A bill to restrict the sale, lease, transfer, retransfer, or delivery of F-16 aircraft, M1 tanks, or certain other defense articles or services to the Government of Egypt.

Madam President, I guess I am compelled to say: Here we go again. We have been down this road a few times before since we passed the Affordable Care Act. Let me see, my notes tell me it is 33-- this makes the 34th time that someone on the Republican side has tried to do away with the Affordable Care Act. This is the 34th time, and they failed every time. But they are free to offer amendments, I understand that. I respect the Senator's right to do that, but we have already made our decisions on this and we are moving ahead.

I have said many times as the chair of the HELP Committee, if someone has suggestions on how to improve the Affordable Care Act, to make it work better, be more efficient, I am open to that. That should be allowed, and we should have a constant exchange on maybe how we can improve it. But this idea that we are going to repeal it? I would also say I wonder if my friend, the Senator from Texas, saw the last election. The Senator from Texas got elected, that is for sure, and I congratulate him on that. But the Presidential candidate of the Republican Party who said he wanted to repeal the Affordable Care Act lost. President Obama, who was the President who initiated this and signed it into law won, I think quite convincingly.

So the American people basically have said it is time to move on with the Affordable Care Act. Yet here this amendment basically would repeal it.

I wonder if the Senator from Texas understands it is not just the Affordable Care Act his amendment would hit, it would hit a lot of other things. When we passed the Affordable Care Act there were authorizations for other programs that were included with it. When the amendment says we cannot fund any of the provisions of the Affordable Care Act, I just made a note that we also reauthorized the Nurse Training Partnership Act. So a lot of the funds there go for training nurses.

Does the Senator really believe we should stop funding training for nurses in America at this time when we need more nurses and more nurse practitioners than ever before, at a time when our nursing profession is facing a kind of age cliff? We have a huge cohort of nurses now who are going to be retiring. We need to bring in new nurses. Yet his amendment would cut funding. He says nothing we can do could support nurse training yet in America.

Medicare fraud and abuse--fighting fraud and abuse in Medicare; that was also included in the Affordable Care Act. Again, they have tried frontal assaults on getting rid of the Affordable Care Act. Now this amendment says we are going to not fund it. It would be strange. We have a law in effect but no funding to take advantage of it.

It is almost like some people on the other side of the aisle have an obsession with tearing down health care reform. I think it is unfortunate that some missed the results of the last election, so it is time to move on. This amendment really is the equivalent of repeal. It would turn back the clock on all we have accomplished in the past year. The administration would not be able to build the insurance exchanges or enforce the act's requirements on private insurers.

Again, if this amendment were adopted, it would mean we would go back to the good old days when the insurance companies were in the driver's seat, telling you what kind of health care you are entitled to and when you are entitled to it.

Ever since we passed the Affordable Care Act, and during the time we debated it on the Senate floor, we kept asking our friends on the Republican side: What is your alternative? Basically, what we got was the status quo: Let's just stay with what we have.

I think the American people got pretty fed up with what we had, where insurance companies could turn people down at the very moment when they got sickest; when people had preexisting conditions and could not get insurance or had to pay exorbitant prices for it.

I had a note, we had a family, the Grasshoffs, from Texas--the Senator's home State. They were unable to find coverage to pay for their son's hemophilia treatment. Why? Because they had reached their lifetime limit on insurance payments.

The Affordable Care Act bans lifetime limits, so now they can get treatment. More than 100 million Americans are currently protected by this provision. This amendment would take it away. So the Grasshoffs' treatment for their son with hemophilia would end, and they cannot afford to pay for it out of their own pockets. Keep that in mind when you vote on this amendment.

The Affordable Care Act allows young people to stay on their parents' policies, we know, until they are age 26. More than 3 million young people are taking advantage of this right now. Repeal would take that away from families. The adoption of the Cruz amendment would take that away because, obviously, we could not fund anything to help make this work.

I mentioned preexisting conditions--people who have high blood pressure, diabetes, heart disease, previous bouts with cancer. Right now the Cruz amendment would say no. The insurance companies can say: No, we are not going to insure you or if we do, you are going to pay sky-high prices for insurance.

One of the big things we put in the Affordable Care Act was prevention and wellness programs that would prevent illness. So we provided for free preventive services such as mammograms and colonoscopies, so people can get those without paying copays, sometimes as much as $300 to as much as several hundred dollars for these essential services. The Cruz amendment would put us back where we would have to pay for those preventative screenings.

The Cruz amendment would deprive States and localities of vital funding to combat chronic diseases such as cancer, diabetes, and heart disease, as well as funding to make sure our kids have access to lifesaving vaccines. Thanks to health reform, the Prevention and Public Health Fund is saving lives. The Cruz amendment would stop that.

I picked up a little bit of what the Senator from Texas said about young people; that their insurance rates are going to go sky high. Has the Senator ever heard of the marketplace? It is where people compete. Under the Affordable Care Act, all of these insurance companies now will have to go on the exchanges in the open market, with full transparency, and they are going to have to compete. We have not had that in the past, but under this we do. The Cruz amendment would take that away--a real market out there for insurance, for individuals, small businesses. They would have the same purchasing power and choice that only big companies had before.

I guess what is most important is these exchanges that we are setting up will bring coverage to 32 million Americans who do not have coverage right now. They live in the oppressive fear that they are just one illness away from bankruptcy, losing their homes, not knowing if they can afford another doctor visit.

Did anyone tell States to stop this, stop what they were doing to help serve our citizens? That is what this Cruz amendment does. The Cruz amendment would take us back to the days of the doughnut hole for the elderly because the Affordable Care Act

closes that doughnut hole. We are closing it year after year; 6.1 million seniors have already saved more than $5.7 billion in discounts on drugs purchased in the doughnut hole. The Cruz amendment would stop that. It would increase seniors' drug prices by an estimated $3,500 per person over the next 10 years.

One of the key features we put in the Affordable Care Act was going after Medicare fraud, preventing Medicare fraud. We have increased criminal penalties, we have launched innovative technologies to detect and pursue those who would defraud Medicare, and we have put more cops on the beat to preserve Medicare funds for beneficiaries and not those who would scam the system. The Cruz amendment would stop all that, stop our efforts we put in there to get a handle on Medicare fraud.

Something that is very important to so many of us is what is happening in rural areas. Right now, under the Affordable Care Act, there are incentive payments paid to rural primary care providers in rural America--States such as North Dakota and Iowa and Texas. Right now the Cruz amendment would stop that incentive payment for primary care providers in rural areas.

I mentioned preventive services--right now every senior gets a wellness visit once a year. More than 34 million seniors got that last year, a free preventive service in Medicare so they can go in and get a wellness check to find out if they need to do something to take better care of themselves. They do not have to pay for that. The Cruz amendment would say if they want to do it now, they have to start paying for it.

Since this is kind of a blunt instrument, this amendment we have before us would defund all activities related to health reform, including paying the Federal employees who administer Medicare. Secretary Sebelius has informed us payments to Medicare providers would be significantly disrupted by this. You just cannot separate the Affordable Care Act from all the other provisions of Medicare that are being run by Health and Human Services or by CMS, the Center for Medicaid and Medicare Services.

Oh, yes, the Senator also talked about the deficit, reducing the deficit. I don't understand why someone would want to stop something which the Congressional Budget Office said would reduce the deficit. I guess we are going to reduce the deficit by increasing the deficit? That is sort of the logic of this amendment.

The Congressional Budget Office affirmed that the Affordable Care Act reduces the deficit by more than $100 billion in the next 10 years, and more than $1 trillion in the decade that follows. So the Cruz amendment would roll that back. I guess the Senator wants to reduce the deficit by increasing the deficit. Go figure that one out.

It is time to stop the silly games, but I guess it will continue. After all, in 1935 the Congress and President Roosevelt passed the Social Security Act. Seventy-five years later there are still some on the Republican side who would like to get rid of that.

I guess we will continue to have a few voices--not everyone--who will still be fighting the Affordable Care Act a year from now.

In 1965 Congress passed Medicare--the Republicans fought it bitterly, by the way--and 45 years later a few on that side are still trying to undo Medicare by voucherizing it, and that sort of stuff. I just have to say: Here we go again.

William F. Buckley was the founder of the National Review and sort of the godfather of the modern conservative movement in America. He was a very intellectual kind of guy. He was very intellectual and a good writer and speaker. I always enjoyed watching William F. Buckley. He once said: ``A conservative is a fellow standing athwart history yelling: Stop!''

Well, is that really the role? I think there should be a different role, and that is to stand with liberals, moderates, and everybody else to figure out what is best. We need to figure out what is best for moving ahead and not to just yell ``stop'' or repeal something. We need to do something that is so meaningful and so broadly supported, then figure out how to make it work the best.

I kind of conclude where I began. If people have suggestions on how to make the Affordable Care Act work better, smoother, be more efficient, more cost effective, fine. That would be a good debate and discussion. Just to say: No, we are not going to fund it is an ideological approach. It is not based on budget considerations, it is not based on reducing the deficit, which I just pointed out. It is not based on a rational reading of the bill and what is happening out there in terms of setting up the exchanges and all the other things I mentioned. It is just an ideological approach. It is sort of tearing it down and sort of going after President Obama, I guess, one more time. I don't want to take the position that somebody cannot offer an amendment such as that. Sure, they can offer an amendment. They can do anything. However, reasonable, rational people in the Senate don't need to follow that. We need to do what is best for the American people and leave the ideology behind.

I hope the Cruz amendment will be seen for what it is, an attempt to repeal ObamaCare at this moment in time when we are on the cusp of actually having it fully implemented. States have already moved ahead. Even very conservative Republican Governors have joined in and said: Yes, we want to extend Federal Medicaid coverage in our States. Conservative Republican Governors are setting up exchanges. We are moving ahead. Now is not the time to say: Well, we are going to cut the funding.

Again, keep in mind, this doesn't just defund the Affordable Care Act. I said there were other things, such as the Nurse Professional Training Act, which we put in the Affordable Care Act, which would also be defunded. It was reauthorized along with the Medicare fraud and abuse and the area health education centers. There are a number of things that were put in with the Affordable Care Act that would also be defunded under the Cruz amendment.

I hope everyone will see the amendment for what it is, and I hope the Senate will soundly reject it.

With that, I yield the floor.

Mr. President, I have an amendment at the desk, and I ask for its consideration.

Mr. President, the spending package we are considering this week I think is a little bit unusual, to say the least. Five of the twelve Appropriations subcommittees get detailed, full-length spending bills: Defense, Military Construction, Agriculture, Homeland Security, and Commerce and Justice. The other seven appropriations bills are basically on autopilot, continuing resolutions. So with a few exceptions, whatever the government spent last year on programs in these seven subcommittees the government will spend this year.

I know for a fact this is not what the chairwoman of the Appropriations Committee wanted. She fought hard for an omnibus that would have included all 12 spending bills. I am very respectful of that. She fought hard for it, but this is where we stand right now.

I am speaking today because the programs under the jurisdiction of the Senate Labor, Health and Human Services, and Education Appropriations Subcommittee, of which I am privileged to chair, would be put on autopilot. I suppose it comes as no surprise I think that is a terrible mistake.

The Labor-HHS bill--or Labor-H, as it is known in the terminology around here--is how we fund the National Institutes of Health, the preeminent biomedical research entity in the world. This bill is how we fund the child care and development block grant, which gives working families access to high-quality childcare. It is how we provide Federal funding to teach students with disabilities--the Individuals With Disabilities Education Act--it is how we help local school jurisdictions meet their constitutional obligation to provide a free and appropriate education to all kids, even kids with disabilities.

These services are critical to this Nation. It has been said before-- actually, the first person I ever heard say it was a recently departed and beloved chairman, Senator Dan Inouye, who once said: The Defense Appropriations Committee is the committee that defends America. The Labor, Health and Human Services, and Education Committee is the committee that defines America--who we are as a country, what we are about as a people, what we are going to do for the future of our children in America.

So we need to examine every year whether we are spending the right amounts of taxpayer money for these services. If that makes sense for the Defense appropriations bill, to take a look at it yearly, to see if we are spending the right amounts, if it is right for Homeland Security and Agriculture, why shouldn't the same level of oversight be applied to the Labor, Health and Human Services bill?

As a way of sort of describing where we are, this past December, we negotiated a fiscal 2013 spending bill with Republican and Democratic counterparts, House and Senate. So I, Senator Shelby, Congressman Rehberg, and Congresswoman DeLauro on the House side all read this bill through in December and signed off on it.

That was going to be in the omnibus bill. Well, as we know, we did not have an omnibus spending bill. So the talks were bicameral and bipartisan. They were difficult talks and we hammered out an agreement and we had a compromise. I got some of what I wanted and I lost some of what I wanted. But that is the nature of compromise. So with an exception, which I will explain shortly, the amendment I have just offered is what was agreed upon in December. No more money, not adding any money. But we are changing some of the accounts to better represent what we decided, both bicameral and bipartisan, should be priorities. That is the amendment I am offering. Again, I repeat, it is what we decided upon in December in terms of what our priorities ought to be. If we just go with Labor-H in a CR, all of that is wiped

out. So what I am proposing to replace that is the autopilot version with a detailed bipartisan compromise.

I want to emphasize this point. This amendment is not my Labor-HHS bill. Now, obviously if I had my druthers, I would have spent dollars as I wanted them to be spent. But compromise does not work that way. This amendment includes the priorities from the other side of the aisle and from the other side of the Capitol. It was a give and take. Even though there are things in the amendment I would like to change, it is vastly superior--vastly superior--to putting all of these programs on autopilot and doing this year exactly what we did last year and the year before, because we were on autopilot last year too.

Let me point out two things that are different in this amendment than what was in December. I said it was the same but there are two things different. The agreement we hammered out in December, with Republicans and Democrats in the Senate, Republicans and Democrats in the House Appropriations Committee, included money for the Affordable Care Act, for ObamaCare. This amendment I am offering today took that out, just took it out. Even though we had agreed upon $513 million for that in December, this is not in my amendment. I want to make that clear.

The second major difference between the December bill and this amendment is the total cost. As I said, the December bill would not fit within our new budget cap. We have a new budget cap since December. So this amendment fits within that budget cap by a very small, across-the- board cut of 0.127 percent. That is one-eighth of 1 percent to every program in the bill. I did not do an across-the-board cut on some at the expense of others. No. We just did it on everything, .127 percent. So the programs that would have received increases in the December bill still get the increases, just minus .127 percent. The programs that were cut in the December cut will still get cut, they will just be cut by .127 percent more. But other than those two changes, no additional health reform money, no other kinds of cuts. The amendment is basically identical to what we agreed upon in December. So I want to take a look at it and see why it is better than what I call the autopilot version or the continuing resolution.

Let's start first with education. Title I is the cornerstone Federal program for helping all students, especially those from disadvantaged backgrounds, helping them meet high academic standards. More than 90 percent of the school districts across America receive title I funds. My amendment, the one that is before us, has $107 million more for title I. What is in the bill before us has absolutely no increase, zero.

We were able to bump that up again by an amount equal to .127 percent, as I said. It is basically the same. That is title I. Special education, I mentioned IDEA, we have a $125 million increase in the amendment I am offering; in the CR, no increase whatsoever.

National Institutes of Health, we are especially proud of this. The omnibus, the Senate CR that is before us, has $71 million more than last year. This amendment bumps it up to $211 million. So the CR has $71 million, we have $211 million for an NIH increase.

Childcare. The underlying CR includes $50 million more than last year. My amendment would increase that to $107 million. That means the childcare subsidy for working families of 10,000 additional children, families who basically depend upon this so they are able to go to work.

AIDS drugs. The Ryan White AIDS Drug Assistance Program provides lifesaving drugs to people living with HIV. My amendment includes $29 million more for this program. The CR has no increase whatsoever.

So far I mentioned only some of the larger programs in the bill. My amendment addresses dozens of smaller priorities as well. At the full committee markup of the Labor-H bill back in July of last year, Senator Inouye, who was chairman at that time, promised Senator Murkowski that the final fiscal year 2013 spending bill would include $10 million for suicide prevention among Alaska Natives and Native Americans. I did not make that promise, but it was made by the chairman of the committee. I am honoring that promise. I honored it when we negotiated this in December. We included that $10 million. That is in my amendment also.

Again, a small increase for suicide prevention is not possible in a CR. But it is in my amendment. If we approve it, that funding will become law.

TRIO Program. It is an important program to many Members on both sides of the aisle. It has had broad support. The TRIO Program makes the dream of a college education possible for low-income students. As we know, this goes basically to students who are the first in their family to go to college. So if your parents had not gone to college, they would be eligible for TRIO, based upon income levels.

The bill we negotiated in December included an increase for the TRIO Program. Again, that is not possible in a CR, the bill that is before us. But it is in my amendment. If Congress approves it, TRIO will get a $14 million increase this year. I just did not have it on my chart.

I could go on and on. There are a lot of things. Food safety, lead poisoning screening for kids in this country, lead poisoning screening, diabetes prevention, worker safety. These are important priorities. They are all addressed in my amendment, because we addressed those in December. But they are not in the bill before us.

Again, let me sort of sum up what we have here in this amendment. It is the same total cost as what is in the bill before us, no additional money. It was a bicameral, bipartisan compromise that we hammered out in December. There is more money for NIH, childcare, education, I mentioned things such as TRIO, I mentioned things such as IDEA and others. I think it fulfills our constitutional duty to be good stewards of the public's money, to do adequate oversight on appropriations, and to mold and shape, again in a bipartisan, bicameral method, to work it out.

There are some who say, gee, if we pass this, the House will not take it. I do not know why not. They agreed upon it in December. I do not mean the whole House, but the House Appropriations Committee, under the chairmanship of Chairman Rogers, agreed on this in December. It was all signed off on. So I do not know why they would not accept it. They did not put it in their bill when they sent it over here. Okay. They did not. Well, there are some other things they did not put in the bill when they sent it over here too. So I think it is incumbent upon us to do our duty, to make sure we look at these programs and decide where we want to bump some up, maybe some we want to cut down, some we want to modify. That is what we did in December. Well, we finished in December. I think we started working on it back around July, if I am not mistaken. We finally got it worked out in December.

If we had had an omnibus, we would have had this. I would not be here today offering this amendment. Again, to those who say: Well, if we had this, the House would not accept it, is that a reason for us not to do our duty? Is that a reason for us not to do what is right and just and fair, because someone says maybe the House will not take it? I mean, the House would have some serious explaining to do on why they would not take it since it was already in the December compromise that was reached.

I would point out again that the defense bill, the Defense appropriations bill that is here is what they agreed upon in December. If that is the case, then why cannot we do Labor-H and all of the things that we fund the same as what we had in December also? That is my basic point here.

As I say, we did make a couple of changes. One change we did is we took out the funding for ObamaCare, which I think is a good deal. I mean, ObamaCare is something we have to continue to implement. It is going to save us a lot of money. It is going to make lives better for people all over America, already is making lives better for people with preexisting conditions, people with very intricate diseases and conditions that need to be managed, young people who are staying on their parents' policies until they are age 26, the elderly who get their free health screenings every year under Medicare. So it is already making a big impact. I am a big supporter of ObamaCare. I want to make sure it gets funded and implemented. But the

fact is that we could not do that. Well, that is no reason then not to increase NIH and childcare development block grants, IDEA, TRIO Programs, a host of other things. If the will of the body was that we could not do anything to implement ObamaCare, then at least let's do our duty and agree to meet the goals and meet the targets we set in December in our negotiations.

We laid the bill down earlier. As I said, it is basically what we had in December. I am hopeful that Senators and their staffs will take the time to look through it and see what is in there, because I think they will come to the same conclusion. No more money than what we have in the CR. It is basically the same with the exceptions I mentioned of what we did in December. We will have a better result, a better platform going forward the rest of this year and next year by not doing a CR but by doing this bill in a bill form, just as we have done for other bills in this appropriations measure.

Again, I want to thank Chairman Mikulski for fighting so hard for this. I know she has done everything possible. But, again, sometimes it falls to an amendment that we have to do to get things done. I am hopeful my friends on the other side of the aisle again will take a serious look at this and support this amendment. As I said, I see no real reason not to support it.

I mean, I am anxious to see if someone has some arguments as to why we shouldn't support this since, as I said, we had hammered out this agreement over a long period of time last fall. We always spoke about how we want to work in a bipartisan fashion, we want to accept the results of bipartisan negotiation.

That is what we did last year. I think we started probably around July, had an August break, at least by September--probably started in July, then September, October, November, December we worked it out in a very bipartisan fashion, although I didn't get everything I wanted in the bill.

If my friends on the other side of the aisle now want to say: No, we are not going to accept this, what is the use of engaging in long, hard, difficult, strenuous bipartisan negotiations where we reach an agreement and they respond: Well, we don't care. We are not going to support it anyway.

I have taken great pride in working with my colleagues in a bipartisan fashion last year on the reauthorization of the Food and Drug Administration bill, the drug user bill, the drug safety bill. We worked long and hard on these for probably almost 2 years and were able to get them through. There were other bills I have been involved in where we did good bipartisan negotiating, and that was the same as this.

This is not something I rammed through and said: This is my bill; take it or leave it. That is not the way I work. I have been the chair or ranking member of this subcommittee since 1989. It is a great subcommittee because it meets the human needs, social needs, educational needs, and, yes, biomedical research needs and disease control needs, as the Centers for Disease Control and Prevention is also funded under our subcommittee.

It keeps Americans safe. The Defense Committee keeps us safe from foreign entities, other entities that would want to do us harm militarily. Homeland Security does the same.

This committee keeps us safe from diseases. It keeps us safe from illnesses. It provides for the kind of research which has overcome so much in the last 20 to 30 years and the great strides we have made in cancer and other chronic diseases. We have made great strides because we have invested in them. This is what the subcommittee does.

It also provides for education, making sure kids who come from the poorest families and poor areas also receive a fair shake in education funds, programs for students who go to college, Pell grants and student loans. It is incumbent upon us, as we can't continue to have continuing resolutions on this type of bill. Times change, circumstances change, and we need to modify the bill and do things which recognize some of the new realities. This is what we have done. I am hopeful we can get support for this amendment. I don't think it is a heavy lift at all for anyone to support this.

I said, and I will repeat, repeat, repeat and keep repeating: There is no new money, no more than what is in the underlying bill. It is basically the same as we hammered out in December through long negotiations.

Hopefully, it may be a little easier for my Republican colleagues, as there is not any money in there for the implementation of ObamaCare. This is something I didn't agree with, but that is life and one of the compromises one has to make. The other items in this bill are vitally important to the health, the welfare, the education, and safety of the American people.

I hope the amendment will pass, and I ask my colleagues for their support.

Mr. President, I ask unanimous consent that an explanatory statement and a detailed funding table accompanying the amendment be printed in the Record.

Before I respond specifically to the question, let me also state how proud I am of the Senator from Maryland and her long service, now the longest serving woman in the history of the Senate, and her devotion to the underprivileged, to those who lack a voice and a vote in the Senate. There is no one stronger for them than the Senator from Maryland.

It has been a pleasure of mine to work with the Senator through all these years. I can honestly say I don't remember any time we have ever disagreed on anything.

I appreciate the Senator's sentiments. One of the things which makes me feel comfortable about retiring is knowing this committee is left in good hands, and I mean that, really good hands.

To answer the Senator's question, I have been either chair or ranking member of this subcommittee since 1989. When the Democrats were in charge I was chair up until 1995, and then Senator Specter was chair from then until 2001. Following that, I became chair for about a year and a half or two. It went back to Republicans, and I picked it back up again in 2007. Since 1989, I was chairman or ranking member of the subcommittee.

Yes.

Madam President, I want to respond to my friend from Alabama, and he is my friend, and he knows that very well. We have traveled

together. Our spouses are friends, and he is a dear friend of mine. We have worked together, as he said, going clear back to our House days. But I am disappointed that my friend opposes this amendment. If there is one thing that has been clear in my association with the Senator from Alabama through all these years, I think it is that he has been an unrelenting champion of NIH research. I am told the University of Alabama at Birmingham ranks 11th in terms of NIH funding. That is even higher than the University of Iowa, by the way.

So my amendment, as my friend knows, would put in a $211 million increase for NIH funding that goes around the country. It doesn't just go to Maryland, although some goes to Maryland, but a lot goes around the country. So this does that.

Then I would say to my friend from Alabama, during the negotiations from last year, the Senator from Alabama offered an amendment during our full committee markup--that was last July--that would require the Department of Labor to delay both the wage rule and the comprehensive rule regarding H-2B visas. I opposed the amendment, but I included it because it was, again, part of a bipartisan, bicameral agreement.

The Senator is right that this agreement was never signed off on high--I guess by the Speaker of the House or the majority or minority leader here in the Senate--but usually they have been very accommodating if the Appropriations Committee agrees and we all agree on what is called the four corners: the Republican House, the Democratic House, the Republican Senate, and the Democratic Senate. Basically, we would move those bills.

So, again, this amendment that was offered by my friend from Alabama that would require the Department of Labor to delay both the wage rule and the comprehensive rule regarding H-2B visas is in this amendment, even though I oppose it, because it was part of a bipartisan agreement. The only way this provision can take effect is by approving my amendment because it is not in the CR. Since my friend from Alabama offered this amendment, I think he considered it to be important, he fought for it, but it won't take effect in a CR.

I would also remind my friend and others that the cost of this amendment is the same as in the underlying substitute.

My friend said there were other things in the bill in December that were not finalized. That is true, I say to my friend. That is very true, there were other things. But these were called riders. Some were Republican riders, some were Democratic riders. Are they in this bill? No, because they weren't agreed to. They were there, but they were never agreed to--and for good reason. Some of them were, obviously, very closely held by Democrats and some very closely held by Republicans, so there just wasn't agreement.

I am just saying that in the amendment now before us are the things on which we did agree. So the Senator is right. Some of the things that were out there on the riders we didn't include because they simply were not agreed to in December. I am just saying that what is in this bill is what we did agree to in December.

With that, I yield the floor, and I suggest the absence of a quorum.

Mr. President, I thank my colleague from Arizona as well. I think we have a rare moment of peacemaking and harmony in the Senate. It may not last for long, so I want to speak while we have that moment and say for the Record that I don't dispute any of the statements made by the Senator from Arizona nor do I question his right to do so, including his responsibility to raise questions about spending.

We are at a time when we are cutting spending right and left--even at the Department of Defense. I do want to put on record the following: This bill, which we are considering as it relates to the Department of Defense in its entirety, is the bill that was passed by the House Republican majority. This is not a bill which was written on this side of the Rotunda. We have received it. That doesn't mean we should not ask questions about what the House did, but I don't want to be assigned the blame or asked to take responsibility for provisions which I did not author. We took the House version and brought it to the floor in an effort to get this moving in an expedited manner.

I know some of the questions the Senator from Arizona has raised are not new. There was a longstanding debate here in the Senate about whether to expand the notion of minority contracting to include Native Alaskans and Native Hawaiians. Understandably, Senator Stevens of Alaska, who chaired the subcommittee for a long time, and Senator Inouye, who also chaired the subcommittee--and unfortunately he passed away just a few weeks ago--believed that the minority status for contracting should include their native tribes people. They fought for it, and it was included. I know the Senator from Arizona perhaps took exception to that and debated with them. To renew that debate is perfectly appropriate, but it is not a new provision in the bill. It is something that has been there for some time. I welcome the debate. I think it is a fulsome debate and an important one, but I wanted to say that for the Record.

This is the House Republican bill and the measures which the Senator from Arizona addressed have been debated for a lengthy period of time. Some issues that were raised are new to me. I have to look more closely--and I should--to find out the merits of the provisions.

Before we go any further with that, I----

Mr. President, if I could ask any time that we use from now until the managers arrive on the floor be for debate only. I ask unanimous consent for that purpose.

I see my friend and colleague from the State of Rhode Island, who serves on the Defense Appropriations Committee as well as the Armed Services Committee, and I will yield to him next.

I do want to say a word about the Department of Defense appropriation contained in this bill. This act provides $604.9 billion, including $87.2 billion for overseas contingency operations. That is a reduction from the 2012 level of $633.2 billion. There were no changes in the bill that passed the House last week. The bill fully complies with the spending caps in the Budget Control Act. It contains no Member- requested earmarks in compliance with the earmark moratorium. Congress has cut the defense budget to find programs which we believe are excessive to accommodate scheduling delays, budget errors, and unspent funds.

The bill includes 671 cuts to programs in the budget request that have funds that are not needed for the remaining 6\1/2\ months of the year. I believe everyone should agree with the notion that if we are going to replicate last year's budget--for goodness' sake, we are not going to build the same ship twice, so we are trying to avoid those obvious misappropriations and waste of Federal tax dollars.

The bill also rescinds $4 billion in unspent prior-year appropriations for 87 programs that have been delayed or terminated.

There has been talk in the press that the Defense appropriations bill included here gives an advantage to the Pentagon when it comes to sequestration, but that is not true. Until this bill is enacted, the Defense Department is dealing with two challenges: sequestration and the threat of defense being under a full-year continuing resolution for the first time in our Nation's history.

This bill does nothing about sequestration. Nearly $42 billion in defense cuts have already been ordered by the President, and this bill does not change that at all.

Some people think the Defense Department is being afforded special treatment in being able to transfer money to deal with sequestration. In fact, this bill keeps a tight rein on the Pentagon's transfer authorities. The bill actually provides less transfer authority than what the Defense Department requested in February of 2012.

The Defense Department asks for $5 billion in general transfer authority. The bill allows $4 billion. The Defense Department asks for $4 billion in transfer authority for overseas contingency accounts. The bill provides $3.5 billion. All these transfer authorities are subject to congressional approval processes.

The perception that this bill gives the Pentagon excessive flexibility to deal with sequestration is not correct.

The other challenge facing the Department of Defense is the threat of a year-long continuing resolution if we fail to pass this bill--a bill that would do nothing more than extend the authority of last year's spending bill. Some of the Department's most pressing fiscal challenges relate to trying to live in today's world using last year's budget. Passing a defense bill will give the Pentagon relief from the threat of living under a full-year continuing resolution for the very first time. But that is not because of flexibility, that is because an appropriations bill is a better steward of taxpayer dollars than a continuing resolution.

Here are five reasons why a continuing resolution would be harmful to our national defense: Readiness. Readiness is the way to measure whether our troops are properly trained and equipped to do their mission. Under last year's funding bill, operation and maintenance accounts would be underfunded by $11 billion. In other words, if we just took last year's bill, we would be short $11 billion in preparing our troops for battle. I will tell my colleagues that these operations and maintenance accounts which result in readiness training mean survivability for our men and women in uniform. It is that basic. That directly translates into less training, if we don't do something about it, and delayed repair of equipment. Every member of the Joint Chiefs of Staff has warned us that readiness is on the verge of plummeting because of fiscal uncertainty. That is disgraceful and unacceptable. Once readiness goes down, it takes years to rebuild it.

Spending on unneeded programs is also a concern. Continuing last year's bill would fund $17 billion worth of programs that are no longer needed--specifically 31 programs that have ended.

For example, a continuing resolution would provide $2.6 billion for MRAP armored vehicles. The Pentagon has already bought these vehicles, and with our troops beginning to draw away from Afghanistan, we don't need more at this moment. This bill would not provide funds for unneeded programs such as this.

Third, no new starts or multiyear authority. A simple extension of last year's bill would extend the prohibition on new programs and multiyear contract authority. A multiyear contract must be specifically authorized by law and only when the government would save approximately 10 percent compared to buying each year's requirements.

If this authority is not provided, the taxpayers stand to lose $150 million in cost savings for the V-22 Osprey and as much as $373 million in savings on the Army's Chinook helicopter. To put that in simple terms, if we can enter into multiyear contracting and get discounts on what we will need in the future, it is in the best interests of our national defense and the taxpayers. Losing that multiyear contracting results in the opposite. We overpay for things we know we will not need.

When the government needs to be finding ways to make taxpayer dollars stretch further, a simple extension would require the government to turn away from cost savings that have already been negotiated.

On the fourth point, shortfalls will go unaddressed. There is a long list of shortfalls in the defense budget that are not controversial but wouldn't be fixed by a continuing resolution. Here are just a few examples we are considering: $1.5 billion for National Guard equipment; $2.3 billion for ship operations; $271 million to close the shortfall in TRICARE health care programs; $211 million added for the Iron Dome missile defense program that protects Israeli cities from short-range rockets.

The President of the United States visited us yesterday for lunch and talked about his upcoming trip to the Middle East to meet with our allies in Israel. I will tell my colleagues the President, as well as the leaders in Israel, know how important the Iron Dome missile defense program is and we should not shortchange it.

Another example: $45 million is added to focus intelligence efforts on finding Joseph Kony, the notorious leader of the Lord's Resistance Army in Uganda.

I recently visited Africa. I have been in the field with our troops who are stalking this man and they will find him. He is a notorious murderer. The President has said we will put an end to his reign of terror and we will. This bill, the bill we are considering, will provide the funds to finish that.

Let me summarize by saying this bill is a compromise solution that meets budget caps, does not unfairly help the Department of Defense compared to other agencies. It eliminates wasteful and unneeded spending, lowers the risk to readiness and the threat of a hollow force, takes care of our troops and their families, and addresses the priorities of our national defense.

I will not quibble or argue with my colleague from Arizona or any other colleagues. If there are provisions in the House bill--which is included here in its entirety--that need to be challenged, addressed, debated or changed, so be it. That is why we are here. But we are starting with this and with the good intention of finding funds for the Department of Defense in very challenging times.

I yield the floor to my friend from Rhode Island.

Would the Senator yield for a question?

I would ask of the Senator, pending before the Senate is the Cruz amendment which would literally remove any funding to implement the Affordable Care Act, as I understand; is that correct?

We have heard from the Republicans on the other side of the aisle that they oppose this intrusion of government into health care and creating health insurance exchanges so Americans who currently don't have a choice in health insurance and want to get a different policy, if they care to get one, would have a choice through the exchanges?

The premise behind this is the government shouldn't be involved in this, as I understand the Republican argument; is that correct?

Did I hear the Republican leader come to the floor and speak about thousands of pages of regulations, government regulations, which will now be part of health care?

I would like to ask the Senator from Ohio, is he aware of the fact every Member of the Senate has a government-administered health insurance plan?

Is the Senator aware of any Senator on the Republican side who has come forward--and there may be one, I don't know--who has said: I am so opposed to government-administered health care, and as a Senator I will not take advantage of the Federal Employees Health Benefits Program?

The same Senators who are critical of ObamaCare because the government is involved in health care have themselves, their families, and children protected by a government-administered health insurance plan?

What is good enough for these Senators apparently is not good enough for the rest of America?

Is it not true the amendment by the Senator from Texas is breathtaking because it says we eliminate all funding for the Affordable Care Act in terms of, for example, the extension of the availability of health insurance for children up to the age of 26?

As I understand the Cruz amendment, we couldn't fund that aspect of the Affordable Care Act.

This breath-taking Cruz amendment would actually say to these families with children who are currently on the family policy up to the age of 26: It is over. Those kids are now on their own.

The Cruz amendment does not eliminate the government----

The Federal Employees Health Benefits Program, which protects Senators and Congressmen, is not affected by the Cruz amendment?

They don't hate that aspect of government-administered health insurance?

Is it also true the seniors who would receive benefits under the Affordable Care Act, for example, annual physicals which are available, those would be eliminated as well?

Is it also not true in the U.S. Capitol we have an Attending Physician's Office run by the U.S. Navy, a government entity, which makes itself available to each Senator if they care to pay a monthly fee for annual physicals--a government-administered annual physical for Senators?

Does the Cruz amendment eliminate this government- administered physical exam which is available for Members of the Senate?

I am starting to note a pattern here. The Senators who wish to do away with government-administered health care for everyone else want to keep it for themselves. Does that pattern emerge from the Senator's analysis?

I would say Senator Cruz would certainly be able to offer an amendment which eliminated all government-administered health insurance as it applies to any person in the United States. If he did that, he would be consistent. Instead, what he has done is go after those today who are struggling to find their own health insurance, cannot afford it, and are simply asking for the same option as Members of Congress have today: to be able to go to an insurance exchange and choose the insurance plan that is best for them and their families. I think it would be more consistent.

I ask the Senator from Ohio if he thinks it would be more consistent?

I thank the Senator from Ohio.

I announce the Senator from New Jersey (Mr. Lautenberg), the Senator from West Virginia (Mr. Manchin), and the Senator from Rhode Island (Mr. Whitehouse) are necessarily absent.

Let me thank the chairwoman of the Appropriations Committee, Senator Mikulski. This is her first major assignment on the floor of the Senate. It is an awesome responsibility. I note that she was not only up for this job, she was made for this job. She has the knowledge, skill, and drive we need to make sure the Appropriations Committee is playing its important historic role in the Senate.

I commend the Senator from Alabama, my friend Senator Richard Shelby too. Senator Shelby and Senator Mikulski have been close partners in developing a very complicated bill. This bill we are considering is going to fund the Federal Government for the remaining 7 months; otherwise, when we run out of money March 24, literally, the government will close. They are working and have worked hard for the last several weeks to get this bill ready.

A version of the bill passed the House. Now it is being considered on the floor of the Senate and Senators are being allowed to offer amendments, which is their right.

One of the Senators who just offered an amendment is Senator John McCain of Arizona, who is well known to virtually everyone in America as a former candidate for President and by virtue of his service to our Nation. I would say I count John McCain as a real friend. We came to the House of Representatives the same year. We have maintained that friendship here in the Senate. We have worked closely together on immigration reform and many other issues. I can't think of a finer Senator on the other side of the aisle.

I don't need to speak to John McCain's reputation when it comes to military service. We know the story: a Navy pilot shot down over Vietnam, captured and held captive, subjected to torture for more than 5 years. John's body still bears the scars of that terrible experience. Thank God he survived and continues to serve in the Senate representing the people of Arizona and the Nation in his capacity as a Senator. He has been the ranking Republican on the Armed Services Committee, so he knows those issues not only as a veteran, a man who served in the Vietnam war, but also as a Senator who has looked closely at each of the issues that affects the Department of Defense. He doesn't hold a candle to anyone, take a step back to anyone when it comes to his commitment to our military and our Nation's defense. But now it is my responsibility to come to the floor of the Senate and argue against an amendment Senator McCain is offering on the Department of Defense bill. You might think to yourself: Durbin, how did you get this assignment? The fact is, as chairman of this particular subcommittee, it is my responsibility to argue the other side of the issue that Senator McCain has brought to the floor.

I come to this assignment brandnew, just a few weeks now, since the untimely passing of our great friend and national hero, Dan Inouye of Hawaii. Because of his passing, there were vacancies created, and I ended up in this position as chairman of the Subcommittee on Defense Appropriations in the Senate. It is a job I am learning, and I confess there are many here who know it better than I do. But I will do my best because I know the awesome responsibility attached to it.

I stand today to urge my colleagues to vote against the amendment John McCain has offered to this continuing resolution as it relates to the Department of Defense. There are basically four provisions in this--three or four provisions in the McCain amendment--and I wish to address each of them.

One of the provisions allows the Department of Defense to give grants to organizations. That sounds like a very easy thing to explain, and it is. The three organizations that receive the grants from the Department of Defense are well-known to most Americans; certainly two are--the USO is one.

The USO for decades has been an organization which has tried to provide help to our veterans, usually stationed overseas, and to give them things as basic as entertainment, to counseling, or when they go through airports to make sure they have a place to stop by and get a cup of coffee and a doughnut. That is the USO. I have understated their mission, but we are all familiar with it.

The other organization is one known to every American, I am sure, the Red Cross. The third is an organization new, but important, called Fisher House. Fisher House. Let me tell you about Fisher House.

Two years ago, I was invited to the grand opening of a Fisher House facility near the Hines VA Hospital in Chicago. Fisher House is to military and veterans hospitals what Ronald McDonald houses are to children's hospitals. What we are saying here in the underlying bill is that the Department of Defense can provide grants to these organizations--Fisher House, Red Cross, and USO. The McCain amendment says no, they can't. The McCain amendment strikes the authority of the Department of Defense to give them these grants. I think that is a mistake. And for that reason alone, I hope my colleagues will vote against the McCain amendment.

The services being provided through these organizations and at these facilities are nothing short of remarkable. Fisher House, right in the city of Chicago, near Hines VA Hospital, is a beautiful home--a place where families who have a loved one who is going through surgery or rehabilitation at the Hines VA Hospital are given a chance to stay overnight. They do not have to pay for a hotel room and they are treated like royalty, as they should be. These are military families-- mothers and fathers, spouses and children, who are treated like royalty at Fisher House while they are waiting for their loved one to finish the treatment or surgery they need to come back home.

Why wouldn't we do that? Why wouldn't we provide that kind of service? The Fisher House facilities are largely built by charitable contributions, donations from everybody. So to give to the Department of Defense the ability to transfer up to $4 million a year--$4 million--to the Fisher House, why, of course, we want to do that. Across America they do such extraordinary things.

In terms of the Red Cross grants, here is what the Red Cross does, and every Member of Congress knows this. A family will call a Senator and say: Senator Shelby, we live in Mobile, AL, and I wanted you to know the mother of a soldier overseas has just passed away and we have to get the word to him right away. What Senator Shelby or what Senator Durbin would do is to call the Red Cross and say: You have to help us. We have to get in touch with this service man or woman overseas somewhere. So it is an opportunity for them to use their network of volunteers and communications to reach out to that soldier, that sailor, that airman, or marine. That is what they do. They spend about $10 million in emergency communication services to keep

a hotline running connecting servicemembers, veterans, and their families with the services they offer. There is $2 million for theater support of deployed troops--emergency communication services between deployed servicemembers and their families back home.

They provide lounges, the Red Cross does, in these theaters of operation, war settings, for troops to have access to computers so they can be in touch with their families back home.

One of the big surprises I ran into as I visited our troops in Afghanistan and Iraq was to find many of them Skyping away with their families while they are far away. Some of these facilities are being provided by the Red Cross.

The list goes on and on of all that the Red Cross does to support and help our troops. But the list can't tell you in specifics what Red Cross volunteers do. These men and women--and you see them everywhere under the flag of the Red Cross--show up when a tornado hits, when a flood hits, and they always show up when our troops need a helping hand.

When our troops get off the plane in Landstuhl, Germany, after being grievously wounded or injured overseas and are about to be hospitalized--maybe facing their first surgery--one of the first smiling faces they will see will be a Red Cross volunteer, there to say: What can I do for you; can I get in touch with your family; is there something you need? The stories are legendary about soldiers who land at these bases and a Red Cross volunteer walks up to them.

I recall one story in particular about one of the soldiers who volunteered at the Red Cross who said: What do you want? And the soldier said: I need a rootbeer float. Imagine, a rootbeer float. And in a matter of 15 minutes, up pops the Red Cross volunteer with a rootbeer float. It was a small thing for that soldier, but it was an important thing.

So to say we are not going to allow the Department of Defense to provide grants to the Red Cross, the USO, or to Fisher House I think is a mistake. These are great organizations with great volunteers and they do a wonderful job day in and day out to help our troops overseas. If it were my son or daughter overseas, I would like to know the Red Cross is going to be there. I would like to know the USO is going to be there. And God forbid that we would ever need some work at a military hospital; I would like to know there is a Fisher House nearby in case a family needs it because they can't otherwise afford to stay at a hotel for a number of nights.

The McCain amendment would stop the grants by the Department of Defense to these three organizations. If it were not for the fact that such a fine man, a veteran, offered this amendment, some people might say: Why would you do that to our military servicemembers? I don't think we should.

There is also a situation that has been going on for some time regarding Guam. Guam is an important place for stationing some 16,000 marines--16,000 men and women who volunteered to serve in the U.S. Marine Corps and are stationed on Guam. It is a challenge. I have been there. It is a remote location, but important for our national security, particularly in the Pacific theater. Wouldn't we want to say to the men and women who are there in uniform that they are going to have the basics taken care of? And wouldn't we want to say that one of the basics is to make sure they have safe drinking water and wastewater treatment facilities?

Here is what we found out. We found out that on the island of Guam our 16,000 marines are in a facility that has reached the absolute limit in terms of wastewater treatment. The Department of Defense came to us and said: For these troops, we have got to build a new wastewater treatment facility. Well, of course, we do. We don't want to shortchange them or jeopardize public health in any way.

The McCain amendment would eliminate this money, $106 million in funding, for a wastewater treatment plant on Guam. This is not some frill, this is a basic. Everyone wants to believe their son or daughter, volunteering for the Marine Corps and stationed somewhere overseas, is being taken care of by our government--that the government is doing everything we can to make sure they have the basics they need to stay healthy. Well, this is one of those basics--$106 million for a wastewater treatment plant in Guam.

There is also a $13 million ask here that I think makes sense when it comes to the safety of these troops. We want to make sure there is a public health lab in Guam. God forbid these men and women in uniform, or anyone who represents the United States, is facing some biological terrorist. God forbid there is some substance being used that could endanger their lives, and God forbid we would have to rely on laboratory facilities in Atlanta, GA, if you are halfway around the world. That is where the most professional facilities are. So the Department of Defense said: Let's put a $13 million investment in a basic public health lab in Guam to protect the safety of Americans and our troops.

Look at these things. Look at what I am asking for--not for museums, not for things that may be considered frivolous and unnecessary in a given context but, rather, for the basics to support our troops in the field and to provide those who are stationed on Guam some of the most fundamental and basic public health facilities.

So it pains me to come to the floor and to resist an amendment offered by my friend Senator McCain, but I do it in memory of Senator Dan Inouye, who helped write this bill, who himself was a recipient of the Congressional Medal of Honor and had a distinguished career of service in the military.

I hope my colleagues will listen carefully to this debate, and though they feel the strong positive feelings I do toward Senator McCain, they will go to the merits of the issue and defeat the McCain amendment. Make sure the ability of the Department of Defense to continue to work with Fisher House, the Red Cross, and the USO is authorized in law. Let's make sure the 16,000 marines on Guam have the most basic things they need to be safe and healthy and come home just as we want them to. That is what this is all about.

I urge my colleagues to vote against the McCain amendment.

I yield the floor, and I suggest the absence of a quorum.

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

I ask unanimous consent that the time until 5:30 p.m., for debate on the McCain amendment, be equally divided between Senators McCain and myself or our designees; that at 5:30 p.m. the Senate proceed to a vote in relation to the McCain amendment and that there be no amendments in order to the amendment prior to the vote.

Mr. President, I don't know if Senator McCain is nearby, but if he is, I want to give him a chance to come over and use the few minutes remaining before the rollcall vote.

But for those Members of the Senate who did not listen to the earlier statements by Senator McCain and myself, this amendment is very basic and very straightforward: Senator McCain would cut or eliminate the ability of the Department of Defense to give grants to three organizations: Fisher House, Red Cross, and USO.

Fisher House is the Ronald McDonald House of military and veterans hospitals. I have visited the one in Chicago. I have talked to my colleagues about other Fisher House facilities around America. They are remarkable and amazing places.

Fisher House is where a family who may not be wealthy has a chance to stay and be treated like royalty while their son, their daughter, their husband, their mother is being operated on in a military hospital. That is what Fisher House is all about. I have seen it. The volunteers who man these houses make sure people are treated in the way they should be and make us proud as Americans. The McCain amendment would eliminate the authority of the Department of Defense to give money to the Fisher House to continue their operations.

The McCain amendment would also eliminate funding grants that are given to the Red Cross and the USO. The Red Cross is an extraordinary organization,

and every American knows what they are about. But in the fiscal year 2010, the Red Cross provided more than 597,000 emergency communications services for nearly 150,000 military families, and they provided nearly $6 million in financial aid to 5,000 military families, not to mention thousands of Red Cross volunteers--including servicemembers, veterans, and military spouses--offered comfort and support to our wounded troops and their families at hospitals around the world.

The USO is another great organization which has provided assistance and entertainment to our troops, many of them stationed far away from home and far away from their family.

In addition, the McCain amendment would eliminate the construction of a wastewater treatment facility in Guam. We have 16,000 marines stationed in Guam. The administration--the President has asked for this money because the wastewater treatment facility in Guam is inadequate. It is not safe. It is a public health hazard. An environmental impact statement prepared for the realignment of marines from Okinawa to Guam clearly finds that the current system is near capacity and needs upgrading.

So whether you argue that Guam is going to have a large future, a small future, the current allocation of marines in Guam deserves the most basic sanitary wastewater treatment facility. You would expect it, would you not, for your son or daughter serving in our Marine Corps? We should expect no less, and the McCain amendment would eliminate the funding necessary for this wastewater treatment facility, as well as a public health laboratory to test samples of suspected toxic substances in a timely manner to protect Americans and our troops in that theater of the world.

I don't know why Senator McCain has picked out these elements. I think they are all positive elements. I hope my colleagues will join me in defeating the McCain amendment. It is an amendment which would take needed resources away from the USO, Red Cross, and Fisher House and deny this wastewater treatment facility in Guam. I hope my colleagues will join me in opposing the McCain amendment.

At this point I yield the floor, and I suggest the absence of a quorum, in the hopes that Senator McCain can return before the vote.

Mr. President, I ask unanimous consent the order for the quorum call be rescinded. I wish to give my friend, Senator McCain, the author of this amendment, the opportunity to speak.

Mr. President, we have been assured by the House in the construction of this bill that this provision was added explicitly to make certain that there be no question that the grants that are given to these organizations would be authorized and included in this appropriations process. That is their belief. With an abundance of caution, we support their belief because we know of the importance of these organizations.

I now move to table the McCain amendment No. 33, and I ask for the yeas and nays.

I announce that the Senator from New Jersey (Mr. Lautenberg) and the Senator from Rhode Island (Mr. Whitehouse) are necessarily absent.

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

Madam President, I call up my amendment No. 30.

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

Madam President, I rise to deliver my first official speech on the floor of the Senate on an issue which I believe is the most urgent issue facing the country; namely, the dire need to restore economic growth to our Nation.

I will note at the outset this is the second opportunity I have had to speak on the Senate floor. The first was last week during the historic filibuster led by the junior Senator from Kentucky for nearly 13 hours.

I will note a particular debt of gratitude I owe to Senator Paul. The very first time I spoke on this floor was in a colloquy with Senator Paul. I had the opportunity to read Travis's letter from the Alamo, to read Shakespeare's ``St. Crispin's Day Speech,'' to read the opening monolog from ``Patton,'' and to read Ronald Reagan's 1964 speech, ``A Time to Choose.'' This is a debt I will always owe Senator Paul. As they say in the beer commercial: ``It don't get no better than that.''

Sadly, I promise my colleagues in the rest of my tenure, I am confident we will not have an opportunity to rival those glorious words William Barret Travis penned as he was standing for principle 177 years ago.

This being said, the topic of the day is, in my judgment, a topic of exceptional importance. Every elected Member of Congress, whether Republican or Democratic, should have as their very first priority restoring economic growth in this country. In the last 4 years we have seen stagnant growth. In the last 4 years our economy has averaged 0.8 percent growth each year. To put that in context, this is a fraction of historical levels. Since World War II, our economy has enjoyed 3.3 percent growth per year.

Last quarter the economy was struggling along and grew 0.1 percent. It was effectively stagnant.

If we want to solve the great many fiscal and economic challenges facing this country, growth is the critical precondition. If we want the 23 million people who are struggling to find jobs to get back to work--and I know every one of us wants those 23 million people to get back to work--we must restore economic growth. If we want to turn around the train wreck which is the balance sheet of the Federal Government, our perennial recurring deficits and debts, this can't be done without restoring growth.

In my view we should be working across the aisle in a bipartisan way to focus on bringing growth back. This should be our No. 1 priority. Given that, the purpose of this amendment is to advance economic growth and, in particular, to delay funding of ObamaCare until economic growth returns.

Let me be clear. In my view ObamaCare should be repealed in its entirety, which was the very first bill I introduced in the Senate. At a minimum, in my judgment, ObamaCare should not be funded and implemented at a time when our economy is gasping for breath, at a time when our economy is struggling to such a degree that implementing it right now could well force us into a recession.

It seems to me every Member of this body should stand together in acting decisively to prevent this economy from being pushed into a recession. Implementing ObamaCare at a time when the economy is so weak could do just that. ObamaCare hurts the economy. It hurts jobs. It hurts young people. It hurts Hispanics. It hurts African Americans. It hurts single moms. It hurts everybody struggling to climb the economic ladder.

I would like to initially talk about four promises which were made when ObamaCare was passed and the reality we have seen as it has begun to be implemented. It is ironic the law is called the Affordable Care Act. In the 3 years it has begun to be implemented, it has proven to be neither affordable nor caring.

No. 1, before ObamaCare was adopted, President Obama promised the American people ObamaCare would reduce the cost of insurance. In particular, the President said American families would pay $2,500 less for their insurance premiums by the end of his first term. I would note his first term ended not long ago. Today, American families are not paying $2,500 less in health insurance premiums. They are not paying a penny less. Indeed, today American families are paying $3,000 more in health insurance premiums than they were. That is a $5,500 swing out of the pockets of hard-working Americans who are struggling make ends meet. The reality has not lived up to the promise.

The management consulting firm Oliver Wyman issued a new study recently which predicted people aged 21 to 29 could see a 42-percent hike in premium costs. The higher premiums in particular are hitting young people. Indeed, I would point out, if you are a young person, this law going into effect right now when the economy is struggling is particularly problematic. If you are a young person coming out of school today, you are facing: No. 1, fewer jobs. If you didn't graduate from high school, you are facing an unemployment rate today of over 12 percent. You have less opportunity. If you are between 16 to 19, you are facing an unemployment rate of over 25 percent.

If you are a minority, if you are Hispanic, you are facing an unemployment rate of nearly 10 percent. If you are African American, you are facing an unemployment rate of over 14 percent.

What are you seeing actually in the job market if you are lucky enough to get a job? More and more employers are dropping health care coverage because of the burdens of ObamaCare. More and more employers are forcing employees to work fewer hours because of the burdens of ObamaCare. More and more individuals are seeing their premiums climb, especially young people.

If you are a young person coming out of school today, you may not find a job.

It is harder to find a job because of economic growth right now. If you do find a job, there is a real possibility that job will not have health insurance and you will find your hours reduced. If you do have health insurance, you will pay higher premiums. The promises have not lived up to the reality.

The second differential between promise and reality is President Obama repeatedly told Americans, ``If you like your health plan, you can keep it.'' This unfortunately has not proven to be the case.

The latest forecast from the Congressional Budget Office estimates some 7 million people are expected to lose or be dropped from their employer-provided health insurance by the year 2020. Indeed, health insurers in 34 States have stopped carrying child-only insurance policies. In my home State of Texas, one of the largest insurance markets in the country, every single carrier has dropped its child-only health insurance coverage. The same is true for other large States such as Florida and Illinois. The promise, if you like your health care coverage, you will be able to keep it, has not lived up to reality, as more and more Americans are losing their health insurance.

No. 3, President Obama pledged repeatedly not to raise taxes on families making less than $250,000 a year. That promise has not materialized. Within ObamaCare, there is a tax on those who do not maintain government-approved health insurance. There are increases on the threshold of the deduction for unreimbursed medical expenses. There is an increase in taxes on distributions from Health Savings Accounts and from flexible spending arrangements. Indeed, in total, over $1 trillion in tax increases are contained within ObamaCare. The promise has not lived up to the reality.

The fourth promise which has not lived up to the reality is in February of 2010, former House Speaker Nancy Pelosi said ObamaCare would create 4 million jobs, 400,000 jobs almost immediately.

This was in 2010. By 2011, the CBO Budget Director testified before a House Budget Committee that ObamaCare would result in an estimated 800,000 fewer jobs in the United States by 2021. The promises have not lived up to reality.

I wish to talk about five distinct harms which have come from ObamaCare and made life more difficult for Americans.

No. 1, ObamaCare harms the poor and those who are struggling to climb the economic ladder. Right now, 60 million people are enrolled in Medicaid. Medicaid is a program which is struggling, which is challenged and desperately in need of reform to improve how it operates. ObamaCare, by raising the eligibility age and trying to incentivize and pressure States into expanding Medicaid, is designed to move at least an additional 18 million people onto Medicaid over the next 10 years.

The data demonstrates Medicaid beneficiaries face worse health outcomes than just about anybody else in the marketplace.

In 2010, the ``Annals of Surgery'' issued a landmark study which examined the outcomes from nearly 900,000 individuals undergoing surgery from 2003 to 2007. The conclusion of this study was Medicaid patients were almost twice as likely to die as those with private insurance. Medicaid patients' hospital stays were 42 percent longer and cost 26 percent more.

Even more striking, Medicaid patients, when compared to people without health insurance, people who were uninsured, Medicaid patients were 13 percent more likely to die. They stayed in the hospital for 50 percent longer and cost 20 percent more.

In 2011, Johns Hopkins did a study of patients undergoing lung transplantation. Their conclusions were very much the same. They found that Medicaid patients were 8.1 percent less likely to be alive 10 years after the transplant compared with those with private insurance and also compared to those without any insurance at all. Overall, the Johns Hopkins study found that Medicaid patients faced a 29-percent greater risk of death, and yet ObamaCare is moving more and more of the economically disadvantaged onto Medicaid, which subjects them to those worse health care outcomes.

No. 2, ObamaCare hurts seniors. ObamaCare took $716 billion from Medicare, a large portion of which came from the Medicare Advantage Program which serves a great many seniors, and especially poor seniors. According to the Office of the Actuary at the Center for Medicaid and Medicaid Services, the Medicare Advantage cuts in ObamaCare will reduce enrollment from 14.8 million to 7.4 million by 2017. It will cut it in half. Seven million people will lose their coverage under Medicare Advantage.

I would remind everyone that the President said, ``If you like your health insurance, you can keep it.'' Yet 7 million seniors are losing Medicare Advantage.

The Heritage Foundation found the substantial cuts to Medicare Advantage in particular hurt seniors in the States of Texas, California, New Mexico, Louisiana, Alaska, New York, Massachusetts, and also in the District of Columbia. Those States are expected to lose more than 50 percent of their enrollees by 2017.

I would suggest that each of us, as we return to our constituents, as we return to address seniors, any in this body who vote today to implement ObamaCare despite the difficult economic times, should be prepared to answer to seniors in our States who say: Why did you vote to damage the Medicare Advantage Program that I was relying upon?

Also, the harm to Medicare Advantage in particular is visited upon minorities. Hispanics are twice as likely to enroll in Medicare Advantage than the average Medicare beneficiary. African Americans are 10 percent more likely. So ObamaCare targets a program that is helping seniors and in particular is helping those seniors who are most vulnerable. In addition, 31 percent of African-American Medicare beneficiaries and 38 percent of Hispanic beneficiaries are enrolled in Medicare Advantage plans.

So those of us who return to our States that have substantial minority populations need to be prepared to explain to Hispanic seniors and African-American seniors why this body, why the Federal Government is damaging a program they are relying upon for essential health care.

No. 3, ObamaCare is harming jobs. In March 2013, the Federal Reserve said, in its annual ``beige book''--which analyzes economic data from across the country--that ``employers in several Districts cited the unknown effects of the Affordable Care Act as reasons for planned layoffs and reluctance to hire more staff.''

Added health care costs are making it harder for businesses to hire new workers and especially low-skilled workers. This is a point that is worth underscoring because the detrimental effects of ObamaCare are not uniformly distributed throughout our population. They fall the hardest on those who are most vulnerable among us. The Heritage Foundation found that ``workers who cannot produce at least $20,000 per year'' for a single plan ``or $27,500 per year'' for a family plan ``of value to employers will have serious difficulty finding full-time jobs.''

Madam President, when I read those statistics, those are not simply empty words on a page. Those are data that strike very close to home because 55 years ago that precisely described my father. When my father came as an immigrant from Cuba in 1957, he was 18, he was penniless, and he could not speak English. The very first job my father received in Austin, TX, was washing dishes making 50 cents an hour.

The reason--he told me--he got that job was, he said: Look, I couldn't speak English. I couldn't interact with people as most jobs required, but I could wash dishes. So he worked 7 days a week. The reason he worked 7 days a week is because when you washed dishes, they allowed the employees to eat, and he didn't have the money to buy food. So by working 7 days a week, he ensured he ate 7 days a week.

So when I read statistics like this and the words, ``those who cannot produce $20,000 per year in value to an employer will find themselves unable to find jobs,'' I can't help but think about my dad as that 18- year-old kid just beginning to climb the job ladder, not speaking English, not having yet developed skills, but what he could do

was wash dishes. And working at 50 cents an hour is what enabled him to pay his way through the University of Texas. It is what enabled him to graduate, to get a higher paying job, and eventually to start a small business. Then, today, to become a pastor.

My father is here today visiting me, and I think about the impact these burdens would have had on him, and I tell you I am grateful that in 1957 this so-called Affordable Care Act had not been implemented because it could well have shut down the opportunity for him to survive and pay his way through school and begin climbing the economic ladder.

Additionally, ObamaCare keeps small businesses small. ObamaCare is designed so that its principal burdens are triggered when a business has 50 employees or more. As a consequence, there is an incredible deterrent to small businesses hiring more than 50 employees because hiring that 50th employee triggers enormous burdens and expenses. That has particular implications for everyone in this economy struggling to find work because two-thirds of all new jobs come from small businesses. By keeping these businesses small, what we are doing is stifling the ability to grow the economy, and in particular to grow the economy by creating opportunities for those who need to begin and want to begin climbing the economic ladder.

By hiring the 50th employee, if a small business does not provide government-approved insurance, it faces a penalty of up to $3,000 for each uncovered worker beyond 30 employees. Thus, as the Wall Street Journal explained:

If a company with 50 employees hires a new worker for $12

an hour for 29 hours a week, there is no health insurance

requirement. But suppose that worker moves to 30 hours a

week. This triggers a $2,000 Federal penalty. So to get 50

more hours of work a year from that employee, the extra cost

to the employer rises to about $52 an hour--the $12 salary

and an ObamaCare tax of what works out to be $40 an hour.

Moving to 33 hours a week costs the employer about $10 more

in ObamaCare tax.

The result is small businesses are staying smaller, and the opportunities for those struggling to achieve the American dream are limited. That leads to the fourth harm: ObamaCare hurts workers.

One of the consequences we are seeing over and over is that in order to avoid the crushing costs of ObamaCare, employers are limiting the hours employees can work. So, for example, in January, a Wendy's franchise in Nebraska announced it would cut the hours of nonmanagement employees to 28 hours a week. As a result, about 100 employees' hours were cut. That is a direct impact of ObamaCare for those 100 employees who were working at Wendy's.

Now, some may say: Well, is Wendy's a career? So many kids, so many young people, so many Hispanics and African Americans begin, as my father did, washing dishes or flipping burgers, and they use those jobs to gain skills and advance up the economic ladder. To have a law that forces small business owners to reduce those hours, to limit the hours those workers can work, is particularly harmful.

A Taco Bell in Guthrie, OK, has also cut worker hours. A single mother of three told Oklahoma News 9:

They informed everybody that nobody was considered full

time any longer, that everybody was now considered part-time,

and [they] would be cutting hours back to 28 hours or less

due to ObamaCare.

She went on:

Several of the people I work with, some of them are single

parents, and we do the best we can, and 28 hours a week just

isn't going to cut it for the bills.

For those who are struggling, for the single moms in this country who are working as hard as they can to provide for their kids, seeing their hours reduced because of the consequences of this law is a real and material hardship, and that, sadly, is happening all over the country.

Stephen Caldeira, president of the International Franchise Association, predicts that ``many stores will have to cut worker hours out of necessity.''

Let me point out, by the way, it is not hard-heartedness on the part of those small business owners. It is the simple reality of trying to survive in this economy. As Caldeira continues, it could be the difference between staying in business or going out of business.

Indeed, a 2011 Hudson Institute study estimates that the insurance mandate will cost the franchise industry $6.4 billion and put 3.1 million jobs at risk. That is worth underscoring: 3.1 million jobs at risk of kids flipping burgers, of single moms struggling to provide for their kids who are facing hard times because of ObamaCare. It is those who are most vulnerable who are hit the worst.

Indeed, if we look at the premium increases, in particular for young people, they have been significant. If ObamaCare is fully implemented, they are likely to be extraordinary. According to a 2013 staff report from the Senate Finance Committee and the House Energy and Commerce Committee, the ObamaCare impact on young adults in the individual market is expected to be staggering.

If we look at the city of Austin--a city I have lived in for many years, a terrific city, a city whose slogan unofficially is ``Keep Austin Weird.'' It is a young, hip, vibrant----

Weird, which in Austin is very fitting. It is a young, hip, vibrant city. It is referred to as the ``Live music capital of the world.'' Right now, a young adult in Austin in the individual health insurance market pays an average premium of $648. Under ObamaCare, that is anticipated to rise to $1,836. That is a 183-percent increase.

I wish to repeat that, to underscore it. Today, they are paying $648. That is expected to rise to $1,836. An additional $1,200 out of the pocket of a young person struggling to survive is substantial. And, indeed, nationally, that is consistent with the pattern that is expected all over the country. That is the average annual increase. It is parallel to what is expected in Chicago, Phoenix, Atlanta, and Milwaukee.

Madam President, I have been informed that the Senator from Utah has a time issue. I ask unanimous consent to yield to the Senator from Utah, and thank him for joining me.

Ms. MIKULSKI addressed the Chair.

In terms of my remarks, I have about an additional 10 minutes I wish to give. But I was just informed that the Senator from Utah had a scheduling issue, and asked if we could show him consideration. I am being told now that--if the Senator from Maryland would prefer, I am happy to continue my remarks.

Madam President, the issue has been obviated. So if I may simply continue my remarks, and when I conclude, I will yield the floor.

The fifth impact of ObamaCare is that it imposes a substantial harm on the economy. On the economy altogether, ObamaCare includes more than 20 tax increases. The Joint Committee on Taxation estimates that over the next 10 years ObamaCare will raise $1 trillion in taxes. That is $1 trillion from the private sector that is not going to be available to be used to hire new workers.

Job losses just in the medical device industry, as a result of the medical device excise tax, could total as much as 47,100 or 10 percent of the medical device industry employment. Those jobs are needed. Those job losses are not

driven by market conditions. Those job losses are driven by one thing, which is the policy decisions of the Federal Government to implement ObamaCare.

On March 5, 2013, Russell George, the inspector general for the IRS, testified in the House Committee on Appropriations:

It is unprecedented in recent history the amount of

responsibility the IRS is being given in an area that most

people don't think of as an IRS function.

He went on, ``This is going to lead to problems.''

The Congressional Budget Office expects ObamaCare penalties to total $130 billion over the next 10 years. That is up $13 billion from previous forecasts. And more taxpayers will be hit with ObamaCare taxes as time goes on. There is a 0.9-percent tax surcharge on individuals' earned income, and a 3.8-percent surcharge on investment income for individuals making more than $200,000.

But those taxes are not indexed for inflation. And so as inflation raises the nominal income of Americans, it will push more and more from the middle class into paying those taxes. The Tax Policy Center estimates that by 2013, 2.4 percent of households will pay one or both of those taxes; by 2022, 4.6 percent of households will pay; by 2032, 9 percent of households will pay. That is a significant additional tax burden falling on Americans.

In addition, one of the most problematic short-term and long-term implications of ObamaCare is less innovation. The United States has enjoyed tremendous advantages because our free-market system encourages investment in innovation. In health care in particular we have seen incredible innovation--whether in medical devices or whether in pharmaceuticals--because the incentives are there to invest in new health care treatment. As a result, millions have lived better lives, have lived longer lives, have not died from diseases that previously were incurable and previously were untreatable. Because of the innovation we have had in the medical field, it has led to the United States enjoying a world-class health care system. ObamaCare is substantially diminishing innovation in health care.

Venture capital, the seed money that funds new research and development in health care, has dropped precipitously. In 2010, venture capital in health care services was $1.2 billion. By 2011, it had dropped more than in half, to $541 million. According to Dr. Scott Gottlieb of the American Enterprise Institute, only about 30 venture stage health care services companies got funded last year, compared to hundreds from previous years.

If we want to continue the incredible medical innovation we have seen over the last century, we can't be drying up the capital that is devoted to research and development, that is devoted to new and innovative companies. And that is exactly what ObamaCare is doing.

Then there are the compliance costs. The compliance costs from ObamaCare are, quite simply, massive. ObamaCare will require American businesses, families, health care providers to spend more than 127 million hours per year in compliance costs. What could be done with 127 million hours? The problem with big numbers is it is hard to get your mind around them. What does it mean that 127 million hours are being spent on complying with ObamaCare?

To put that into perspective, Mount Rushmore--which took 14 years to build--could be completed over 1,000 times, and that is each and every year. That underscores how staggering; we are talking about 1,000 Mount Rushmores each and every year. I would note there may be some Members of this august body who would like to see themselves on those 1,000 or more Mount Rushmores.

But rather than needless compliance, we should be putting that energy into productive endeavors. None of that compliance cost is productive. As we say in Texas, it produces neither trucks nor tortillas. It is simply wasted time dealing with the burdens of government.

To give you a sense of the volume of burdens, as of today the administration has created more than 19,000 pages of regulations, bulletins, and guidance since ObamaCare became law. If the IRS and HHS and the Department of Labor continue at their current pace, we can expect an additional 3,000 pages of rules--which is what I have here, 3,000 pages--in the next 6 months, the period covered by this continuing resolution.

This is 3,000 pages right here. I will tell you, I am very glad I don't have to sit down and read these 3,000 pages. But I will tell you also, yesterday I held a tele-townhall with thousands of Texans. A small business owner asked a question. She said, Look, in our small business, we are struggling to make ends meet. How do we ascertain what these regulations contain? I will tell you, I was very frustrated that I could not give her a good answer, because on my desk here is 3,000 pages, and yet what has already been promulgated is over 19,000 pages. So take this stack and send it six times up in the air. It would reach nearly into the gallery.

I told her, I don't have a good answer for how you, struggling to make payroll, to make sure your employees keep their jobs, possibly digest 19,000 pages of regulations, with new pages coming out without ceasing.

Why is our economy struggling? It is not hard to figure out why our economy is struggling when you think about the compliance costs and regulations that are being heaped on small businesses, when they are told, Figure out what is in the 19,000 pages of regulations, and if you get it wrong, you can be assured the hammer of the Federal Government will come down upon you.

That is why I am introducing this amendment today. This amendment to the continuing resolution is a very simple amendment. It simply provides that none of the funds within the continuing resolution shall be spent to implement ObamaCare or to engage in rulemaking under ObamaCare.

Let me be clear. In my view, ObamaCare should be repealed altogether. I think the harms from ObamaCare--and particularly the harms of the most vulnerable among us--are significant enough that we should repeal it in its entirety. I recognize that is not a view shared by every Member of this body. At a minimum, however, I would submit that every Member of this body will agree that restoring economic growth should be a critical priority. And with our economy gasping for breath--last quarter, we were at 0.1 percent growth--allowing ObamaCare to be fully implemented right now has the potential of pushing this economy into a recession. I know no Member of this body wants to see the economy go into a recession. No Member of this body wants to see the American people pay the price for damaging economic growth. If we allow ObamaCare to be funded and implemented right now, each of us who votes to do so will bear a significant amount of responsibility for the economic damage that comes.

I would submit that every Member of this body, Republican and Democrat, should stand together and say, at a minimum, let's restore growth first; at a minimum, let's wait until we get back to historic levels of growth--3.3 percent--before implementing such an incredibly antigrowth, job-killing omnibus bill.

Let me close with a simple observation of the power of growth. If we could get back to historic averages, 3 percent to 5 percent, every other problem this body wrestles with becomes much simpler to resolve. Four percent growth for a decade would create over 10 million new jobs. Four percent growth for a decade would produce over $3 trillion in additional tax revenue. I would note, that exceeds the tax increases. The revenue from the tax increases that have been proposed by President Obama exceeds the revenue from the tax increases that, my understanding is, the Budget Committee will include in its budget before this body.

I am all for new revenue to pay down our debt. I just believe the revenue should come from economic growth and not from higher taxes that hammer small businesses, kill jobs, and restrict growth.

Most importantly, 4 percent growth over a decade would lift over 3 million out of poverty and into the middle class. Growth sometimes seems to be an abstract number that only economists worry about, but sustained growth is what has led to the unprecedented prosperity of our great Nation. It is the reason why for centuries millions of people have come to America seeking a better life, because there has

been no country on Earth that has allowed so many people to start with nothing and achieve anything.

A stagnant economy hurts, first and foremost, those struggling to climb the economic ladder. And, in my opinion, every one of us should come in to work every day fighting for those struggling to climb the economic ladder to make sure we remain the land of opportunity; to make sure we remain the hope and beacon to the world; to make sure that every American has a fair chance to achieve the American dream. With stagnant growth, millions are shut off from that American dream. And I know no Member of this body wants to see that happen.

Respectfully, I would urge my colleagues to restore growth first. Do not allow this bill to be implemented, to kill economic growth, to kill jobs, and to potentially push this economy into a recession. Instead, let's get growth back, let's maintain our economic strength and security, and let's make sure opportunity remains--not just for us but for the next generation and the generations after that.

I yield the floor.

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

Madam President, thanks to the cordiality and cooperation of Members on both sides of the aisle, but particularly those who initially had an objection to us going forward, we now can move forward. We are waiting for the junior Senator from Texas, Mr. Cruz, to come to the floor. He will be offering the first amendment. As soon as he gets here, we are off and running.

I am going to thank everybody for getting us to this point: Senator Shelby for working with me on the bill, Senators Reid and McConnell, and particularly now Senators McCain and Coburn. We have a way of addressing their concerns. So we are ready. We are waiting for the Senator.

I note the absence of a quorum.

Weird?

Madam President, as the manager of the bill, I thought we were going to--of course Senator Cruz has offered his amendment--but we were going to rotate speakers from the Democrats and Republicans. There was no agreement to do roundrobin here, where the Senator from Texas would yield to the Senator from Utah. I think there is some confusion. I wish to follow the traditional regular order, where the Senator from Texas, the proponent of the amendment, has full and ample time; then other Senators respond, and then Senator Lee. I am not going to make a scene, but that is the way we usually do it.

Has the Senator from Texas concluded his remarks?

And for the Senator from Utah, we all have scheduling issues. What we would want to do is make sure everybody has their say. If the Senator from Utah has a statement he wishes to put into the Record or wishes to return, we welcome him back. We in no way want to impede his ability to speak.

Madam President, we will be alternating on both sides of the aisle. I regret Senator Lee had to leave, and we welcome those who support the Cruz amendment to speak before we have to take a break.

I have to go to a meeting with Senator Reid and other members of the committee at 12:30 p.m. We ask those who have views on this to come forward and speak. I do have some comments on the Cruz amendment.

First of all, we welcome Senator Cruz. He is the new Senator from Texas. He replaced a very dear friend, Senator Kay Bailey Hutchison. Senator Hutchison and I were close friends and we usually agreed on goals, but there were times we didn't agree on methods. With Senator Cruz we agree that we do need a job-creating strategy. We know we need to promote economic growth in whatever we do and even follow the physician's adage of ``do no harm.'' That is why I absolutely disagree with the Senator's amendment. The very things he wants to accomplish and his underlying premise--though obviously well argued from his view in a persuasive way--I totally disagree with.

First of all, let's talk about what the Cruz amendment does. It prohibits discretionary funds from being used for the Affordable Care Act. It is affectionately known by some of us as ObamaCare, because Obama does care. So the Cruz amendment would prevent the Department of Health and Human Services from implementing the Affordable Care Act. This would mean the staff, for example, CMS, could not issue or enforce regulations on insurance abuse practices, such as gender discrimination. Quality reforms that improve the care that everybody does and actually lowers cost would also be affected. For example, Johns Hopkins lung transplants were cited as one study--Madam President, I could go on, but if the Senator from Utah is ready to speak, I will yield the floor. We were alternating, so it is actually the Senator's turn.

Madam President, as robust as my remarks would be, I will yield to give the Senator from Utah his rightful chance to speak.

Madam President, I rise to speak on the Cruz amendment. I am glad Senator Lee had a chance to speak.

As I said, the Cruz amendment would prevent the Department of Health and Human Services from implementing funding for the discretionary spending aspects of the Affordable Care Act. Since the Presiding Officer knows the Affordable Care Act so well and played a major part in it when she was a Member of the House of Representatives, she knows this amendment would have disastrous consequences. It would essentially defund the Affordable Care Act. They call it ObamaCare. I call it ObamaCare. As I said earlier, Obama does care, and that is why we passed the legislation in the first place.

The Cruz amendment means that CMS couldn't do their job to, for example, issue regulations on ending gender discrimination. It has been said that there are all these pages of regulation. But why should we pay more for health insurance than men of comparable age and health status--as much as 50 percent more?

The Affordable Care Act also ends discrimination on the basis of preexisting conditions. As the Presiding Officer knows, in eight States women were denied health insurance because domestic violence was deemed a preexisting condition. They were battered in their own home, and then they were battered by their insurance agency. What are we doing here? This is not where we are going.

Excuse me. I promised I wouldn't try to incite; I would try more to inspire. But I feel very strongly and passionately that the Cruz amendment should not pass. It should not pass.

I wish to speak to what the Senator said about economic growth. He said he is for economic growth. I want to be on that list. He is a progrowth Senator. I want to be on that list too. I think it is a committee of 100. What I want him to know is that without a form of health care that provides universal access but insisting on delivery models of reform, we will have a catastrophe and not only in an earned benefit program such as Medicare. What happens is if people don't have health insurance, it gets shifted onto other people who do have health insurance and the employers who have the generosity and wherewithal to pay for it.

So if we want to be for economic growth, the first thing we need to do is clean up our own act here. This is what we need to do here. The politics of brinkmanship, ultimatum politicians, shut down, show down, and slam down must end. That is what we are trying to do here. What we are trying to do is move legislation so there is no government shutdown.

Businesses don't invest in creating jobs because they don't have certainty. They don't have reliability. Where is the Federal Government going? What is it going to do? How is it going to get its act together so businesses can invest, whether it is in their own employees or perhaps bringing money back home from overseas, legally earned profits, to put into infrastructure? So if a person is progrowth, they want to have health insurance.

The two costs business cannot control are the cost of health care and the cost of energy. We can control the impact on reforming the cost of health care through ObamaCare. Why do I say that? First of all, if a person doesn't have health insurance, they get sick and go to the emergency room. Do my colleagues know what the average cost of an emergency room visit is? It is $1,000. Do my colleagues know what a primary care doctor gets? He gets $40. Now, what is wrong with that picture? He gets $40, not $400, by the time all of it is taken out.

I wish to bring to the attention of my colleagues a fantastic documentary that was on CNN on Sunday night. It was called ``Escape Fire.'' It was a complete 2-hour documentary from CNN, not some lefty think tank or nothing like the Institute of Medicine. This was a CNN documentary on the cost of health care and how the system we have now increases costs but does not increase or improve health outcomes.

I am not going to argue all those dynamics here today, but if we really want to lower the cost of health care, we want to have President Obama and our Affordable Care Act. This is what businesses want. What they don't want is cost-shifting. Because some people don't have it or because they got it too late in their own situation, the cost is actually greater.

The other side has talked about small business. Senator Cruz just told this wonderful story about his father--a Cuban refugee, essentially--who came to this country. Because he couldn't speak English, he took a job where it wasn't required, washing dishes. And then here we go, one generation later, Senator Cruz is a Senator. I think that is a wonderful personal story. He then went on to talk about business.

His story is a lot like my own family's story. We came from Poland. When we came from Poland, it was not because we were rich; we came because we thought that Lady Liberty and her shining light really meant something. My family started small businesses. My grandmother ran one of the best Polish bakeries in Baltimore. My father had a small grocery store. Because of a large family, he left school in the eighth grade, but through his own grit and determination, with my mother at his side, he served a community. Over 700 people came to my father's funeral because they loved him as much, in their own way, as we did. My father, through his grit, determination, and working--the same as Senator Cruz's father--my father worked 6 days a week, 12 hours a day. He sent his three daughters to college to be sure they had an education in post-high school.

He wanted to have health care. My father was crazy about Social Security and BlueCross and BlueShield. My father couldn't get on Social Security until the 1950s because small business was excluded. The reason he liked Social Security was that he worried about my mother and he worried about his girls. He was worried that if he died, would his own insurance--my father had insurance. My father was a planner and a provider--a planner and a provider--but he worried about whether that would be enough to take care of us. So when he was eligible for Social Security, he said: I will pay my fair share so if anything happens, fine, and if nothing happens, I am glad to pay my fair share.

As a small businessman, he didn't have access to big markets, but through the Maryland Grocers Association--again, in the 1950s--he could come in on BlueCross and BlueShield. He wanted health insurance for himself, for my mother, for his daughters, and, if he could, for the few people who worked for him because he knew that people were one financial bankruptcy away if a big illness happened.

What my father faced in the 1950s America is facing now in 2013.

So what does ObamaCare do? It improves access for 35 million Americans who are without health insurance. It ends the punitive practices of insurance companies, one of which is gender discrimination. The other is the preexisting condition denials. It also strengthens Medicare in a way that actually reduces health costs. Data has been released in the last several days that actually shows health care costs are going down, and it is not because of the recession. It is because our reforms

are going into effect, such as the famous Pronovost checklist developed at Johns Hopkins University that was quoted in another study: If we wash our hands and take care of certain things in the OR, we won't get an infection. And if we don't get infections, we don't stay in the hospital longer than necessary.

I chaired the quality initiatives committee that examined how we could, through improvements in quality, not only save lives but would it save money, and the answer was a resounding yes. I didn't make that up.

They said: Mikulski, you are a social worker. What do you know about delivering health care?

It wasn't my idea. I went to learned societies, such as the Institute of Medicine, that said to err is human, but it is also costly. I am not talking about the medical malpractice stuff--infections, returning admissions to hospitals within 10 days or 30 days because of the way people are often discharged, the issue of prevention.

I am the author of the so-called preventive amendment that went into the health care bill.

What was that all about? It meant that early detection and screenings save lives--early detection and screenings save lives. That means if you get your mammogram, if you get your PSA test for a man, you are more likely to find it.

But it is not only for that dread, awful ``C'' word. Let's take a ``D'' word: diabetes. A lot of people walk around and do not know they have diabetes or high blood pressure. Both are silent killers. They can result in strokes or death. If you have undetected diabetes, it can kill you through a coma and other things, but it can also kill you slowly. The consequences of prolonged diabetes can result in the loss of eyesight, the loss of a kidney, diabetic myopathy, where you cannot walk. And if you come in so late, you are often--rather than facing an amputation, wouldn't it have been better to find it 10 years before and get you into the right program, with the right diabetic educator, to make sure we not only control your diabetes but we are not paying for amputations, which is a heartbreak for the family and the person and a budget buster to us?

This is what prevention is all about. It is not some gooshy-pooh thing. It is not like a slogan on a cereal box. This is the real deal. If you find certain of these chronic conditions sooner, you can manage their escalation. That helps the family and the patient. It also helps control our costs.

This is what we are talking about. This is why we care so much. And for women, we were helped through this bill, dealing with gender discrimination, preexisting conditions. Children were helped. And now, right now--because ObamaCare is not fully implemented--it stops insurance companies from denying families health insurance or charging sky-high premiums because their child has a preexisting condition.

What are we talking about here? We are talking about autism. We are talking about type 1 diabetes. We are talking about even children who have arthritis.

The other day I had such a poignant thing happen. I was dashing to the elevator, and there was a family with a young lady, a young girl about my height, but about--well, she was 13 and a tween. When they showed me their picture of the last time we met, that tween, that young lady, was in a wheelchair. We do not think of someone around 11 or 9 having arthritis, but she does. This is going to be a chronic condition with this young lady. But through the work of NIH, other great research, and working with a biologic that was used for other medical issues but allowed under FDA to work with her, under very strictly controlled conditions, with parental consent, of course, this young lady stood next to me. We laughed and we joked, back to back, because the little girl that was in the wheelchair is now a tween, and she is a lot taller than I am. We had a good laugh. But I will tell you, when I got on that elevator I had a good cry, and I was so emotional about it, I even feel it today.

What are we doing here? Don't we want to give this little girl a break? When her mother and father applied for health insurance, do we want the schoolmarmish no--the nos of the insurance company saying: No, that kid has arthritis. We cannot insure you.

That kid does have arthritis, but she is walking today. She is standing proud with her mother and father, joking with a U.S. Senator, doing well in school. Isn't that what we want for our country and for our young people? Why would we want to repeal legislation that does that?

I could talk a lot about this bill. I feel so strongly about the incredible infrastructure we have in our United States--NIH, academic centers of excellence, learned societies from IOM to the American Academy of Pediatrics that have advised us along the way--all of us working together. The biologic was developed by the private sector--the private sector--working with doctors, working with FDA, to say: Can we try an off-label that meets all the ethical things where children are involved?

We did it, and look at the story. That is just one story. We are a country of 300 million people. That story is being acted out every single day, and it is being acted out right now in the ER. If you came to the ER with me at Johns Hopkins, the University of Maryland, at Mercy Hospital, are there people who are there from trauma? Yes. Are there people there who were in an automobile accident? Yes. I was there 3 years ago myself with a fall coming out of church. Yes. But over 70 percent who are there are there because they do not have health insurance. And they are using a thousand dollars a visit being in there. What kind of system is that?

So if we repeal the President's Affordable Care Act, the consequences on families, the consequences on business, will be horrific. We are simply shifting the cost rather than solving the problem.

Are there reforms necessary? Yes. Do the Senators from Texas and Utah, who spoke, offer suggestions? Yes. But let's let ObamaCare go forward. Let's evaluate, let's do due diligence, and let's do oversight and make sure health reforms we have instituted are working, but do not repeal it. We will endanger lives, and we will endanger our economy.

I yield the floor.

I suggest the absence of a quorum.

Madam President, I ask unanimous consent that the time until 2 p.m. be equally divided between Senator Cruz and myself or our designees; that at 2 p.m. the Senate proceed to vote in relation to the Cruz amendment; that there be no amendments in order to the Cruz amendment prior to the vote; further, that upon the disposition of the Cruz amendment, the next amendment in order be an amendment offered by Senator Harkin relative to Labor-HHS appropriations.

Madam President, I ask unanimous consent that the time in the quorum call be equally divided.

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

Mr. President, could we just have quiet. We are going to have our first vote on this bill.

I move to lay that motion on the table.

The motion to lay on the table was agreed to.

Madam President, I wish to speak on the bill and comment on the amendment.

First of all, I want to say to the Senator from Iowa how much I admire him and the fantastic job he has done on behalf of the poor, people who didn't have health care, and the disabled people who had no voice in Washington. I want the Senator to know I am so sorry he is retiring. I really am. The Senator is neither shy nor retiring in the leadership role he played and the very pragmatic solutions he came up with over the years.

If I may ask, how long has the Senator chaired the subcommittee on Labor-HHS?

The Senator is correct. If I might comment back, we sound like two war horses at the VFW Hall. The next thing, if it wasn't prohibited, we would be doing shooters on the Senate floor.

This would be, in 2014, essentially the Senator's diamond jubilee, 25 years.

We could exchange a lot of things about diamonds, but that would be quite a benchmark.

This is what I am going to say: What we would like to do is return to regular order where the Senator could have brought his bill to the floor all by itself--not in the midst of a threat of a showdown, shutdown, lockdown. He could have brought it up with his ranking member. Now you have the Senator from Kansas, Mr. Moran, and we have open, public debate, transparent, going through category after category: education, special education, funding for the National Institutes of Health, the Department of Labor, all of those things.

The Senator's subcommittee is one of the most robust, other than defense, and second in size in expenditure. It funds the entire Department of Labor, the entire Department of Education, and the entire Department of Health and Human Services. Under that, there are spectacular agencies and independent agencies, such as the Social Security Administration, which is literally headquartered in my hometown of Baltimore.

It has, I would say, 40 percent of the domestic expenditures which meet compelling human need. It also funds the kinds of programs we need for the workforce of the future and our research of the future.

The Senator deserves to have his day. Anyone who wishes to analyze it, scrutinize it, amend it, improve it from both sides of the aisle should do this.

I say to my colleague, what I want to do is get this bill through this Senate, working with my colleague Senator Shelby, who has been my ranking member over the years and who is so well versed on the agreement. Essentially, the ideal situation would have been regular order where we would have passed our bills before October 1. You could have been on the Senate floor.

Now we are in something called a continuing resolution where the entire Federal Government is in one package. Everybody is trying to parse it, understand it, and they should. This is not the way to govern. We shouldn't be threatened with these deadlines and kind of an ultimatum-type situation.

We are going to try to do the best we can. The Senator has made his point and done it robustly. He produced a great bill, along with Senator Shelby, in terms of coming out of the subcommittee, and then fashioned it. It is not only great on content, policy, but it has the sense of receiving value for the dollar as well and keeps an eye on that.

At the same time, we were able to fashion a bipartisan agreement, but you couldn't move the bill. Here we are now into this larger issue. My job is to get this bill through the Senate, working with Senator Shelby. This is our job.

I am going to say to Senator Harkin and to all Members on both sides of the aisle, we need to get back to regular order. We can't be doing big bills nobody understands, that everybody is suspicious of. We need to be able to do this the way the founders of the Appropriations Committee wanted us to, committee by committee, out in the open, with full and open debate where we could focus on the content. When we bring Commerce-Justice-Science, we can focus on the Justice Department, focus on Federal law enforcement, and focus on science programs.

We can look at Labor-HHS, which has such an enormous labor impact on our economy and an impact on the future of our economy. Remember, research and development, the workforce of the future, through education, Pell Grants, are all of the great things on this bill.

As the Senator proposes this amendment and the Senate works its will on this amendment, I want to say get the job done. Let's get the bill passed and then let's solve the sequester problem, which has a Draconian shield hold over us. Let's get rid of brinkmanship, shutdown, showdown politics.

Let's return to our regular order where we may produce bills, debate them in the full sunshine of the Senate--and not only do a good job, but the American people can understand what we are doing. There aren't just views on policy. This is America. That is what a democracy is and what a parliamentary body is. We should be able to bring process and procedure. This means following a regular order with our legislation.

I thank the subcommittee chairman, Senator Harkin, for his advocacy in the last 2 years. He and Senator Shelby worked together to produce a great bill. We are where we are, and I hope we do all we can to pass the bill and return to regular order.

Mr. President, I note the absence of a quorum.

Would the Senator withhold?

First of all, I know the Senator has been waiting patiently to file his amendment. I have been waiting patiently for him to be able to do it. As I understand it, we are trying to negotiate a sequence to vote on the Harkin amendment and for the Senator to be able to offer his amendment as promptly as swiftly as we can.

Mr. President, I suggest the absence of a quorum without violating the Senator's rights.

Mr. President, I wish to say the Senator who currently now chairs the Subcommittee on Defense will speak on the amendment of the Senator from Arizona. I wish to speak about the process and about sequester.

First, the Appropriations Subcommittee on Defense finished its work before the August recess. The authorizers didn't get it done until December 20. There is a gap here because Senator Inouye--a very happy, blessed, and beloved memory--moved his committee in an expeditious way, which appropriators are supposed to do.

Remember, appropriations are supposed to be done before October 1. Senator Inouye chaired the committee, chaired the full committee and then chaired this Appropriations Subcommittee on Defense. Senator Inouye did his job under the authorization that was present before him.

The authorizers didn't pass their bill until December 20. We want to respect the authorizers not only on defense but on every committee. They need to pass their bills before we pass ours. We work on our bills by holding our hearings under regular order beginning when we get the President's budget, which we wish would be up-tempo a bit. Then we start our hearings, mark up our bills in May and June, and begin to move them through the process.

Before we attack the Appropriations Committee, we should attack the process and get back to regular order, where authorizing and appropriating are in sync.

The second thing I wish to comment on is sequester. I want to acknowledge what the Senator from Arizona said about the impact of sequester. Sequester is an awful, awful, awful thing. That is not on this bill. When the Budget Committee comes up, along with the negotiations by the President with the leadership of the House, I absolutely agree with him, we must cancel sequester and ensure that not only our Defense Department but others who defend America, such as our Border Patrol guards, are not unduly harmed. And we are hollowing out, to use the quote from General Amos, an extraordinary Commandant.

What we need to do is get a process in order to have the proper policy debates.

I note that the subcommittee chairman will now comment on the specifics.

I yield the floor.

Mr. President, the Senate is not in order. I know there is a lot of gloating over this amendment--I don't mean yours. Could we kind of keep it quiet so Senator Inhofe can offer his amendment.

Mr. President, before the Senator leaves the floor, the chair of the Budget Committee--first of all, I want to compliment her on the work she has done on the Budget Committee. It is indeed impressive. I want to compliment her because she is headed for a balanced approach, really. Increased revenue. We are not talking about rates, we are talking about getting rid of tax break earmarks, earmarks that go on not for one group for 1 year but go on indefinitely, such as subsidies for corporate jets and sending jobs overseas.

But the other areas she is looking at are how we can be more frugal in our spending, and then a rigorous review of mandatory spending. We have to review it to see how we can get more value for our dollar.

The Senator has championed veteran's health care. She and I know we can get more value there. I compliment the Senator on that.

I am going to ask the Senator a question about timing and process. Does the Senator have a time mandate that has been assigned to her to complete her bill?

It is the economic framework for the United States of America.

Well, I want to share the Senator's sense of urgency to get her bill done. In order for her to get her bill done, I need to get my bill done. I want to pledge my cooperation, and I believe that of my vice chairman, Senator Shelby. We have a sense of urgency to move our bill because we must take it over to the House. There, we have a deadline that is a Draconian one: If we do not have a continuing funding resolution passed before the Easter-Passover break, we will face a government shutdown. That is horrific in terms of our economy and the people who want the U.S. Government to govern itself. It is also one more sign that we have a problem governing. I say that because, while the Senator is marking up her bill tomorrow, we want to move through here so that we are done.

I would like to have this bill done tomorrow. There are those who have obligations in their States and even at an international conference. I would like to support that, but Senator Shelby and I need support too. So we do not doubt people offering amendments, we do not question their content or their policy, but we have timing and process.

Our bill is not meant to be ``pin the tail on the donkey.'' It is not meant to

solve every problem the U.S. Government has. Our job is to keep the continuing resolution.

I want to say to the Senator, while, speaking to a much larger audience, I know there is pent frustration not to be able to offer amendments and debate. We are doing that. You win some, you lose some. That is called the Senate. I want the Senator to know we want to work with her so that we do not interfere in her work. But I believe one of the ways we can get to the budget, which is the real framework for how we can even vitiate sequester, is to get out our bill, meaning the continuing funding resolution.

So I want to compliment the Senator on her work. I pledge to support it, but I ask the support of all of the other 98 of our colleagues. Let's look at what we need to get done on the continuing funding resolution, not what we would like to get done.

That is right. An open and transparent process in that legislation that we put together over a weekend, 571 pages. Senators McCain and Coburn were right, but I could not do any more because I did not get it from the House until Thursday. So, again, I am not here to debate process, but I am the prodder of the process. So I am out here prodding and pleading: Please, let's get a simple, contained order of amendments. We thank the other side of the aisle. They are working with us.

In terms of the floor staff who is working on this, we need the cooperation of the Senators.

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

Madam President, I rise to speak on the pending question, which is the Cruz amendment, to defund ObamaCare. I appreciate him offering the amendment on this very relevant issue. I am glad we are talking again about it.

When I ran for office 2 years ago, this was one of the central issues. There has been a court decision since then. We need to understand, court decisions are about the constitutionality of something. They do not speak to its policy wisdom. That is what this debate is about today. I think it is important because since the election--and even going into the election--we had lost some view on this.

But let me begin by saying health insurance is a problem in the United States. There is no doubt about it. I think that to be in opposition to the health care bill is not to say that we think nothing should happen. On the contrary, I know health insurance is a major problem for millions of Americans. Its affordability is a problem. Its access is a problem, the ability of people to get the kind of health coverage they want.

In fact, when I was speaker of the Florida House--I had the honor of being that for 2 years in Florida--we actually worked on some ideas that created a marketplace where the private insurers and others could come together and create creative packages for people. That is the kind of insurance you need. Not everybody needs the same health insurance. Let me give you an example.

A family of four with two children--I have four children--I promise you, you are going to wind up in the pediatrician's office quite a bit, for everything and all kinds of stuff. We are very blessed. My children, thank God, are very healthy. And even then, there are issues where you need to bring them, whether it is primary care, whether it is vaccinations, whether it is a cold that does not go away--whatever it may be. I think it is so critically important to have that. So families in that circumstance need a certain type of coverage.

Then there are other people, people I know who are in their mid to late twenties. They never go to the doctor. But if they ever get sick, it is probably going to be, unfortunately, something very bad. So those folks maybe would rather have a plan that covers them upfront with some primary care coverage--maybe a higher deductible that you could pay with a health savings account--but on the back end some catastrophic hospitalization costs so if you truly get sick, God forbid, you have the opportunity to have the kind of coverage you need.

The point is everybody needs different kinds of health care coverage. My hope is that this country and the Federal Government--to the extent it has a role to play in all this--would help incentivize the creation of marketplaces for those sorts of innovative health ideas.

As I said, not everybody needs the same health insurance. That is why there are some principles that should have guided us when this was debated before I got here and should guide us going forward.

For example, I think one of our guiding principles should be that Americans should be able to buy health insurance from any company in the country that is willing to sell it to them. Right now, health insurance is regulated at the State level. In essence, these States have mandates as to what insurance companies must offer in order to sell insurance in that State, and you cannot buy insurance if it does not have all of those. The equivalent would be of saying: You either have to buy a Cadillac Escalade or you have to buy nothing. Some people do not want a car that is that big and that fancy. They need something that is a little different.

The point is those choices are not available to consumers. We should start with an organizing principle by saying every American should be able to buy health insurance they want from any company in America that is willing to sell it to them.

Another part of that is you should be able to buy health insurance for yourself. Let me tell you why that is problematic. If your employer buys the health insurance for you, they do not have to pay taxes on the money. Taxes are not paid on the money that is used to buy that health insurance. But if you buy it for yourself, it is income, it is treated as income. You have to pay tax on it. That is problematic for a couple reasons. No. 1, some businesses and some employers would rather give them the health care money so they can go out and buy the plan they want. Others would want to buy you plans or give you options among different plans.

Federal employees know very well what that is like. Let me tell you what a Federal employee gets. A Federal employee gets a book. In that book you get to choose between--depending on where you live--a bunch of different plans. You go right down the graph, and it tells you: This is how much this plan offers, this is how much you have to pay in premiums per month, this is how much you are going to owe in copayments if you go to a doctor, if you go to a specialist, if you go to a hospital.

How many people in America get that choice? How many people in America get the same choices on buying health care that their Congressmen and their Senators get? Very few. To me, that is a serious problem.

The good news about this--imagine now, for a moment, a country where people control their health care dollars, where you got to buy the insurance you wanted from the company you wanted. Let me tell you what the market is going to do. It is going to react to that. What the market is going to do--when there are people out there who are going to have choices over how they spend their health care dollars--they are going to start creating insurance packages that people want to buy. They are going to realize: We have a bunch of 25, 27, 29-year-olds in the United States who do not get sick. We should create special packages of insurance for them. They are going to realize: We have a lot of families out there who can afford to pay ``X'' amount of money for a family coverage plan. We should go out and create a special plan for families like them.

By the way, along the lines of this level of flexibility, you could see where small businesses all of a sudden can get together with other small businesses. As an example, a small chamber of commerce in a midsize city somewhere can decide to bring all of those companies together. Together they can buy health insurance for their employees. It is hard to buy group coverage if you only have four or five employees. But if you can get together with a bunch of other companies that have three, four, five employees, all of a sudden you have a buying pool. That buying pool gives you leverage and power to go out and create plans for all of your employees.

There is no one size fits all. We should have that kind of flexibility in our insurance marketplace. We do not. These are not going to cure everything, but these are important steps forward.

By the way, I would be remiss in talking about medicine to not talk about the malpractice insurance rates, especially for specialties. Do not underestimate what a significant impediment that is for some people to go into the medical profession or to stay in the medical profession.

Right up front, let me tell you, if a doctor is negligent, if a doctor commits malpractice, you should have a right to recover your economic damages, and there should be some level of punitive damages to encourage people not to do that in the future and to be careful. The problem is it has gone beyond that. In many States we have a crisis when it comes to litigation and medicine. People are not just suing because, unfortunately, something went wrong. They are suing on outcomes. They are not just suing because the treatment was bad. The result is that doctors practice defensive medicine.

You go to a doctor, you go to a hospital, they order a slew of tests. It is not because you need them, but because they want to make sure they are covered; that if they ever wind up in a court they can be able to say to the jury: Look at all of those tests I ordered--even though most of them might not have been necessary. Who do you think pays for that? We do.

It is worse than that. There are places like in Florida where obstetricians do not even have coverage at all. They go bare. They hire lawyers to protect their assets so they cannot be sued. I know true stories of obstetricians who will not see certain patients anymore because they are afraid of the outcome of what may happen.

So I think we need to look at, perhaps, not as a part of the insurance situation but in health care across the States, a way to incentivize States to pass medical malpractice reform that protects patients. People should always have the right to access the court system for wrongdoing, and especially to be compensated for their economic damages. If a doctor commits malpractice and you cannot work anymore, all of those lost wages that you are not going to be able to work for in the future, you should be able to be rewarded for that.

If we allow doctors to continue to be sued in this country as an industry,

which is what it has become, people are not going to go to medical school.

Here is another problem we are starting to see. A lot of young people in medical school do not want to go into the complex issues anymore. They do not want to become brain surgeons. They do not want to become OB-GYNs. They want to go into some other specialty that in addition to offering better hours--your beeper does not go off if you are a plastic surgeon at 3:00 in the morning. In addition to that, they do not have to worry about liability. Let me tell you, that is a problem. In Florida, most of our cardiologists are over the age of 50. What does that mean 10 years from now? That means we are not going to have enough cardiologists. It is discouraging people from going into very important professions in medicine because they are afraid they are going to get sued--not for doing something wrong but because things did not turn out well in treatment.

Let me put on the record that I am not against people being able to sue a negligent doctor. In fact, I think negligent doctors should not only be sued, they should lose their license. I am just saying, if we go too far, like anything else in the world, you are going to lose people from medicine. They are going to decide not to go in it.

Let's talk about this issue for a moment and the amendment that is before us. The problem with ObamaCare is that it is a one-size-fits-all approach to the entire country. The health care needs of Americans are very different. No. 1, they are very different geographically depending on where you live; No. 2, they are very different depending on your family situation, your health situation, et cetera.

Now, some people are very sick. They are chronically ill. That is where we can have a conversation about high-risk pools because these people are very difficult to insure. If someone is sure to get sick, it is hard to find an insurance for them because you are guaranteed to be sick. So we have to find a solution for that problem. That is where conversations about high-risk pools at the State level are a valid thing to talk about. But beyond that, I think people should have flexibility. That is not what ObamaCare does.

I understand that people read the newspapers and say: This is good. We are going to get a health care plan. We are going to be able to buy insurance. My boss is going to be forced to give me health insurance.

That is not how it is going to work out, guys. That is not how things work out in the real world. We are already starting to see the impacts of it. What is amazing to me is as this law begins to develop, as people start to see the true impact and the unintended or maybe even the intended consequences of this law, I predict right now that the number of people who were excited about ObamaCare is going to dwindle dramatically.

The proof is how many groups have come here already and asked to be exempted. How many unions, how many other groups have raised their hands and said: Please do not make us live under the laws that we supported. Do not make us live under their laws that we held rallies for. Do not make us live under these laws that we bragged about because it has a negative impact on us. And some of them are coming to bear right now.

No. 1 is the cost. When this bill was passed, they said it would be about $1 trillion--$940 billion to be exact. Now we know it is $1.7 trillion in gross cost over the next few years.

How about tax hikes? Absolutely, because starting in 2014, the IRS is going to create a problem for millions of Americans and small businesses. Basically, if you are not buying health insurance of the kind they want, of the kind the law requires--not just health insurance, a specific kind of health insurance--you are going to owe the IRS a fine. Think about that for a moment. If you are a small business owner or an individual, and you are not buying the health insurance the government says you must have, you now are going to have to pay a fine every year to the IRS.

Some people are going to do the math. They are going to say it is cheaper to pay the fine than it is to buy the health insurance. That is problematic, but it is a cost.

We are trying to grow our economy. That is the only solution to our problems. Over the next couple of weeks, we are going to debate budgets, we are going to debate continuing resolutions, and the word ``debt'' is going to come up. We cannot tax our way out of this debt. There is no tax increase that gets us out of this debt. To my own party, I say while we always have to have fiscal discipline, you cannot cut your way out of this debt alone either. The only real solution to our debt problems--and the debt matters because it is killing jobs in America--the only real solution to our debt problems is a combination of two things: rapid, robust economic growth.

If we can grow our economy at 4 percent a year, we could generate $3 trillion for debt reduction over the next decade, and we would create millions of jobs and pull people out of poverty and strengthen our middle class, which is the source of our exceptionalism as a country.

The second thing we need is fiscal discipline on future spending. This bill violates both. This bill violates both. It hurts economic growth because the only way you are going to grow your economy is if you make America a better place to create jobs and start businesses. That is how economic growth is created. When someone takes money they have or money they borrowed or money someone invested in them, and they use it, they risk it to open a new business or to grow an existing one, as the idea works, they start hiring people, and those people now are making a middle-class salary. Those people are now buying things and spending money, creating jobs and opportunity for others.

That is the formula for growth and prosperity. This hurts that because what you are now saying is, in addition to everything else you have to put up with in America--all the State and local regulations, all the complicated Tax Code stuff, the natural downturn in the economy, globalism and the changes that it has brought--in addition to all of that, here is one more thing you are going to have to do: You are either going to have to offer health insurance of a certain kind or you are going to owe the IRS a fine.

I promise you that is not the kind of thing chambers of commerce put on their pamphlets when they try to attract businesses to their communities or their States. This is not going to help in job creation. The tax hikes are a big problem. It is especially bad for small businesses because they have this arbitrary number of people--50 employees or more--who have to do certain things. OK. So what do you think a lot of businesses are going to do? I know people. They have already told me about this.

If you have 51 employees, this is a huge incentive to only have 49 employees. So you think about that for a moment. If you own a small road-paving company with 50 full-time employees or 51 full-time employees, you sit down with your accountant to do your math for next year. Your accountant will tell you: By the way, if you get rid of a couple of employees, this is how much money this is going to save you because of ObamaCare.

So do we want to have an incentive in our laws to have businesses get rid of workers because it helps them avoid certain costs mandated by government? This is happening. This is not pie in the sky, this is going to happen. There are people planning to do that already. It is happening right now.

Here is another thing. How about part-time workers versus full-time workers. We have already seen evidence of this across the board. But I will tell you where you are seeing it already is in people who own a bunch of franchises. So you own a chain of Kentucky Fried Chickens or a chain of McDonalds, and all of a sudden you have incentive to move as many of those people as you can to part time because they do not trigger the ObamaCare mandates either. So now you have all of these businesses across America that have an incentive that we have created in this law--I say ``we,'' the people who were here when this passed--a perverse incentive to cut people's hours so they do not trigger the mandate. These are horrible consequences that are going to have an impact on our country at a time when we should be growing our economy and creating middle-class prosperity, not working against it.

So my prediction is that when they start to fully implement this over the next 12 to 18 months, it is going to be an epic disaster. Not because it was ill-intentioned, per se. I think the goal of providing an environment where everybody can buy affordable health insurance is something we should take very seriously and something we have to work on. You cannot have a strong, stable middle class if people cannot afford the cost of living. You cannot have a strong and stable middle class if people do not have access to quality health care at an affordable price. We should work on that. We should work on that very hard. But we have to do that with balance.

This is not balanced. This is an across-the-board application to the entire country that is going to hurt a lot of people. There are people in America who are going to lose hours at work because of this bill. There are people in America who are going to lose the health insurance they have which they are happy with because of this bill. There are people in America who are going to have to lay off people, and therefore there are people in America who are going to lose their jobs because of this bill. Our debt is going to grow.

I hope we will pass this amendment. I hope we will defund this program. It was ill-designed. As the true ramifications of this bill begin to apply over the next few months and the next couple of years, we are going to be right here on this floor trying to fix it because this country cannot be what it is meant to be if it has to deal with something like this hanging around its neck.

I yield the floor.

Let me say a couple of things--actually, a true world example. Here is the startling thing about it. A lot of people are not fully aware of what this means yet. This may surprise some of us who are here every day or the people who cover politics on a daily basis, but most Americans are not tuned into C-SPAN 24 hours a day. They get their news in tidbits in the morning when they are making their coffee. They have the radio on. They hear some stuff on the radio on the way to work. Then they go to work for 10, 12, 14 hours to run a business. They get home, they have to do homework with the kids, make dinner, put them to bed. Maybe they get to watch an hour or two of TV. They wake up tomorrow morning and they do it all over again. They are not in touch with all of this on a daily basis. They have lives to lead.

You will be surprised how many small business men and women and how many employees around the country are not even aware of this yet, do not even realize the decisions they are going to have to make next year. So if you are in a business that has anywhere between 45, 55, 60 employees, when you sit down at the end of this year with your planner--be it your accountant, your lawyer, whatever it is you use, your human resources people--and do next year's planning, they are going to tell you: OK, next year we have this new law. This new law says we have to offer this kind of insurance. Here are your choices: Option No. 1 is you can offer the insurance, and this is how much more it is going to cost than what you are paying right now. Option No. 2 is do not offer any insurance and pay a fine to the IRS every year from now on. Here is how much that is going to be. Option No. 3 is to let some people go so you do not have to do any of this.

I am telling you, a lot of these people are going to say: You know what. It breaks our heart; we do not want to do it; it is not good for our business, but of the three options, the only one that is going to allow us to survive is to let some people go. That is not good for us. That is not good for us.