy that provided preventive care, and under that policy they provided a free checkup. Indeed, his insurance covered his ability to go and have his checkup in the evening so he didn't even have to take a day off from work.

He went in, had a checkup, and the doctor found a mole on his back and said: This doesn't look so good. I think I should take it off.

A week later when he went back to have the stitches out, the doctor said: I think you should sit down. You have a pretty serious form of cancer.

The young man went to the hospital and had an operation which removed a hunk of his back. He had stitches under his arm. The lymph nodes were taken out, and fortunately they found that the cancer had not yet spread. He didn't have to have chemotherapy or radiation. He was OK.

The other young man didn't have insurance, so he didn't go to the doctor and have a checkup. He had the mole on his neck, but he didn't really notice it or pay much attention to it.

Six or 8 months later he noticed a lump in his neck. He still didn't pay any attention to it. He didn't have insurance and didn't really want to spend the money to go to the emergency room or go to the doctor, so he didn't pay much attention to it and he let it go.

Six months later the lump was so large that he finally went to the doctor, and they biopsied it and found that it was metastasized malignant melanoma. He had chemotherapy, radiation, and surgery, but a year later he died.

That story means a lot to me because I am the first guy. Forty years ago, when I was a staff member in this institution, I went and had that checkup because I had insurance. They found the mole, they did the surgery, and here I am today.

I have often thought about that and wondered, why me? Just luck--but also because I had insurance. I can say with certainty that if I had not had that insurance, I would not have gone to that checkup. If I had not had the checkup when I did within months or perhaps a year and a half, I would have been gone.

I have a similar story about a daughter of a friend of mine, Dick Gould up in Maine. Dick had a daughter named Cindy who was diagnosed with severe asthma at the age of 3. All her life she battled it. She lived in a very rural part of Maine. She didn't have a lot of money and could never afford insurance, but she fought the asthma as best she could. She did the best she could, but she couldn't afford the expensive treatments.

Finally, not long ago, at the age of 53, Cindy Gould died, leaving a husband, children, and grandchildren, one of whom she hadn't ever met. Why did she die? Because she didn't have insurance. She couldn't afford to go in and have the care she needed.

Why are we having this discussion here in the Senate this week about health care? The answer is pretty clear. There are 50 million people in this country who have no health insurance. The estimates are that between 20,000 and 30,000 of those people die each year--like Cindy Gould--because of the lack of health insurance. Why doesn't that bother us? Why aren't we spending days and nights here talking about how to solve this problem instead of how to dismantle the most significant health care program that has come to this country in years? Why?

I have a theory about that. It is because those deaths are invisible. They happen one at a time in Greenville, ME; in Portland, ME; in San Diego, CA; and El Paso, TX, so nobody knows. It is not listed in the obituary: Died because of no health insurance.

I would submit that if those 25,000 people--which is a conservative estimate--in this country all died at the same time and in the same place, we would be turning the world upside down to solve the problem. Just imagine that kind of loss in a small town in the Presiding Officer's State each year--25,000 people a year.

On September 11, 2001, we had a tragedy in this country, and 3,000 people died. It was a terrible day. What have we done as a result of that day? We turned our society upside down, we protect ourselves at airports, and we spent money for screening and protection. We spend $70 billion a year just on intelligence in order to protect ourselves from another September 11. Yet, quietly and insidiously, every year over 20,000 people die because they don't have insurance.

Another 700,000 families lose everything because of medical bills. We are the only country in the world where that happens. We are the only country in the industrialized world where people are prone to lose everything because they are swamped with medical bills. That is ridiculous. Would we watch someone die in our front yard? Of course not. We would call 911. We would call the doctor. We could do CPR. We would do whatever we could to keep them alive. But we are quietly as a society watching over 20,000 people a year die, and we are arguing about the details of how to solve this problem.

To me, it is a moral question. There is a lot of economics involved. There are a lot of questions about costs and we will talk about that. But, fundamentally, it is a moral question. The moral question is, Are we going to stand by and watch people suffer and die because of ideology and politics? No other country in the world has answered yes to that question, and that is the question that is before us.

So what is this thing called ObamaCare, the Affordable Care Act? What is it? The first thing to say is what it is not. What it is not is a tremendous impact on American business. Ninety-six percent of the businesses in America have less than 50 employees. They are not affected by ObamaCare at all. In fact, they are probably benefited by it because whether or not they choose to buy health insurance, their employees can get health insurance through the new health exchanges, and that is probably a benefit to those businesses. But 96 percent of the businesses the law doesn't apply to. Ninety-eight percent of the larger companies--200 employees and more--already provide health insurance to their employees. So the law doesn't apply to them. Ninety- four percent of the smaller firms, from 50 to 199, already provide health insurance to their employees.

So this idea that somehow ObamaCare is taking over the health care industry in this country is nonsense. Eighty percent of the people are largely unaffected by it. They are either the 50 percent who are covered by their employers now or the 22 or 23 percent who are under Medicare now and 7 or 8 percent under Medicaid. But that leaves 15 percent uncovered, uninsured, unprotected, and that is between 45 million and 50 million people.

This is not a government takeover. There is no place in America one can go and sign up for ObamaCare. If one goes onto an exchange, they get insurance from Anthem or Blue Cross or Health First or Aetna. One doesn't get ObamaCare, one gets insurance coverage from private insurance companies, just as we have done in this country for most of the 20th and 21st centuries. It is not a government takeover.

Here is what it is: It is a mechanism to make it easier and cheaper for those people who are uninsured to find a way to get insurance: to go online to a health exchange, which is nothing but I suppose one could call it the Amazon or e-Bay of health insurance where people can see what their options are, make their choices. They get support from the rest of us if they are within certain income levels, and it makes health insurance affordable.

It is based upon the free market principle of competition, and that group rates are better than individual rates, and the essence of the system is a marketplace where people can buy private health insurance.

It is also insurance reform. It repairs and improves and mandates some improvements in the way health insurance works, to avoid some of the real glaring problems that most people have identified with and many people have run up against. One is a limitation that health insurance companies have to spend 80 percent of the money they take in on health care. In other words, there is a limit on profit and overhead. I think all of us feel that is reasonable. That is already happening, and, in fact, some people are getting refund checks from their insurance companies because they were spending too much on overhead and profit.

Under the insurance reforms of the bill, women are treated equally for the first time. There is an emphasis on preventive care.

I go back to my own story. Preventive care saved my life. It was a heck of a lot cheaper than the care that was provided to the fellow who didn't have insurance because he didn't catch it in time. He ended up in the emergency room. He ended up having surgery, chemotherapy, and radiation, and ultimately futilely, but that treatment cost a lot more than my treatment did because I was insured and had preventive care.

It also allows kids to stay on their parents' policies until they are 26. This is a big deal, because it allows kids to take jobs and do things and travel and work but not have to focus on whether they have health care. They can stay on their parents' policies until they are 26. That is happening right now all across America.

There are no lifetime caps.

As I mentioned earlier, we are the only country in the world where people get wiped out by health care costs. Nowhere else is that even remotely an issue the way it is here.

Finally, a person can't be denied health insurance because of preexisting conditions. That is crucial, because there are millions of people across this country, through no fault of their own but because of the vagaries of health, who have problems they were born with or that came on in their youth and under the old rules, they can't get insurance. Now they can't be denied insurance. That is going to make a lot of difference to people in this country.

Because of that--and I watched Senator Cruz last night, and he talked about this. If you are going to require insurance be issued to people even if they have preexisting conditions or some kind of illness, then you also have to mandate that everybody buys it; otherwise, nobody would buy it until they are in the ambulance on the way to the hospital. If a person didn't have to buy fire insurance before the fire, everybody would buy it when they saw the flames coming up from their house. I think Senator Cruz, the Senator from Texas, used that image last night. To me, that makes common sense.

It also makes common sense because it is a matter of personal responsibility. I always thought that was a conservative principle. I remember in the 1970s and 1980s it was a conservative principle that people should take responsibility for themselves.

Right now in our society, if a person is sick, and if a person has no insurance, they are treated. The hospital cannot turn you away. What that means is we all pay. That person is in effect a free rider. They have insurance; it is all the rest of us. I think it is a basic principle that they should take care of their own responsibility.

People act as though this is some kind of radical notion. We have had--I don't know about the State of the Presiding Officer and other States, but in

our State we have had mandatory automobile insurance for as long as I can remember and nobody questions it, because it is a responsibility. You need to be responsible for yourself. As I say, this was always a conservative principle until lately, and all of a sudden it isn't. It reminds me of the old line of Mort Sahl, the comedian back in the 1950s, who said, ``If you maintain a consistent political opinion in this country long enough, you will eventually be tried for treason.''

And here we are; what was once a conservative principle is now anathema. But I think it is all about personal responsibility and providing for yourself.

I understand,--I have seen press releases that there are people going around the country telling young people not to sign up for coverage. I think that is outrageous. It is unbelievable. And they are sentencing some of those people to death or to severe injury because they are not going to have health insurance when they are going to need it.

All young people are immortal. I was when I went in for that checkup when I was 29 years old. They think they are. But to tell people not to get insurance when it is available, particularly when it is available at low cost, I think is something that should weigh on the conscience of whoever is funding and developing that campaign around the country.

So what is the Affordable Care Act? It is a mechanism to buy insurance. No. 2, it is reform to the insurance industry in terms of what the requirements are; and No. 3, buried in it are pilot programs that may turn out, in my view, to be the most important part of the project, the most important part of the bill, because they encourage changes in the way we deliver health care.

As I will mention in a minute, the real problem with health care is cost, and these pilot programs that are being used around the country, including in Maine, are already having some spectacular results. I talked to two people from our two major Maine hospitals this morning. They are seeing a 60-percent reduction in emergency room use and a 70- percent reduction in rehospitalization because of what is called the Accountable Care Organization Structure that they have put in place for Medicare patients in Maine.

They are seeing better care at substantially lower costs, and this is the kind of pilot and innovative program that is also in the Affordable Care Act that nobody ever hears about or talks about that I think, as I mentioned, may turn out to be the most important part of the bill.

That is it: limits on insurance provisions, greater access to insurance. I think we need to calm down around here about what this bill does.

It is not perfect. It is complicated. It does have some implementation issues that I am worried about. I am worried about too much regulation. I am worried that they will overdo the regulations somewhere in the government as they implement this, and I think that is something we need to pay close attention to. There are problems such as the 30-hour workweek versus 40 hours. Those are the kinds of things I think we need to pay attention to and we need to fix. There has never been a perfect piece of legislation, perhaps, other than those Ten Commandments on Mount Sinai, but we need to try to fix things and not just say, Oh, well, we are going to tear the whole thing apart and start over. I am a little skeptical on the starting over part because I haven't seen any inclination to do so.

As I mentioned, the larger health care problem is cost. We are now spending 18 percent of our gross domestic product on health care--by far the highest number in the world. Japan is at about 11, and everyone else is at 8 or 9 percent. We are spending twice as much per capita as anyone else in the industrialized world and our results aren't that good, by all kinds of international standards, including infant mortality, longevity, customer satisfaction. We are in the 15, 17, 20, 25th in the world, and we are paying twice as much.

There is also this cost problem is what is killing our budget. All of the debt and deficit problem we are projecting in the Federal budget is based upon health care costs: Medicare, Medicaid, and public employees. That is where the deficit is. It is not in the national parks, it is not in Head Start, it is not even in the Department of Defense. It is health care costs, and we need to talk about that and work on it and do something about it.

I think these pilot programs within the Affordable Care Act are showing amazing promise just in the last couple of years that they have been in place.

A note on process, and then I will yield the floor. I have never known of a time when the repeal of a particular piece of legislation has been used, has been held hostage, in order to keep the government running. We have had arguments about budgetary matters at the ends of budget periods, and there was a shutdown in the 1990s about spending and budgets, but I have never heard of a time when a group tried to use a bill and say we are going to repeal this bill or we are going to shut down the government.

In the 1950s and 1960s, the southerners were dead set against civil rights legislation. They filibustered and tried to stop it, but it ultimately was passed in the 1960s, and was a proud moment for this body and this institution. They never said: But we are going to shut down the government if you fund it or enforce it. They had too much respect for the institution. They had too much respect for the importance of the continuity of government over and above any issue, no matter how passionately they felt about it.

I hope this weekend we can let go of this idea that a minority of the government can hold it hostage because of one particular piece of legislation that they don't like.

This is an economic but it is also a moral issue. It is about trying to help people deal with the shadow of health care hanging over them. It is not perfect, but it corrects some of the most glaring defects in the private insurance system, and it provides an opportunity to millions of Americans to escape the day-to-day shadow of a health care catastrophe.

To those who want to fix it, I stand ready to help. To those who have ideas and suggestions, I stand ready to listen. To those who want to destroy it, however, I stand in your way. And to those for whom the shadow has finally been lifted, I stand at your side.

I thank you, Mr. President.

I yield the floor.

Mr. President, I ask unanimous consent that at the conclusion of my remarks, the Senator from Connecticut, Mr. Blumenthal, be recognized.

We are going to have a vote here in the next few days, depending on how the schedule and the calendar works out, on whether to defund ObamaCare. That is a vote that I think many of us in this Chamber want to have. I know many of our colleagues on the other side, the Democrats, would prefer not to have that vote. But it is time for us to go on the record and to indicate to the American people, who are very fed up with this law, and frankly have not had a good opportunity yet to see much of it being implemented, because much of the implementation will occur in the next few months--but we are going to get to that vote here in the next few days, one way or the other. The pressure is on. The pressure is on Republicans and Democrats to stand and to indicate one way or the other about whether they are willing to stand with the American people and against ObamaCare, which is having a harmful impact on so many different levels across the country.

I want to point out, if I might, a few of those impacts. Obviously, many of us here in the Chamber are very concerned about the economy, about jobs and about creating a better economic future for the people we represent.

We are suffering through a very sluggish, anemic economy, with growth rates that are hovering in that 1 to 2 percent range, but certainly not a range that gets Americans back to work or increases the take-home pay for middle-income Americans.

If you look at the economic data, it is pretty sobering. We have had this chronic high unemployment rate that has been sustained for several years in a row, 7.5 percent. If you add in the number of people who have quit looking for work or are underemployed, in other words they want to work full time but they are working part time, the real unemployment rate is much, much higher.

There are about 22 million Americans who are unemployed today. If you factor in those who have quit looking for work and those who are underemployed--who are working part time instead of full time--the unemployment rate goes up to well over 10 percent.

You have a lot of Americans looking for jobs. At the same time, the jobs that are being created in the economy are part-time jobs.

What is happening? A lot of Americans, who would love to be working full time to be able to provide for their families, are now being forced into part-time jobs.

In fact, 60 percent of the jobs created this year are part-time jobs, not full-time jobs.

If you look at the labor participation rate, it is at the lowest level that we have seen in 35 years. You have to go back to the administration of President Jimmy Carter to find the time when the number of people in the workforce, as a percentage of those available to be working, is as low as it is today, 63.2 percent.

The economic data just rolls on and on. This is a very sluggish, very weak, very anemic economy.

When you ask people and ask businesses why that is, why are you not hiring full-time workers, why are you hiring part-time workers, why are you reducing the size of your workforce or not hiring people that you otherwise might hire, why is this issue of take-home pay going down relative to what it was when the President first took office, the answer, in most cases, comes back pretty simple: It is ObamaCare. It is the cost, the mandates, the requirements, and the uncertainty associated with the President's health care law, and some other concern, I might add--government regulations. But policies coming out of Washington, DC, are making it more difficult and more expensive for our small businesses and job creators to create the jobs that are necessary to keep our economy going.

This is why you have this sluggish economy and this chronically high unemployment rate, part-time jobs rather than full-time jobs, and lower take-home pay. This is the slowest recovery we have seen, literally, in the last 50 years. This is the economy that we are in the midst of right now.

As we talk about ObamaCare--and my colleagues and I come down here, and I was here when we voted on it back in 2009 and 2010--I was on the floor on a regular basis talking about why I thought this was going to be a disaster for jobs, for the economy, for health care costs. I was offering up amendments, alternatives that we thought would be better. We think there are many that would work much better in terms of actually making health care more accessible and more affordable to more Americans, but we were unsuccessful.

They had the votes. They passed it. It was a partisan vote. It was without a single Republican vote here or in the House of Representatives. It was a party-line vote. I think that is now why the American people have rejected it. They know that it was a partisan piece of legislation passed without any input from the other side and without the ideas and alternatives that might have made more sense in terms of addressing the health care needs the American people said they wanted to see addressed.

But that being said, it is not only us who come down and talk about this. We have now seen, as this thing has been slowly implemented, some of the impact. Some of the taxes have kicked in. You are starting to see some of the additional costs that we said would impact middle- income families in this country when it comes to the cost of their health insurance.

You don't have to look very far to see the people who are writing stories about that.

In fact, instead of listening to only Republicans who come down here on floor and talk about this, you can look at the headlines of the newspapers across this country. These are just this last week. We are not talking about a long period of time, these are headlines from the last week.

The National Review Online: ``Sorry, Mr. President, There Is `Serious Evidence' Obamacare Is Bad For Economic Growth.''

The Associated Press: ``Census: No sign of Economic Rebound for Many in the U.S.''

The Hill: ``Franchise owners come to the Hill to plead for ObamaCare relief.''

Washington Times: ``Georgia Health Care Company Cuts 101 Employees Due to Obamacare.''

Reuters: ``Cleveland Clinic announces job cuts to prepare for Obamacare.''

WSB-TV: ``Emory Healthcare to cut 100 jobs partly because of Obamacare.''

Lancaster Online: ``How part-time workers are feeling the pain of Obamacare.''

You can go on and on with only the headlines talking about the impact on jobs and the economy of this ObamaCare legislation, which is in the process now of being implemented.

I think the other thing that we have said all along would happen--and that is what we are seeing happen as well--is that health insurance costs are going up, not down. If you look at the data--and these are some of the news stories that I have mentioned, these are headlines from just the last week.

National Public Radio: ``Health Care Costs Are Projected To Outpace Economic Growth.''

Associated Press: ``Premium concerns lead some small businesses to temporarily sidestep health law.''

I could go on. But the point, very simply, is that the validators of the things that we are seeing here are out there every single day in the media.

There is a study that came out, or I should say a report that came out from HHS, which was supposed to give us a new idea, or a glimpse of what the premiums are going to be under the exchanges when they are fully up and running. That is supposed to be sometime next week.

The Health and Human Services department issued some information about that yesterday.

What is ironic about it is that with less than a week to go before these exchanges are supposed to go online, it is a 15-page report and a press release that summarizes some of the premium data.

What they did is HHS compared what the Congressional Budget Office projected rates might look like in 2016 to its own findings. It didn't compare it to what it cost last year. It didn't compare it to the reality that most Americans are experiencing in terms of the health care costs that they deal with on an annual basis. We are not getting any information that gives us any insight into what these costs are actually going to be.

Fortunately, there are others who have looked at this same information, the data dump that was released yesterday by the Health and Human Services department, and compared it to what insurance costs before the Affordable Care Act passed. In other words, we heard the promises from the President when this was being debated, that health care costs were going to go down by $2,500 per family. Obviously, we are seeing the exact opposite. There was a CMS study that came out just a few days ago that said health care costs, because of ObamaCare, actually are going go up by $621 billion. If you divide that by the number of families in this country, a family of four, that is $7,450 per family of four increase, not decrease, in health care costs. That is the estimate of the CMS actuaries.

When you look at what the information coming out of HHS suggests, and you compare it to a baseline of what health care costs are before this becomes implemented, you get a very different picture. Some of the analysis that has been done suggests that ObamaCare is going to increase underlying insurance rates for younger men by an average of 97 to 99 percent and for younger women by an average of 55 to 62 percent.

It says the worst off is the State of North Carolina, where individual market rates are going to triple for women and quadruple for men. We can go down the list State by State, and we get sort of a detailed explanation of people at various stages in life, such as a 40- year-old woman. I am looking at some charts here comparing my State of South Dakota. This is the Affordable Care Act bronze premium versus the pre-Affordable Care Act health care premiums that people in similar circumstances were faced with. For a 40-year-old man in my State of South Dakota, it says that this is going to increase his premiums by 146 percent and for a 40-year-old woman 96 percent.

The evidence keeps piling up out there. It is in the news stories, from the people, and the businesses who were talking about the impact that it is going have on them. The analysis that is being done actually compares what this is going to do in the exchanges--the premiums are going to be at the exchanges--with what people are actually experiencing today. It is not some hypothetical like the HHS numbers suggested; you find that it is like a picture. A picture is being painted of a very serious situation for middle-class families who were hoping, hoping, when all the promises were made, that they were going to see their health insurance costs go down, not up. An exact opposite effect is happening.

We can go through, again, State by State and look at the various analyses. But I think the point is that instead of having health insurance costs go down as a result of ObamaCare, they are going up, and they are going up dramatically.

In this CMS estimate by the actuary, that just came out a few days ago, there is a $621 billion increase in health care spending in this country attributable solely, singularly to ObamaCare. Divided by the number of families in the country, as I said, that is a $7,450 increase.

Why are people rejecting this? Well, I think that is the obvious reason. They realize, most people do, at least, that these are pocketbook issues. These are kitchen table issues. These are the types of things that as Americans they are trying to figure out, how to pay their bills and how to keep their family covered. They want to figure out how to save a little money for their children's college education, how to make ends meet, and how to keep things afloat.

They are very concerned about what they are seeing and the impact of this legislation on what they are having to pay for health care coverage. They are also very concerned about what it might mean for the jobs that they have today and hopefully aspire to in the future. Many of these are in jeopardy, because businesses who are hit with these new mandates, these new penalties, these new requirements under ObamaCare. Businesses are finding it more and more difficult and more expensive to create the jobs that will help these middle-income families meet the needs of their families and try to provide a better future for their children and grandchildren.

One of the reasons is, at the end of the day, as people are assessing this, there is so much information, polling data, and survey data that corroborates the anecdotal information we are hearing from individuals and businesses out there. People are increasingly skeptical, increasingly suspicious, and increasingly frustrated with the ObamaCare legislation. They want to see a do-over.

One of the biggest examples of that--and they probably were the biggest advocates of this--were the labor unions. If you look at what the labor unions are now saying, there was a letter a few weeks back from three of the largest unions in the country, including the Teamsters union, led by Jimmy Hoffa.

They said that ObamaCare would shatter benefits for their members. They said it would create nightmare scenarios. They said that it would destroy the foundation, the backbone, if you will, of middle-class families, and that is the 40-hour work week.

The reason they are saying that is because, as I mentioned, the number of jobs that are being created in America today are primarily part-time jobs. Why? Because small businesses have incentives to hire part-time workers.

One, if they hire above 50 employees, they are covered by the mandate that says they have to provide government-approved health care to their employees.

Two, the full-time employee hour limit is 30 hours. More and more, employers are trying to stay under 50 employees and trying to employ people for fewer than 30 hours a week so that they are not hit with these mandates under the ObamaCare legislation.

This is not a good scenario for someone who is out there looking for a job and for someone who is looking for a better job. It certainly isn't going to help Americans improve and increase the amount of take- home pay that they receive on a weekly to monthly basis.

That is why, if you look at again, some headlines from newspapers.

The Washington Examiner says: ``Just 12 percent think Obamacare will have a positive impact on their families.''

Fox News poll: ``68 percent concerned about their health care under the new law.''

NBC News poll: ``Obamacare remains highly unpopular as implementation looms.''

Washington Post poll: ``Many Americans confused about the health-care law.''

CNN Money: ``Most employees still in the dark about health care reform.''

There is anxiety, there is frustration, there is skepticism. I think most of these folks share the view that was expressed by the unions, perhaps the biggest advocates of the health care law when it passed. What we would like is a do-over. It either needs to be fixed or it needs to be repealed.

That was essentially the message that was coming from the unions at a meeting they had in California a week ago.

It goes on and on. We are going to have an opportunity to right that wrong. We are going to have an opportunity to get that do-over and to have a vote.

The vote is going to occur in the next few days, and it is going to give us an

opportunity to go on the record about whether we ought to continue to fund a program that we now know is not working. And all the evidence that I mentioned here today, all the conversations we have with businesses in our home States, with hospitals--I mentioned earlier Cleveland Clinic, which is reducing its workforce to prepare for ObamaCare. That is going on all across this country. It is not too late for us to get this right. We can correct this. There is a better way to do this. It didn't take a 2,700-page bill and 20,000 pages of regulations to fix the things that were wrong with the American health care system.

But now we have a government takeover of literally one-sixth of our economy, massive amounts of redtape and bureaucracy and regulation and the uncertainty associated with that, higher cost for individuals, much higher costs--dramatically higher costs, as I pointed out--and fewer job opportunities for families around this country, at least for full- time jobs, and lower take-home pay and a lower labor participation rate and sluggish economy. That is what this has wrought. That is what we need to correct and fix, and we are going to have an opportunity to do that with a vote later this week.

So, Mr. President, I know it is very hard to acknowledge sometimes when something is not working, and it is something you have invested in, something that in this case a number of our colleagues voted for when it was passed here several years ago. But in the interest of the American people, in the interest of doing what is right for jobs, for our economy, for the health care needs of American middle-class families across this country, it is time for us to fix this, to right this wrong, and to move in a different direction.

So I hope we will have the votes. There will be some of our colleagues on the Democratic side who will vote with us when we get to this vote here in the next few days and may send a very clear and loud message to the American people that we are listening, that we hear you, we understand your frustration, we want to fix this and get it right, and we want to go in a different direction. And I think that will be a welcome relief to Americans, who in overwhelming numbers are finding this less and less to their liking. The more they find out about it, the less they like it and the more concerned they are about their future and their families.

Mr. President, I yield the floor.

Mr. President, will the Chair please let me know when 15 minutes has expired. I have 20 minutes. I would like to know when 15 minutes has expired.

Mr. President, once after I made a speech my late friend Alex Haley, the author of ``Roots,'' came up to me and said: Lamar, may I make a suggestion.

I said: Of course.

He said: When you speak--instead of ``making a speech,'' would you say, ``let me tell you a story,'' and someone might actually listen to what you have to say. So I do have a little speech on the new health care law to make. But before I make a speech, let me tell a story that I think applies to the new health care law. It is a story about two famous and patriotic Tennesseans who went to Texas.

The two men are Sam Houston and Davy Crockett. In the early part of the 19th century, Sam Houston was the Governor of Tennessee. He resigned that position because of a problem with his marriage. He went to Arkansas, lived with Indians, and he went to Texas. Congressman Davy Crockett went for a different reason. He got crossways with President Andrew Jackson, who recruited a one-legged veteran of the War of 1812 to run against him and he lost his race for Congress in 1834. He later went to the courthouse steps in Madison County,

TN, and said what every defeated candidate has always wanted to say to such voters. He said: I am going to Texas and you can go to hell and he went to Texas. That is historic fact. I am not using bad words here.

So we had these two famous Tennesseans, patriotic, brave men, both of whom went to Texas. They had the same goal in mind, the independence of Texas, but they had different tactics. Former Congressman Davy Crockett said: I think I will go to the Alamo. Some people said: Davy, if you go to the Alamo, you will get killed. He went to the Alamo anyway and he did get killed, but we remember him for his bravery and we remember the Alamo.

Sam Houston took a different tack. He withdrew with his men to San Jacinto. He was heavily criticized by some people in Texas at that time for withdrawing. Some said it was a retreat, but he waited until the Mexican General Santa Anna was in a siesta with his troops, he attacked, defeated his troops, and he won the war.

Today we celebrate both men. We think of them both as patriots, as great Americans, and we remember the Alamo. But we celebrate Texas Independence Day on March 2, 1836, when Sam Houston won the war.

The moral of the story is that sometimes in a long battle, patience is a valuable tactic. That is why I am in Sam Houston's camp on this one. I am not in the shut down the government crowd, I am in the take over the government crowd. Americans should elect more Republican Senators and then ultimately a Republican President and then I am going to delay, dismantle, and replace the new health care law which we call ObamaCare with a law that actually reduces health care costs for Americans.

My first reason for not shutting down the government is that it will not work. The problem is even if we were to vote to shut down the government, according to the way some people argue--and I understand their passion and I respect it--ObamaCare would just keep going like the Energizer bunny. The reason Senator Coburn, the Senator from Oklahoma, has pointed out is that 85 percent of the funding for ObamaCare is mandatory spending. Mandatory spending is the type of spending that just keeps going. So money for the exchanges, money for the subsidies, and the individual mandate would continue. What would we have achieved? We would have shut down the government, but most of ObamaCare would keep going. If that is not enough, the President has authority in the law to declare some services essential. I assume, since this is his signature issue and he is President for another 3 years, that he would declare most of ObamaCare essential services.

So where would we be? As long as we have a Democratic majority in the Senate and President Obama in the White House, it takes 67 votes in the Senate to repeal ObamaCare and we have 46 on the Republican side. Every one of us has voted against ObamaCare repeatedly. Every one of us would do so again. Every one of us would vote to repeal it. But in my view, the right tactic is not to shut down the government. It won't work, ObamaCare would just keep going, and we would have shut down the government.

What does that mean? What does a government shutdown mean? Not everything would shut down, but here are some of the things that would or could happen: The 3.4 million Active-Duty military who would have to report to work--whether at Fort Campbell in Kentucky and Tennessee or in Afghanistan--would not be paid for their service as long as the government is shut down. At home, their spouses could suddenly find the Department of Defense schools closed. What are they going to do for childcare, or with a check arriving too late to pay the mortgage? Social Security checks would continue to be paid, but the offices might be closed. Same for more than 20 million of our veterans who receive benefits; they might come late. Two million Americans fly everyday. There would likely be fewer TSA agents, fewer air traffic controllers, leading to long lines at the airports in Nashville and New York and Chicago. How do you think those 2 million people are going to feel about that?

The national parks would close. Head Start might close and many of the 110,000 people at our National Laboratories could be furloughed.

The last time the government shut down was nearly 20 years ago. Back then, 200,000 people applied for passports and couldn't get them during the shutdown. There are 200,000 Tennesseans going to college this fall who want or are in the process of getting a new student loan and they might not get it on time.

Your gun permit might not come through, neither might your FHA loan. The last time we had a government shutdown, it cost the taxpayers $1.4 billion extra dollars, according to the Congressional Research Service.

So I am in the Sam Houston camp on this issue in that I want to show a little patience in trying to win the war. If we shut down the government, ObamaCare keeps going, it costs the taxpayers a lot of money, and inconveniences a lot of Americans. Who do you suspect is going to get blamed for this? We will have suceeded in shifting the blame for passing ObamaCare from the Democrats, who did it unanimously, to the Republicans for shutting down the government. You would think the Democratic National Committee might have come up with that idea, not the Republican National Committee. That might not be a good public policy position, but it is a fact and people are observing it.

Then there are people who say to be a good conservative, you have to vote to shut down the government. I have been listening to these people who define who is a good conservative and who is not a good conservative. It is a little bit like being in Sunday school and somebody new comes into class and says: I am a better Christian than you are and if you don't agree with me get out of the church.

You might say: Grandma is a Quaker and Uncle Sam is a Baptist and we all try pretty hard in our faith. It is not up to us to judge which one of us on the Republican side is a better conservative than another. Everyone who looks around knows among Republicans, most of us are conservatives, but we have different kinds. We have neoconservatives, we have paleoconservatives, we have fiscal conservatives, we have social conservatives, we have cultural conservatives, we have Ross Perot conservatives--we have opened the door over the last 40 years to every kind of conservative, and it has made our party bigger and more successful because we have tolerated different points of view.

So I am not for shutting down the government for all those reasons. It will not work. When the government has been shut down before the Congressmen could not buy their plane tickets back to Washington fast enough to open the government because the voters were absolutely outraged. It would shift the blame for ObamaCare, which ought to be the referendum in 2014, to should you shut down the government or not shut down the government? We should not be in this business of saying I am a better Christian than you are or I am a better Jew than you are or I am a better conservative than you are. We ought to respect each other's point of view.

Instead, what should we do? First, we ought to delay implementation of the new health care law. My colleague from Tennessee, Representative Marsha Blackburn whose conservative credentials I've never heard anybody question, and Senator Jeff Flake from Arizona wrote an editorial the other day--I ask unanimous consent for it be printed in the Record following my remarks--saying the health care law must be delayed.

There is good reason for that. It is coming too fast and the chairman of the Finance Committee said it is going to be a train wreck. The logical thing to do is delay it for 1 year. The President has already delayed many provisions of the health care law. The employer mandate has been delayed for 1 year. The requirement that insurance companies report to the IRS information about health insurance products has been delayed for 1 year. The ability for small employers to provide employees with multiple health insurance plan options in something we call the small business SHOP exchange has been delayed for 1 year. The ability for state Medicaid programs to send electronic notices to beneficiaries, that is delayed for 1 year. The start of the Basic Health Program, delayed for 1 year.

Other provisions have been delayed for 1 year and there are regulations that the administration has simply not had time to issue. So why not delay the entire law for 1 year? That would give the administration time to at least get ready it would give the American people a chance to have a referendum on the law in 2014. So that is the first thing we could do.

The second thing we could do is begin to dismantle the law. By that I mean we should repeal all of the job-killing, premium-hiking taxes, especially the medical device tax. This is a particularly onerous tax that is 2.3 percent on the revenues of those companies and it drives up the cost of medical devices that tens of millions of Americans use. We should also and repeal the mandates on individuals, families, and job creators that drive up premiums. But that is not all we should do.

We have a responsibility to say what we would do as Republicans if the voters were to trust us with the government. If they were to give us more Senators who would vote to delay, dismantle, and repeal ObamaCare, what would we do with it? Or if in a couple of years they were to give us a Republican President, what would we propose?

We can do a pretty good job of saying what we don't like in ObamaCare. Three years ago, I was asked by Senator McConnell and Speaker Boehner to lead off for the Republicans at the President's Health Care Summit. I took the opportunity to outline for the President some of the problems with his proposal that we saw at that time. It turned out that we were pretty prescient in what we were saying because most of the problems we predicted have happened: increased premiums, more spending, more taxes. We said a 2,700-page bill, more or less, probably has a lot of surprises in it. The bill cut Medicare by one- half trillion dollars, not to make Medicare solvent, but to spend on a new entitlement even though Medicare is going broke within several years according to the Medicare trustees. If Medicare goes broke, people will not be able to depend on it.

We said the new law would mean there will be about one-half trillion dollars of new taxes, and millions of Americans' premiums would go up. Today, the newspapers are filled with stories of rising premiums. So that is what we said at the President's Health Care summit 3 years ago. Now we have an obligation to say what we would like to do instead.

I said to the President at that time: Mr. President, the President's--your proposed health care law is an historic mistake because it expands a health care delivery system that already costs too much instead of taking steps to reduce its costs. The law is a mistake because it attempts to be comprehensive, and it is too big a bite to chew, too much to swallow, and too much to digest at one time.

That is turning out to be right. That is why we have all these delays. So we suggested why don't we go step-by-step to begin to reduce health care costs? We suggested at the President's health care summit working with him in a bipartisan way to do that.

We can still do that. We can delay it. We can dismantle the parts of it I talked about. Then what do we do?

Step No. 1, make Medicare solvent so seniors can depend on it. Senator Corker and I have a proposal which will do that, offer seniors more choices and at the same time reduce the Federal debt by nearly one trillion dollars over the next 10 years. Medicare needs to be solvent because we have many Tennesseans who depend on it to pay their hospital bills, and it is going broke in a few years if we don't take steps to do that.

No. 2, give Governors more flexibility with their state Medicaid programs. Medicaid has gone from 8 percent of the State budget when I was Governor in the 1980s to 26 percent today. It is soaking up money that ought to go to higher education. Governors would like to keep tuitions from going higher, but they cannot and the main reason is Federal Medicaid mandates get in the way so we need to make Medicaid more flexible.

I said when the health care debate was going on that every Senator who votes for it ought to be sentenced to go home and serve as Governor for 2 years to implement it. That may be one reason we have so many Governors who are having a hard time balancing their budgets with all these federal mandates.

No. 3, strengthen innovative workplace wellness programs. The administration has a regulation that needs to be repealed that restricts the ability of employers to say to employees: If you live a healthy lifestyle, you can have lower insurance premiums.

No. 4, let small businesses pool their resources and offer a lower cost insurance plan for their employees.

No. 5, provide families the opportunity to purchase insurance across State lines.

No. 6, expand access to health savings accounts and catastrophic health insurance plans, which would give people an opportunity to buy cheaper insurance rather than more expensive insurance.

No. 7, incentivize the growth of private health insurance exchanges.

No. 8, make it easier for patients to compare prices and the qualities of doctors.

No. 9, incentivize States to reform junk medical malpractice lawsuits.

I have talked about one way to delay ObamaCare, two ways to dismantle it, and nine steps to move from expanding a health care delivery system that already costs too much. By introducing more choice and competition into our health care delivery system, we can acheive the goal of reducing costs for most Americans. That is a strategy, an agenda and a plan that will earn the confidence of enough independent voters in Tennessee and other States across this country to elect more Republican Senators, or Democratic Senators who agree with us, and that will give us a chance to dismantle, delay, and repeal the health care law, which was an historic mistake.

This is nothing new. We counted it up. Republicans mentioned 173 times in the health care debate our step-by-step plan to reduce health care costs. We still stand ready to put it into place.

The best way to repeal Obamacare is not to shut down the government. The best way to do it is to take over the government, elect some more Senators, and elect a President. Put it in a bill. That is our constitutional system. We all admire the Constitution. We carry it in our pockets, and we talk about it. We have a constitutional system, and we have to follow those rules if we want to make legislative changes.

I greatly respect the passion and the endurance of those Senators who argue that we should shut down the government if we don't get our way immediately on the health care law. I respect that just as I remember the Alamo and respect our great Tennessean Davy Crockett who went to Texas. But on this one, when it comes to tactics, I am in General Sam Houston's camp. I think we will have to show patience to win the war. In the meantime, let's delay ObamaCare, let's dismantle it, and let's show the American people that we have a better plan with better steps to replace what is in the law now with a step-by-step plan to reduce the cost of Americans' health care. That is the plan I am voting for today and the rest of this week and the rest of this year and next year, until we get the job done.

I thank the Presiding Officer.

Mr. President, I rise today to talk about what is happening in my home State of New Hampshire as a result of ObamaCare. When I ran for the Senate in 2010, one of the reasons I decided to do so is because when I saw ObamaCare had been passed, I worried about what was going to happen with this law.

We saw it could offer less competition, limit peoples' choices, limit their choices on who would be their physician, and also change their insurance policies and raise costs in a health care system that costs too much to begin with.

Sadly, we are now seeing all of these fears come true with ObamaCare. Unfortunately, I have seen it firsthand in my home State of New Hampshire. In fact, I have heard it from my constituents, whether it is at a townhall, whether it is visiting with a small business, whether it is listening to someone who is having their hours cut because their employer is trying to meet a 29-hour requirement.

In fact, right now in New Hampshire there is only one insurer that was approved to offer health policies on New Hampshire's ObamaCare exchange. In order to prevent premiums from skyrocketing--and by the way, people in New Hampshire will be paying higher than the national average for premiums under ObamaCare. But to prevent them from skyrocketing even further, this lone New Hampshire insurer has been essentially forced to limit its network of providers to exclude 10 of our 26 hospitals.

What does that mean for the people of New Hampshire? Several of the hospitals have been excluded as a result of ObamaCare from this exchange and did not make the list for coverage. They are, for example Concord Hospital, which serves residents in and around our State capital, and that is not one of the providers in the network; Portsmouth Regional Hospital in Portsmouth. The largest city on our seacoast, Portsmouth Regional Hospital serves the surrounding areas. Not in the network.

Other hospitals in New Hampshire that are not in this network: Frisbie Memorial Hospital in Rochester; Southern New Hampshire Medical Center in Nashua, where I live; Monadnock Community Hospital in Peterborough; Valley Regional Hospital in Claremont; and Alice Peck Day Hospital in Lebanon.

This problem is especially challenging for people in New Hampshire who live in rural areas. It is particularly unfair to them. For example, Upper Connecticut Valley Hospital in Colebrook did not make the cut. What does that mean that Upper Connecticut Valley Hospital in Colebrook did not make the cut? If you live in Colebrook or Stewartstown or Columbia, and you need maternal care, you have to drive to Berlin. If you have to drive to Berlin from some of those areas, this round trip can take you 3 hours.

What does that mean when you need maternal care? If you have to drive over an hour or an hour and a half to get to the hospital, I have to tell you, the north country in the winter can be some tough driving. One thing I know about the residents of our north country, they are resilient, they are tough, they are wonderful people. But they should not be put through this as a result of fewer choices under ObamaCare.

I have been making trips across New Hampshire directly talking to my constituents, including to business owners. The message I have heard from them is very clear. In fact, it has been raised with me on almost every stop that I made in New Hampshire in August where I had the chance to talk to people from throughout all our State.

This is not an issue that is being raised because I am a Republican or a Democrat or an Independent. It is universal concern and worry about the impact of ObamaCare and the increasing costs that people are seeing in health care as a result of ObamaCare and fewer choices that people in New Hampshire are going to have.

Here is some of the mail I have received from some of my constituents about this law.

Dave in Manchester wrote me that he and his wife are in their forties. This is what he had to say:

Our premiums went from quarterly in May to monthly as of

June. No birthdays or changes in health. Our monthly bill

went from $497.39 for myself to $572.67, a jump of over 15

percent. My wife had her bill go from $572.67 to $801.84, a

jump of over 40 percent.

Dave says he makes approximately $31,000 a year after taxes and that health care takes up half of it.

Caroline from Grafton wrote:

Our school district and surrounding ones are cutting back

paraprofessional jobs to 29 hours. Many of these people were

full time. Instead, they hired several part-time people to

cover the once full-time positions. This law of unintended

consequences is devastating for those whose hours and

benefits have been cut. Now they are no longer entitled to

benefits; many of these individuals have worked for 15 years

or more as full timers.

John from Middleton wrote:

I am 61 and retired. I buy my own health insurance

privately. Since the Affordable Care Act, I have had to

change my insurance carrier because they left the State. I

changed my coverage because it became too expensive, and I

have had three increases in my premiums.

Chris from Nashua wrote:

As a small business owner and self-insured, I am very

worried about my costs going up. My broker mentioned that we

may see a 200 percent increase in our monthly rate.

Nancy lives near a hospital that was left out of the exchange. Ten of our hospitals, which is a huge amount in our State of New Hampshire, almost a third of our hospitals, have been left out of the exchange. Nancy wrote:

I want to continue to have my medical care with the

doctors, nurses, therapists, et cetera, whom I know and trust

and with whom I have an established relationship. Again, what

do I do? This is what the Affordable Care Act did for me.

We have seen recently that the headlines of what is happening with the impact of ObamaCare tell the story. In my home State of New Hampshire today, from the Associated Press: ``Health overhaul premiums in NH above average.''

The National Telegraph: ``Decision to eliminate Nashua hospital from health exchanges causes confusion.''

The Union Leader: ``Companies look for new ways to pay fees coming from ObamaCare.''

Concord Monitor: ``Concord hospital not part of provider network for ObamaCare exchange plan in New Hampshire.''

Nationally, the headlines are telling the story as well. A Politico recent article: ``ObamaCare: One blow after another.''

USA Today: ``Family glitch in health law could be painful. It could leave up

to 500,000 children without coverage and cost some families thousands of dollars.''

Washington Post: ``One week away, ObamaCare's small business insurance exchanges not all ready for launch.''

CNBC on Main Street: ``ObamaCare hurts hiring: Staffing.''

USA Today: ``Pew poll: Health care law faces difficult future.''

There are many more I can go through here. It has been one bad story after another because of the reality of implementing this flawed law.

The private sector impact of ObamaCare: We all want our economy to do better than it is doing right now, to provide jobs and opportunity for people in this country, to make sure everyone in this country can live the American dream. Yet the Affordable Care Act is hurting job creation and job hiring in this country.

Increasingly, employers are cutting benefits and shifting the burden of health insurance coverage to their employees. We have seen in the recent impact of this law that the Cleveland Clinic is probably the best example. The President went to the Cleveland Clinic during his campaign and cited it as a model in terms of how health care could be delivered in pitching his health care law. Yet the Cleveland Clinic recently announced, as one of Ohio's largest employers, that it would cut jobs and slash 5 to 6 percent of its budget to prepare for President Barack Obama's health reforms.

Walgreen's recently announced it is dropping health insurance coverage for 160,000 workers and will instead give them payments to purchase insurance through private exchanges. Time Warner and IBM plan to move retirees from employer-administered health plans to private exchanges.

We have seen similar stories from companies like Home Depot and Trader Joe's. They are going to end coverage for part-time employees. UPS is dropping coverage for employees' spouses.

In terms of the impact on jobs, what I have heard from companies in New Hampshire, from the smallest to the largest, is they want to do right by their employees. The rising cost of premiums and the questions that have been raised by ObamaCare have put them in a position where they can't do what they want to do for their employees and their health care. In many instances they are forced, because of higher costs, to not hire that next employee.

If you think about the structure of this law, that it applies to those with 50 employees or more, some are not going to open that next business, or that next restaurant, because they do not want to fall under this law.

What kind of law would we pass here to deal with the issue of health care that actually makes it more difficult to hire people, that actually thwarts the private sector's desire to expand businesses or if you have one restaurant, to have a second restaurant; if you have one shop, to open up a second shop?

The flaws in this law are not only that it reduces choices for consumers, but it is reducing the choices that people in this country have for jobs, which is wrong.

I think the best critiques that we have seen of the law actually came from President Obama's supporters, and they are the Teamsters Union, the United Food and Commercial Workers International Union, and Unite Here.

They recently wrote the President and said:

We can no longer stand silent in the face of elements of

the Affordable Care Act that will destroy the very health and

well-being of our Members, along with millions of other hard-

working Americans.

They have also expressed concerns that this law will destroy the 40- hour work week.

As Senator Cornyn from Texas said:

As Republicans, we are united in repealing this law. We are

united in wanting to defund this law and wanting to make sure

that we can replace this law with commonsense reforms that

drive down health costs, increase competition for insurance

companies, and give people more choice, while making sure

that we do not interfere with the doctor-patient

relationship. If you like your doctor, you can keep your

doctor, which we are now seeing is not true, unfortunately,

under ObamaCare.

I will do everything I can to make sure we repeal this law, to make sure that we can ensure that people have choice, that they can keep their doctor, and that health care is affordable for people in this country.

However, I do not support shutting down the government in order to defund this law. While some of my colleagues have urged us to shut down the government--and they haven't said it in this term, they have said they don't want to shut down the government--but the reality is they have asked us to vote against a bill that is coming over from the House that will defund ObamaCare, but will continue the funding for the government. If we were to vote as a block against ending debate on that bill, then the result could be to shut down the government.

While Americans are opposed to ObamaCare, what we have seen in a poll as recently as today is that 80 percent of Americans say threatening a government shutdown during budget debates is not an acceptable way to negotiate. I believe we should make sure that we repeal this law.

I join in what the senior Senator from Texas said, and I would hope that my Democratic colleagues would listen to what their constituents are saying about the negative impacts of this law and that they would join us, join Republicans, in ensuring that we do defund this law, that we work together, that we make sure that, by the way, businesses aren't treated better than individuals in where we are right now with the implementation of this law.

One of the most absurd things that I don't even know how you can explain to people is the President has made the decision that the employer mandate is going to be delayed until 2015. With regard to individuals, they have not been given a similar delay. How do we justify treating businesses better than individuals with a law that is going to force many people into a position where they are paying higher premiums? They may, unfortunately, lose the hospital they prefer to go to in my home State of New Hampshire, or the physician they have that trust and relationship with.

I would ask my colleagues on the other side of the aisle, how is it that we can treat businesses differently than individuals here? Why don't we join together and delay the individual mandate, at least until 2015, as businesses are being treated by the President now in his delay of the employer mandate?

I hope on the other side of the aisle we can work together and listen to the American people who loud and clear are expressing the worries, the concerns, and the impact this law is having on them. It has not been, unfortunately, a good impact.

Finally, I wish to say in terms of the strategy of shutting down the government, I don't support it also because it is not going to work. The Congressional Research Service has said that even if we shut down the government, there has been mandatory spending baked into this law, so ObamaCare can mostly continue.

To those who are asking us to take that step, I would say that even if we were to do so, we will not achieve the purpose of fully defunding ObamaCare or stopping ObamaCare from hurting average Americans.

I hope we can work together to make sure that we don't continue to hurt Americans, such as my constituents who are going to have to drive much longer distances to go to the hospital in the ObamaCare exchange in New Hampshire. They are paying higher premiums because of ObamaCare and have less choice. I would hope we could work together to ensure that average Americans don't continue to be harmed by this law.

Finally, this piece of legislation was a signature of the President's policies. It was something when he got into office he pushed right away to pass. The impact that many of us feared about this law--less competition, higher costs, interfering with keeping the doctor you want, hurting jobs--we have now seen come to fruition. So why would we at this point try to shut down the government? Why would we at this point give the President a lifeline? To quote the President's own former Press Secretary on ``Meet the Press'' this weekend:

If you think about this from the White House perspective,

you've had three fairly forgettable weeks at the White House,

right? About to lose a vote on Syria; immigration reform

looks dead; you're sinking in quicksand, and here your

enemies throw you the

rope and want to get in the quicksand instead of you.

Why would we put ourselves in a position where we would shut down the government over a law that is the President's signature piece of legislation and hand him a lifeline on this issue and, in the process, hurt average Americans, such as our military, that could be impacted by a government shutdown, such as our veterans that could be hurt by a government shutdown, such as air travel that could be impacted by a government shutdown.

By the way, the last time we shut down the government, it cost us more to reopen the government--$1.4 billion more--than it would have cost to just run the government. So from a fiscally conservative perspective it doesn't make any sense either.

I urge my colleagues on the Republican side to be united in repealing and replacing ObamaCare, and let's work together to do that. Let's work together while keeping the government going forward with responsible spending levels. Let's not forget we are $17 trillion in debt. Let's not let that debate get sidelined by this debate of ObamaCare.

Finally, to my colleagues on the other side of the aisle, you have been hearing many of the same stories from your constituents. How can we treat businesses differently than individuals? Why wouldn't you agree to something such as a delay of ObamaCare for 1 year for individuals similar to the delay businesses have been granted by the President? Why would you want to continue to fund a law right now that is already hurting people in terms of their choice for their doctor and driving up costs and hurting job creation?

I know we can resolve these issues and I know the American people expect us to. I think we can do this in a way that helps address health care costs, coverage, and in a more responsible way than ObamaCare has done, allowing people to keep the doctor they have chosen and allowing people to have greater choice through competition.

I yield the floor.

Mr. President, I have had the chance to listen for almost a better part of an hour to my two neighbors, Senator Harkin and Senator Coburn, one from Oklahoma and one from Iowa, both of whom, as many of us know, have totally different views of why we are here and what is going to happen based on what we do in the next few days and the days that follow after that.

First of all, why are we here? The new spending year starts a week from yesterday. It starts next Tuesday. Has the Senate passed a single appropriations bill? No. Why are we doing this again? Why are we so committed over the last 5 or 6 years to management by crisis?

I think in the last 6 or 7 years now, the appropriations process has not worked one time. It wasn't too many years before that when we passed all of the appropriations bills for the year that ended September 30 and began October 1 in July--all of them, individually. That is how the government worked and was supposed to work. Here we are a week away, and why are we here? Why does everything have to ride from crisis to crisis? That is why people are frustrated, people are upset.

Senator Harkin, my good friend, we are both frustrated and upset. We would like to see this process work. The Appropriations Committee would like to see the process work. Why do we go from standing on one edge of the cliff, and the next time people pay any attention, we are on the edge of another cliff again? We need to work together to make this process work.

There has been, as Senator Coburn pointed out, some significant disagreement on where the current debate could take us. One side believes that at some point--one side of the debate believes that at some point the President of the United States would sign a bill that eliminated the health care plan that he now calls ObamaCare, so I am going to call it that too, as he has, and Senator Harkin has alternated using that term. I don't believe the President would sign that bill. I do believe he is President and I do believe he has to sign a bill for the bill to happen, and so we have to at some point decide what can we do to make this process understood in a better way by the American people.

Senator Harkin referred to this as a starter home. I don't know exactly where this goes, but I do know that the majority leader said over the last few days, Well, what this really is is a single-payer system. I am not for that. As far as I know, nobody on my side of the aisle and many people on the other side of the aisle aren't for that, but that is where the Senate majority leader says this goes. I don't want to go there.

So what can we do to make the health care system work better? I wish to talk about that a little later too because there have been plenty of ideas about what could make this better. Apparently, when it comes to not moving forward with the Affordable Care Act, the administration believes it can decide what not to move forward on, but the Congress can't. It can decide what to essentially repeal. Part of this act was called the CLASS Act, long-term health care provisions that about a year and a half or 2 years ago, the Secretary of HHS said what I said, but in the committee, when this bill came up, when I was on the House Commerce Committee that dealt with this, essentially saying this long- term plan won't work. ``Oh, no, it will work and it will provide lots of money.'' Secretary Sebelius--even though it is the law--said, about a year and a half ago, this will not work, so we are not even going to try to do it.

The President said recently--or I guess the Secretary said recently-- that the small business plans that were supposed to be available on January 1, 2014, will not be available. The President said: We are not going to have any penalties for the business requirement in 2014, but we are still going to have the individual requirement.

Interestingly, the President also said: In normal circumstances, I would go to the Congress and say change the law, but these are not normal circumstances. I do not believe there is a Presidential prerogative to decide whether you are in normal circumstances or not. If the law needs to be changed, let's change the law. If parts of it need to be repealed, let's repeal it. If parts of it need to be postponed, let's postpone it.

Here we are, only 6 days from the beginning of a new spending year. We are also 6 days from what will be a critically important moment for a lot of families--a lot of individuals, employers, people who are going to be looking at these exchanges, and they do not seem to be ready.

It had been hoped that there would be available information out there so that for weeks we could have sort of what is called the dry run, where people could see if this works, where they could compare plans. That is just not there, and we know it is not there.

In Missouri, where I live, people have been concerned from the very first about what they saw as a flawed law. In fact, our State was the first State in the country to actually vote on whether we wanted to be part of this. Overwhelmingly, Missouri voters said no, and that was when it was more popular in any polling than it is right now. People have looked at this and they do not want to go there.

Missourians, in August of 2010, had a vote on the ballot, and 71 percent said we should not participate--71 percent--and that was, again, when the law was more popular than it is now. That was the first time people had a chance to vote on this.

In November of 2012, Missouri voters voted again. This time the direction to the legislature and all State agencies and the Governor was: Do not establish a State exchange unless the legislature agrees. There was some disagreement as to whether the Governor could do that on his own. Missouri voters said: We do not want you to do that on your own. So in our State, as in a majority of the States, it has not happened. The implementation will is not there because people do not believe this plan will work.

The elements of this that improve what happens in a competitive marketplace could still be there in other changes we could make. This is incredibly unpopular around the country. People are frustrated by it. People are looking for ways to end moving into the Affordable Care Act; that it simply will not work. Senator Coburn explained earlier why they would not work. Charles Krauthammer, one of the leading conservative commentators in the country today, said about one of the plans this week: It will not work. The President's health care plan is falling under its own weight. When something such as that is happening in politics, you do not rush in to stop it from happening. If you do not think the law should be implemented anyway, let people see that this will not work, and we are seeing that.

I am for defunding the plan. I am for starting over again. I believe most Americans would like to see us start over again and take the best health care system in the world and make it work better.

Anybody who was defending our system as perfect got into a trap they should not have gotten into because it was not perfect. It was largely an accident of a couple of decisions made in the 1940s, where health care and health insurance became way too dependent on where people worked, where people did not have the ownership they needed in health care, and where we did not have the competition that we needed to buy across State lines, to shop for a better product, to do all those things.

But this is a plan where, again, the law is the law, unless it applies to the administration, apparently. The Congressional Research Service--no partisan organization--recently found that the administration has missed 41 of 82 deadlines.

If you are a batter in professional baseball, that is a pretty good average, .500. It is not very good if you are trying to figure out how to implement the law. They missed 41 of 82 deadlines.

The employer mandate requirement, the White House has said, is unworkable now and announced its delay. How in the world we could defend saying that employers do not have to meet their requirement but individuals have to pay a penalty if they do not have insurance--how can any of my friends defend that? We ought to, at the very least, postpone the individual mandate for as long as we postpone the employer mandate. If individuals are paying a penalty and employers that the law says are supposed to offer insurance are not offering insurance and they are not paying a penalty, there is something wrong with a government that decides that is the appropriate way to do this.

Despite the employer mandate delay announcement, we still see businesses beginning to react because they know or they believe this is eventually likely to start. Businesses, big and small, are trying to look at: If somebody does not have to have insurance if they do not work more than 30 hours, maybe we should have more employees who work less than 30 hours because our competitor might decide that companies that have always provided insurance and assistance for families and spouses decide the law now does not say we have to do that, so we are not going to do that any longer.

The law initially anticipated 3 million people who currently had insurance would lose that insurance. It is going to be a lot higher than that. The same people who were saying 3 million are today saying somewhere between 8 and 15 million, and that number is going to go up. All we have to do is calculate what has just been announced in the last few days to know that is going to go up.

The Cleveland Clinic hosted President Obama in July 2009, during the height of trying to convince Americans this was going to work. He talked about how the Cleveland Clinic was an example of cutting-edge technology. But what they recently cut in cutting-edge health delivery--what they recently cut--were 44,000 employees, and they said it was because of the President's health care plan. The same organization the President went to, to talk about how that organization runs and why we should have his health care plan, announced they are terminating 44,000 employees because of the health care plan.

This is a plan where people who were for it--and I was not for it, I have not been for it, I just simply do not believe it will work--people who were for it overpromised, and now they are underdelivering.

That famous statement made over and over again: If you like your health care plan, you can keep it--nobody believes that anymore. In fact, ask the employees at General Electric or IBM or UPS or Walgreens or Home Depot or thousands of smaller businesses than those: What about keeping the health care plan you like--the day that commitment was made? Those plans are not there anymore. It was one of the main selling points of this plan: If you like your health care, you can keep it. It just turned out not to be true at all.

Not only has this not made health care more affordable, but family premiums have gone up by more than $2,500 since this became the law-- even though it was the law and we are moving toward it, not implementing it.

Nearly three in four small businesses say they plan to cut hours or let employees go because of the President's health care plan. People who have more than 50 employees are doing everything they can not to have more than 50 employees because that is one of the criteria where they are penalized under this law.

Meanwhile, in April of 2013, the administration said it would delay a provision that allowed employees to pick their own plans in States that have the Federal exchange--States such as ours. It is not going to happen. Another delay.

In July of 2013, the administration delayed enforcement of the employer mandate for a year. In July, the administration announced it would significantly scale back the requirements for new State-based insurance marketplaces to verify income. When you scale back the requirements to verify income, you are also scaling back the burden that people have to provide information in order to get assistance.

I assume that means more people will get taxpayer assistance. But it also means the cost of that assistance is going to be higher, for many reasons. That is one of them. Another one is that people are going to be on the exchange that everybody anticipated would still be getting workplace-based health care.

In August of 2013, the Department of HHS--Health and Human Services-- delayed the signing agreements with insurance companies that was supposed to have specific amounts available in August. I wrote a letter at the time that said: It is very important that you meet this deadline because people need to begin to think about the decision you want them to make beginning October 1.

The Department of Labor delayed a limit on out-of-pocket spending for beneficiaries from 2014 to 2015. Again, apparently, if you want to delay the law, if you want to decide that you are not going to enforce the law, that is OK. But for those of us who say: Let's have a permanent delay, let's not fund this and now go back and start with a process where the House passes a bill, the Senate passes a bill, the two bodies come together and talk about the differences--that never happened with this law.

My friend from Iowa said: It is a starter home. But there is no remodeling process to start up for the starter home, and we are seeing what happens there. Unfortunately, there are too many examples of this.

Americans deserve commonsense health care solutions, where doctors and patients are in charge, not government bureaucrats, not people at the IRS.

When you have a health care bill that adds thousands of new IRS workers and does not add a single new doctor or nurse, you probably missed the boat in what you are trying to do with health care.

There are lots of better ideas out there: More individual ownership, fair tax treatment. The tax treatment we have had for decades now, where you do not pay income tax on a benefit you get at work, but if you get insurance on your own, you do that with dollars you have paid taxes on--now one way or the other, make that equal. Either say nobody gets a tax benefit for the money that is used to buy insurance or everybody gets the tax benefit. Let people shop across State lines. Let people find what they need that meets the needs of their family.

You are going to have more single, young adults without insurance. Why are you going to have more? Not because of the provision that allows people to stay on their family's policy--that actually added people to the insurance roles--but because of the provision that says that the most expensive people you insure cannot be charged more than three times that of the least expensive people you insure. Young, healthy people are going to look at insurance rates higher than rates they have ever seen on the individual market before, and it will make a difference.

There is plenty that can be done here. My colleagues on the other side face an important decision this week. They can stand with what is now the overwhelming majority of Americans who have rejected the direction we are headed and say: Let's defund this. Let's start over again. The one thing we have in front of us that would allow us to start over is the House bill that we just voted to move forward on that would defund ObamaCare and let us start over again or my friends on the other side can decide that the President and Senator Reid are right, that Senator Reid's idea that this leads us to a single-payer system is where we want to go, that the President's idea that he can change this law however he wants to and the Congress is not involved is right.

I will strongly urge all of my colleagues to join me in voting against any attempts by the majority leader to restore funding for this flawed law and to work with all of us, working together, as we work to replace it.

With that, I suggest the absence of a quorum.

Mr. President, as we discuss our efforts to support an effort that started in the House to defund ObamaCare in this legislation, I want to start by congratulating my colleague Senator Cruz on his remarkable 21-hour performance. I promise I will not try to duplicate that, at least not right now. But I do admire his passion and his energy, and I think probably more than anyone in recent memory, he has done more to raise this issue to the American consciousness and inspired people by his passion.

I want to say that I share his determination to stop ObamaCare before it does any more damage to our country. The two of us represent 26 million people in the State of Texas, and we have heard countless stories of how the President's health care law is already hurting not just individuals and families and small businesses, but hurting the economy.

I heard the distinguished Senator from Maine saying the President's health care law is working pretty well. But I have to say, even though I disagree with him about ObamaCare actually working, it strikes me that one point is irrefutable; that is, ObamaCare is hurting the economy and hurting job creation. We have heard at least from some of the major organized labor organizations in America--people like Richard Trumka, who said that ObamaCare is killing the 40-hour workweek. It is making full-time work into part-time work. That is one reason he and other labor organization leaders went to the White House recently and asked the President for a special opt-out or waiver.

I believe the only solution is to dismantle ObamaCare in its entirety. Some have said: After Senator Cruz got through speaking today, after his remarkable 21-hour performance, the debate is over. To them I would say, the debate has only just begun. We will be here in the Senate for the remainder of this week debating the effort to defund ObamaCare.

My friends across the aisle have repeatedly said that because Republicans want to protect the American people from ObamaCare, we want to take health insurance away from millions of Americans. Nothing could be farther from the truth.

Democrats argue that Republicans have not put forth any alternatives to ObamaCare. That is false. It is time to set the record straight.

When it comes to health care reform, Republicans have three main objectives, all of which are filed under ObamaCare. One, we want to reduce costs. The President said this was one of his goals in ObamaCare. He promised that the average family would see a reduction in their health care costs of $2,500. What are the facts? We have seen health care costs go up by an average of $2,400 for that same family. We want to expand quality insurance coverage, and we want to improve access to care.

The President has put most of the apples with his health care plan in the same sack, which is Medicaid. In Medicaid in my State, only about one doctor out of every three will see a new Medicaid patient because it only reimburses doctors about 50 percent or less of what they charge other patients. So they simply have had to refuse to see new Medicaid patients.

So we want to reduce costs, we want to expand quality coverage so that you own your own insurance policy, and we want to improve access to care.

In order to achieve those objectives, we first have to remove ObamaCare from the table. We know what the evidence has been in the years since ObamaCare first passed in 2010.

ObamaCare is already causing employers to drop health coverage. So if you like what you have, it turns out you cannot keep it. It is already causing doctors to leave Medicare, for the same reason. As I mentioned, they are leaving Medicaid. It is already causing insurance providers to reduce consumer choice. We saw a story in the New York Times just a couple days ago about that. We know it is already causing businesses to lay off workers and turn full-time work into part-time work.

It is already causing medical device manufacturers to close existing factories here in America and to move their businesses offshore because of the taxes that target that particular part of the health care industry.

And it is already causing many physicians to consider early retirement, causing a restriction in access to coverage, because unless you can find a doctor to accept you, you do not have effective access to coverage, even though you may have something called Medicaid or Medicare.

If and when the law is fully implemented, ObamaCare will drive up individual insurance premiums, it will cause millions of Americans to lose their existing health care coverage, it will jeopardize medical privacy rights by injecting the IRS into the implementation, it will further damage an already broken Medicaid program, and it will prompt even more doctors to stop treating Medicare patients.

The closer we get to full implementation of ObamaCare, the more we learn about its myriad problems and its unintended consequences. For example, the ObamaCare exchanges are supposed to open next Tuesday. But most people still do not know how much money they will be paying for insurance. Meanwhile, a front-page story in USA Today talks about a little noticed provision of ObamaCare which threatens to cost some families thousands of dollars in health insurance and leave up to 500,000 children without coverage.

For that matter, even if ObamaCare is fully implemented on schedule, the Congressional Budget Office projects that about 31 million Americans will still not have coverage. I thought ObamaCare was designed to make sure everybody had coverage. So it seems to me it has failed again in its stated objective.

My friends across the aisle like to say that Republicans are opposed to expanding health insurance coverage. But, as I have just told you, we are actually for replacing ObamaCare, which would provide people with more access to affordable health care.

In reality, what we are opposed to is policies that reduce health care choices and dramatically disrupt people's existing health care coverage. We are opposed to policies that raise taxes by more than $1 trillion on people like the medical device manufacturers that I mentioned a moment ago, which hurts innovation, which hurts people's access to the best quality of health care. And, yes, we are opposed to policies that kill full-time jobs in favor of part-time work. And we are opposed to policies that cause insurance premiums to go up rather than down.

It is true, we are opposed to policies that put government bureaucrats between you and your doctor when it comes to deciding what access to health care you and your family ought to have. And we are opposed to policies that cause physicians to refuse to see Medicare patients.

We are opposed to policies that weaken our health care safety net. And we are opposed to policies that massively expand the power of the Internal Revenue Service--that is currently racked in scandal--getting involved in implementing your health care plan.

So again, we are for reform that helps bring down the cost and improves access to quality health care in a way that does not interfere between the doctor and the patient. The kinds of health care reforms that we are for are those that deal with cost, coverage, and access.

For example, we support equalizing the tax treatment of health insurance so that individuals and employers are put on the same footing, unlike today. We support letting individuals and businesses form risk pools, particularly across State lines, to provide more choices and more competition when it comes to keeping down health care costs. And we support abolishing onerous mandates.

Why should you have to buy health coverage that includes coverage you do not need or want? For example, if you are a young man, why should you have to buy a mandatory health plan that has maternity coverage in it? It does not make a lot of sense.

And, yes, we support giving more Americans choices when it comes to how to pay for their health insurance using pretax dollars--things like tax free health savings accounts.

We also believe that making price information more transparent will create the kind of discipline that comes with a market. For example, if people know what their health care costs are going to be, and they see what their choices are, they know that the competition that comes through market discipline will improve not only the price--it will bring it down--but it will improve the quality of service.

Perhaps the best recent example of that is the Medicare prescription drug plan, which has now come in 40 percent below projected cost, because now seniors have choices when it comes to their prescription drugs, and those plans compete based on price and quality of service. That is benefiting the consumer and providing a lower price.

And, yes, we do support tighter curbs on frivolous medical malpractice lawsuits, which drive up the costs of medical liability insurance and drive doctors out of business. In Texas, we have had a wonderful pilot program. And I tell you, we have seen doctors move to Texas because they want some predictability when it comes to their medical liability exposure and the costs of their malpractice insurance. That, in turn, provides people with better access to doctors.

And, yes, we believe that you can use State high-risk pools to insure people with preexisting conditions. In other words, the idea that you need to embrace the behemoth called ObamaCare just in order to cover people with preexisting conditions is simply false. You do not. We can do it much cheaper and more effectively by supplementing the State high-risk pools so people with preexisting conditions can get access to health care.

We support States having a lot more flexibility to manage Medicaid-- something that can only happen now based upon a special dispensation from the Federal Government.

If we are able to help people coordinate their health coverage, we can do a better job of making sure that even people on Medicaid get access to health care at a lower cost.

As I said, we support introducing competition into Medicare so that patients and physicians could work together to hold down costs, just as they have done in the prescription drug program that I mentioned a moment ago.

So here is the bottom line: ObamaCare is not the only way to expand access to quality health care. In fact, it may well be the worst way to expand coverage because it raises costs and it reduces patient choices, and you have to depend on the tender mercies of the Federal Government when it intervenes between you and your doctor when it comes to your choices.

By contrast, we believe that health care reforms such as those I have outlined just a moment ago would allow us to expand access to quality health care at a lower price without interfering with the doctor- patient relationship.

Mr. President, before I conclude--because I know there are other colleagues who want to speak--I want to explain once again why I support moving ahead with this legislation that is now before us.

I note that 100 Senators just voted for cloture on the motion to proceed to the continuing resolution which contains the defunded provision passed in the House. I am committed to defunding ObamaCare for the reasons I said. But I also believe that we ought to avoid a Government shutdown. I believe that to deny cloture--unlike the vote we just had, 100 to 0--to vote against cloture on the very resolution we are for that came from the House that would defund ObamaCare is a little hard to explain.

It may well prompt the government shutdown, which I think benefits no one, and it could possibly damage our economy, which as I said earlier is fragile indeed. Here is the ultimate irony. If we are to shut down the government because we refuse to pass a continuing resolution to keep the government operating, ObamaCare still gets funded. That is because it has mandatory spending, in other words automatic spending, that even if the government shuts down, ObamaCare still, by and large, gets funded.

You do not have to take my word for it. Dr. Coburn, Senator Coburn, has asked the Congressional Research Service for their authoritative opinion. They said even if the government were to shut down, ObamaCare will continue to be funded. So I support whatever strategy is likely to help us defund and ultimately dismantle ObamaCare, but in my view, shutting down the government is not the best strategy, because it would not work. According to the Congressional Research Service, ObamaCare would continue to be funded.

To be clear: Republicans are united in our desire to defund ObamaCare. The bill before us does exactly that. So if we proceed to the bill, my hope is that five Democrats--maybe the five Democrats who voted for ObamaCare in its first instance but have been listening to their constituents as I have, people such as Richard Trumka and organized labor who have said: The promises you made, this simply is not performing as advertised. We need something to be done to ObamaCare.

We have solutions that will address that. So if we can find five Democrats to join us, perhaps those Senators who are running for reelection in States that Mitt Romney carried by double digits, the Senate would have voted to defund ObamaCare. It is that simple.

Plenty of our colleagues have acknowledged the harm ObamaCare is doing to our health care system, and to our broader economy. Now they have a chance to do something about it. Now they have a chance to actually vote with Republicans to stop this law before it is fully implemented.

Four years after Senate Democrats voted to enact ObamaCare on a party-line vote--no Republican voted for it, all Democrats voted for it--the consequences of ObamaCare are plain for all of us to see. By proceeding to the House bill, we are forcing each Member of this Chamber to take a stand either for or against their constituents when it comes to a failed health care bill, one of the most unpopular laws in the history of the country.

I know where I stand on ObamaCare. I know where all of my Republican colleagues stand. All of us stand united in our desire to protect the American people from this failed public policy.

I would urge our colleagues across the aisle to think again, listen to their constituents, including people such as Richard Trumka and organized labor and help us save America from this failed public policy disaster.

I yield the floor.

Madam President, I wish to start by acknowledging the work of my colleague, the junior the Senator from Texas, who held the floor for nearly a day speaking passionately about an issue that unites every single Republican: ObamaCare is wrong for America and needs to be repealed. The Senator from Texas has focused on the dangers of this law, explaining once again why we are all on this side of the aisle committed to overturning it. Later this week every Republican will unite to vote against any amendment to add funding for ObamaCare.

This afternoon I would like to call on my colleagues across the aisle to once again listen to their constituents and actually join us in this effort. I would like to ask Senators to take their minds back to Christmas Eve 2009. Some of us remember it very, very well. In the early hours of the morning, the majority leader rammed through a massive 2,700-page takeover of the U.S. health care system against the will of the American people, against the principles of open and accountable government, and, I would argue, against their better judgment because the people who voted for this bill didn't have to listen to all the speeches I was giving back then to realize it would never, ever do what the President said it would. But they in the end obeyed the orders of the Washington Democratic leadership anyway, and now our friends on the other side are seeing the results of their votes.

ObamaCare is just as bad as many of us said it would be, and it is about to get a lot worse. This train is picking up speed, and there is a bridge out ahead. It is sort of like one of those Wile E. Coyote cartoons, except this isn't funny because these are people's lives we are talking about. We are talking about the college graduate who is faced with a choice between exorbitant premiums and government tax penalties. We are talking about the working mom forced to scrape by with less hours and smaller paychecks. We are talking about the small businesses that are unable to grow and hire more Americans. And that is not even getting into the concerns about glitches that could expose personal information to fraud or about Americans losing the health care they like and want to keep.

Even the administration is having a terrible time spinning this law. Just look at the cherry-picked report they released today. About the best they could claim was that some premiums would be lower than projected. Let me say that again: Some premiums would be lower than projected. Note that I didn't say ``lower'' but ``lower than projected.'' Basically, this law is a complete mess.

So Washington Democrats may have been able to brush the American people off back in 2009--just brushed them off--but they have no choice but to deal with reality now. We have seen how this has worked out over the last 4 years.

It is hard to blame them for looking back at their ObamaCare vote with a lot of regret. But here is the good news. Later this week the Senate will take up the House-passed CR. If the House-passed CR passes, it will keep the government from shutting down without increasing government spending by a penny and--and--defund ObamaCare.

So for all those Democrats who shanked it back in 2006, here is your opportunity for a mulligan. Here is your chance to finally get on the same page with the American people because the American people overwhelmingly oppose this law, and you can't open a newspaper these days without being struck by some new reason you should be opposed to it too.

Remember, it is more than just our constituents who are opposed to ObamaCare. Small businesses are opposed. Even big labor bosses are souring on it. All we need is five Democrats to show enough courage to stand against their party and with the American people on this vote. That is enough to pass the bill--enough to keep the government open and to keep ObamaCare funding out of it--before this train collides with reality.

I urge my Democratic colleagues to join us, the members of my conference who are already united in our opposition to ObamaCare. Democrats, on the other side of the aisle, can help us get this job done.

I yield the floor.

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

Mr. President, I ask unanimous consent that the Senator from Kentucky and I be allowed to participate in a colloquy.

Mr. President, I would say to my friend from Kentucky, I have had over 50 hospital town hall meetings in our State over the last year and a half. The Senator and I have done a couple of these together. As a health care professional yourself, looking at it from a hospital and health care provider's point of view--which the Senator and I both had, either he in his profession or me by being in these hospitals a lot the last couple of years, and have learned a good bit-- what does the Senator think is the most devastating impact of ObamaCare on the provider world?

Speaking of Medicaid, I remember reading that our Governor got teared up when he announced that he had decided to accept the additional Medicaid mandate, which the Supreme Court actually had said was optional. I remember having a teared-up feeling too, but for a different reason. I gather what will happen in our State is there are going to be between 3- and 400,000 new people with free health care cards rushing toward the emergency rooms. What I have heard in a number of my town hall meetings is they cannot handle the Medicaid load that they have now, not to mention all of those new people who are headed their way, coupled with the $750 billion in health care provider cuts over the next 10 years to help provide a subsidy for people who are not old.

I mean, it is coming out of Medicare. It can provide subsidies for people who are not old. What is the Senator's take on where this all heads?

This bill was also sold, as we both recall, as doing something about health care costs. I was just noticing here that HHS's own actuaries revised their projections just last week to say that ObamaCare will actually increase health care costs by $621 billion out across the economy. Is there any way, I would say to my colleague, Dr. Rand Paul, how this could possibly hold down costs?

One of our constituents--I was going to mention here a letter--the Senator probably got it from the same constituent I did--to underscore how the rising cost is impacting people outside the health care provider world, regular people in business. This from a follow constituent of ours who writes:

My father began his Kentucky Fried Chicken business with

the colonel himself, and with the colonel's family. We

proudly served Colonel Sander's original recipe for 40 years.

It saddens me, however well intentioned, that this law will

undermine my ability to provide employment. It will deplete

resources that could otherwise be used to grow my business.

The Senator and I both have heard from a lot of Kentucky business people indicating, as this KFC franchisee underscores, the impact of this on the private sector.

The other thing that is clearly happening here is that

all indications are, we have a record number of part-time employees in our country now. Employers are downsizing in order to try to get below the 50-employee threshold. Of course, even as they do that, they are not necessarily unaffected by the rising costs of health insurance premiums. But we are looking around at some way to try to prevent the worst case scenario here, all of this disruption in our economy is actually the reason we have so many part-time workers; is it not?

The Senator was not here yet, but is the Senator fully aware of how this bill passed in the first place? Not a single member of our party in either the House or Senate voted for it. They brought us into session the day after Thanksgiving in 2009 and we were not allowed to leave for a month. We were here 7 days a week for a month. And we managed to eke it out. They had 60 Democrats, there were 40 Republicans. They eked it out with not a vote to spare on Christmas Eve, as a result of things like the Cornhusker Kickback, a special deal for Nebraska, the Louisiana Purchase, a special deal for Louisiana, the Gator Aid, a special deal for Florida, all while the President, the Vice President, and former President Clinton were up here telling me: Believe me. They are going to love it by the fall.

Here we are 4 years later. It is more unpopular today--I would say to my friend from Kentucky--than it was on the day it was passed. Is it not reasonable to conclude that is because of what it does?

The President himself seems to be kind of conceding that some things aren't working out well. He decided to delay the employer mandate for a year. Apparently, he has been meeting with some of his union allies to figure out what he can try to do for them.

I believe the 100 percent view of the Republicans is that if we are going to have a delay for business, why not have a delay for everybody? Obviously, we would like to defund the law entirely. There is a math problem on that in the Senate. There are 54 Democrats and 46 Republicans. But couldn't we all agree on delaying this train wreck? The train wreck, by the way, was what the Democratic chairman of the Finance Committee in the Senate, one of the authors of the bill, called it.

We have another example of this that affects our State. The President, even when he had a 40-seat majority in the House and 60 votes in the Senate, couldn't get cap and trade through the Congress.

Yet last Friday he has announced he is going to do it anyway. All indications are there won't be another coal-fired generation plant built ever.

It is a perfect example of what the Senator is talking about, a kind of executive arrogance, that if I can't get what I want through Congress, I will just do it on my own and see you in court, or whatever limited options we have left.

If he really believes he has the power to delay ObamaCare, why not delay it for everyone, not just businesses.

Here at some point, regardless of differences of opinion that we have had on our side over procedure, what is likely to happen here at some point is we are going to have a 51-vote vote on defunding ObamaCare, something we have not been able to achieve here in the last 4 years. Four Democrats, who had second thoughts, who had an opportunity to take a look at the carnage of the last 4 years, could actually pass a bill that defunds ObamaCare.

I remember, I say to my friend and colleague, standing at this very chair, 4 years ago, looking at the other side

and saying if only one of you, only one, would come with us, this bill wouldn't pass.

I also said, however, if none of you do, every single one of you is responsible for its passage. Had any Democrat on the other side, any one of them, said this is a bridge too far, I am not going to do it, it wouldn't have passed.

Consequently, every single one of them is responsible for its passage, but they have a second chance now, an opportunity for a do- over. At some point here this week they will have a chance to cast a real vote on an up-or-down basis. I have watched this for 4 years, and I don't think we ought to go forward.

It will be interesting to see if party loyalty will be so great that none of these folks will be able to bring themselves to admit that they made a mistake 4 years ago.

The tragedy of this, correct me if I am wrong, but we passed a 2,700 page bill on a totally partisan basis. We have about 20,000 pages of regulations now issued.

I used them in a speech recently. They were 7 feet tall. We had to put them on a dolly to get it out on the podium.

I would ask my friend and colleague from Kentucky, didn't I read the other day, that even after we do all of the 2,700 page bill, the 20,000 pages of regulations, there still may be 25 or 30 million people uninsured?

I think this law has no chance of working. I don't believe that, even if we are unable to defund it here in the next few days, that we are necessarily stuck with it. I have been here a while, and you have been a long-time observer through your father's career and your own. I think it is pretty safe to conclude that things that can't work don't stick and don't last. We are, after all, a representative democracy. People complain, discuss, and tell us how they feel.

I don't think this law can possibly stand. It is pretty hard to predict exactly the day upon which it ends, but it is cracking.

We have Jimmy Hoffa, the President of the Teamsters, saying you are destroying the 40-hour work week, and their Cadillac health care plan. Don't you think ObamaCare can't possibly work?

I thank my colleague from Kentucky for the opportunity to exchange some views here about the impact of this on our State and our country.

I yield the floor.