Floor Statements

Madam President, I yield back Republican time.

Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

I come to the floor today, as I do each week, as a doctor who practiced medicine in Wyoming for 25 years, as someone who has taken care of families all around the State of Wyoming, as a doctor who has great concerns about what has happened to the American health care system, and will continue to happen under the health care law that has been passed by this body and signed into law at the insistence of this President.

I come as a doctor giving a second opinion, because I have great concerns about this health care law. In talking with patients, in talking with doctors, and from my own personal knowledge, I believe this health care law is going to be bad for patients, bad for providers--the nurses and the doctors who take care of those patients-- and bad for the payers, the taxpayers of this country who are going to be left to pay the bill.

Recently my friends on the other side of the aisle have been using what I believe to be significant scare tactics about my party and Medicare.

Medicare is the program for our senior citizens. I believe it is important that the American people receive the truth. They deserve to have the truth about the future of Medicare, not scare tactics.

The fact is, unless Congress takes action, Medicare will go broke in 13 years. Again, in 13 years, Medicare will go broke. Today, more money is going out than is coming in. A bankrupt Medicare equals no Medicare for our seniors. These are people who have paid into Medicare, but a bankrupt Medicare means no Medicare.

If Washington doesn't show leadership now--today, this year--this program will run out of money and Medicare patients will run out of care. Many of my friends on the other side of the aisle continue to ignore the ticking clock and ignore reality.

Let's take a look at some of the reality the other side is ignoring. They are ignoring the fact that the life expectancy in the United States has risen significantly since Medicare was signed into law. When Medicare became law, in 1965, the average life expectancy was about 70. So, on average, you are talking about people being on Medicare for a certain number of years. Now, with the advances of medicine, the life expectancy is almost 80--the high seventies for men, but the low eighties for women. People are living about 10 years longer now, on average, than at the time Medicare was signed into law in 1965. It is an undeniable fact.

Another fact is that there are about 10,000 new Medicare recipients adding to the rolls every day as the baby boomers turn 65. An entire generation of baby boomers is retiring. The other side seems to ignore the fact that there are far more retirees today than ever before, and they are getting more money paid out of the program than they ever put in. I have townhall meetings and I travel around my State of Wyoming. People say: I paid into Medicare. They are absolutely right. On average, a couple who is retiring this week has paid into Medicare about $110,000--that is over a lifetime of working. That is significant money they have paid in. What kinds of services will they receive over the remainder of their lifetime, adjusted for today's dollars? It is $343,000. So you are talking about $109,000 that they paid into the system, and they are taking out $343,000.

American seniors know Medicare is in trouble. They understand the math doesn't add up, that this $3 coming out for every $1 paid in cannot work forever and ever. My friends on the other side, who attack Republicans for wanting to address this problem in a responsible way, tend to want to ignore this reality.

To make matters worse, Members on the other side actually voted for a health care law that puts Medicare on an even faster track to bankruptcy. In fact, the President's health care law cuts $500 billion from Medicare--not to save or strengthen or secure Medicare for the next generation. No, they took $500 billion from our seniors on Medicare to start a whole new government program for someone else. So it was no surprise to me when I read recently that those folks who look at the numbers, who work for the government, say Medicare is going to be broke 5 years sooner than even they had anticipated. It is odd how Democrats never even mention this when they attack Republican plans to save Medicare. Well, when they run advertisements and hold press conferences focused on scare tactics, why don't they ever explain their own $500 billion cut to Medicare?

It is also odd to me that the Democrats never talk about the other very significant piece of the President's health care law that attacks our seniors on Medicare. Hidden away in the bill is the President's Independent Payment Advisory Board, or IPAB. As a doctor who practiced medicine for 25 years in Casper, WY, I can tell you what this board is. It is a rationing board--a board to ration the health care of our seniors.

Rationing, some may say, is a very strong word. But that is exactly what

it is. The President's health care law puts Medicare on the road to rationing. This health care law creates an unelected, unaccountable board of Washington bureaucrats, who will decide how much Medicare pays for certain Medicare services.

Starting in 2014, after the next Presidential election, members of the board will decide how much they will reimburse hospitals and doctors for taking care of Medicare patients. Then providers all across this country will have to decide whether they can continue to care for American seniors.

Let's face it, even today doctors are running away from taking care of patients on Medicare. According to the American Medical Association, one in three primary care doctors already limits how many Medicare patients they are willing to see. According to the same survey of the American Medical Association, 60 percent of doctors say they are looking for ways to get out of Medicare completely.

Even more providers are going to stop seeing Medicare patients, and this situation will continue to get worse. If you don't believe me, ask seniors in your own community what happens when their doctor retires. Ask somebody on Medicare how easy it is for them to find a doctor to take care of them. If they happen to be with a doctor, and they turn 65, ask if they are allowed to stay with that doctor or if they move to another community to be closer to their children and grandchildren, ask them how difficult it is for those on Medicare to find a doctor. The reason is, of course, because Medicare pays a lot less than the going rate.

Yet, the Democrats' and the President's solution is to pay even a lower amount and continue to ration and ratchet down that amount, resulting significantly in additional rationing of care as our seniors find it harder and harder to find physicians and nurses to take care of them.

The other thing about this rationing board is that it gets worse when you look at the details. It will be practically impossible for this Congress--or any Congress--to overturn the rationing board's recommendations.

Again, to me it seems very odd that my friends on the other side don't talk about this rationing board when they hold their Medicare events. But as Nancy Pelosi said, first you have to pass it before you get to find out what is in it. The American people continue to find out what is in this health care law, and they continue to oppose it. I say to my colleagues on the other side of the aisle, if you are so proud of the work you have done on Medicare, then you should stand and defend this rationing board. My colleagues on the other side of the aisle should explain to American seniors how it will work and how it will impact their care. America deserves a thorough and honest debate about the future of Medicare, how we got to this point, and how we can, in a responsible way, strengthen and secure Medicare for those on Medicare and for the next generation.

I bring this to you today because today a new study came out in the New England Journal of Medicine. It has to do not with Medicare--a program for our seniors--but with Medicaid, a program for low-income people--specifically, in many cases, for children. The study from the New England Journal of Medicine today talks about how very difficult it is for people--specifically children--on Medicaid to even get an appointment to see a doctor.

During the health care debate over the last year, I have come to the floor continuously and talked about the fact that many physicians refuse to take patients on Medicaid, because the reimbursement from the government is lower than the cost of actually even treating the patient--considering rent, office expenses, and other costs.

This study out today in the New England Journal of Medicine talks about researchers in Chicago who called a number of doctors' offices with an identical voice, the same person calling--actually, the same office--a month apart with the same symptoms, whether it was for asthma or different conditions such as diabetes, for the child's care, and the question came: Do you have insurance or are you on Medicaid?

What they found is that for 89 percent of those with insurance, they were able to get an appointment--regular insurance. Of those saying, no, we have Medicaid--and they called hundreds and hundreds of offices and clinics--only one in three was able to get an appointment. Think about that. It is something for our seniors to think about, as well as the President's rationing board. It pays less and less for a visit to a doctor.

We have talked about the fact that Medicare rates, as a result of the $500 billion cut from Medicare, will be in many places similar to Medicaid rates. So I would assume that at some point soon seniors will have the exact same amount of trouble getting an appointment to see a physician, as the New England Journal of Medicine found today, for children on Medicaid.

With that, I say that I will continue to come to the Senate floor week after week with a doctor's second opinion about the health care law, because week after week we see new information, new relevant information about how the impact of this broad, sweeping law, significant changes for the health care of all Americans--how it is, in my opinion, bad for patients, bad for providers, the nurses and doctors who take care of them, and bad for taxpayers.

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

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

Mr. President, I come today to visit on the floor of the Senate because since last November the President has been trying to convince the American people that he has a plan to restart our economy. He was in North Carolina yesterday with his council to talk about issues. To me, the President's approach has left a lot to be desired. If the White House created as many jobs as it creates speeches, things would be a lot better. The President's empty words are not filling the pockets of American citizens.

The President has been given a new chance to show his commitment to economic growth, and that is the chance

he has recently had to nominate a Secretary of Commerce for the United States.

When I think about the Commerce Department, it is a department with a job, in terms of American businesses, to make those businesses more innovative at home and more competitive overseas. Well, the mission of the Commerce Department states that it ``promotes job creation, economic growth, sustainable development and improved standards of living for all Americans.'' So at a time of economic crisis such as the one we have now, a nominee who can fulfill that mission, that very mission--of promoting job creation, economic growth, sustainable development, and improved standards of living for all Americans, that very mission--is needed more than ever.

Despite the administration's promise that their so-called stimulus bill would keep unemployment rates below 8 percent, we know unemployment went to 10 percent. It is still over 9 percent, and our job growth last month was the slowest it has been in almost a year. Over 13 million Americans are still out of work, and nearly half of them have been unemployed for 6 months or more. This is the highest rate of chronic unemployment we have had since the Great Depression.

These problems aren't just happening at home. America's position on the international stage is slipping as well. America's ability to pay its debts has already been called into question by Standard & Poor's credit ratings. Moody's is asking the same questions. Recently, Fitch credit ratings also warned us that the United States was playing with fire. Gas prices are very high. I hear it every weekend at home in Wyoming. Families are spending $800 on average more for gasoline this year than last year. We spend $48 million more on goods from other countries than we do on our own goods, and our economic situation is already bad.

The headlines sound worse every day. Let me give a couple of examples. From Gallup: ``U.S. Investor Optimism Declines.''

From Reuters: ``Wall Street ends down as jobs data disappoints.''

From Bloomberg: ``Economic Recovery Is Languishing as Americans Await Signal of Better Times.''

Even the Chairman of the Federal Reserve said the job market was ``far from normal.''

The facts are clear. Americans deserve the best leadership in the Commerce Department--the Department that is responsible for trade, job creation, and economic growth.

Last week, the President nominated John Bryson to be his new Commerce Secretary. Many may ask, who is this man? Is he a job promoter, someone who can bring economic growth and improve the standard of living for all Americans? Well, John Bryson's record clearly shows he is not such a nominee. In fact, his resume is exhibit No. 1 in proving that this administration is not serious about job growth. At best, it is unclear why John Bryson is the President's nominee for this position. At worst, his nomination is proof the President wants environmental activists running our economic development strategy.

When announcing Mr. Bryson's nomination, the President praised Mr. Bryson's background. According to the President, Mr. Bryson would be a good Commerce Secretary because ``he's been a fierce proponent of alternative energy.'' Well, if Mr. Bryson was being nominated to be Energy Secretary or the Administrator of the Environmental Protection Agency or even Interior Secretary, that fact might be relevant. But Mr. Bryson is being nominated to be Secretary of Commerce.

Mr. Bryson does have a background in the private sector. The problem is, his private sector success has more to do with government help than with his own ability to create jobs or grow the economy.

Don't take my word for it. The Wall Street Journal already has written that Mr. Bryson believes ``wholeheartedly in a strategy of politicized investment.'' They also wrote that the companies he has been associated with have generated revenue through handouts from the Federal Government rather than by being profitable.

We need a Commerce Secretary who knows how businesses turn a profit and how to create private sector jobs. We need a Commerce Secretary who will make it easier and cheaper for the private sector to create jobs, not someone who will make it harder and more expensive for the private sector to create jobs. We need a Commerce Secretary who can understand all sectors of the economy rather than someone who picks winners and losers.

Already, to me, Mr. Bryson fails the test. His support for politicizing U.S. investments is the least problematic element of his resume. Along with his private sector experience, he is also the founder of a group called the Natural Resources Defense Council, or the NRDC. This organization is so radically antibusiness that even Massachusetts Democrat Congressmen Barney Frank and John Tierney think it is troubling that Mr. Bryson is associated with it.

These Members of Congress have described the NRDC as ``one of those environmental organizations that has reflexively attacked the fishing industry inaccurately and without any real environmental basis.''

It is not just the fishing industry the NRDC reflexively attacks. Members of the NRDC staff are on record saying: ``There is no such thing as clean coal.''

But while gas prices soar and energy jobs are needed, a spokesman for the NRDC has said:

NRDC has been very active and proud to be active in

fighting new coal plant proposals in the United States.

They have also stood in the way of lifesaving sonar technology that would enhance America's national security. Why? Well, out of fear that it might harm the whales.

They have also filed thousands of lawsuits to stop the production of American energy, and American energy is critical and a part of our American national security. This anti-energy agenda is so reflexive that the NRDC has even filed lawsuits to further delay future energy exploration in the Gulf of Mexico. Well, the delay has already stretched on so long that even former President Bill Clinton has called it ``ridiculous.''

John Bryson's career has consistently shown that he agrees with this overzealous approach to environmental policy. When Mr. Bryson first started at Edison Electric, the Los Angeles Times said he had founded ``one of the Nation's most aggressive environmental organizations.''

When it comes to being antibusiness, an unpopular policy such as cap and trade is one area where he is focused. He is one of its most aggressive supporters, and the record shows it. More importantly, his own words show it. Most Americans recognize cap and trade as a job- killing energy tax. That is why the Waxman-Markey cap-and-trade bill couldn't pass the Senate. However, when referring to this very bill, John Bryson called it ``moderate but acceptable.'' He called it a moderate but acceptable piece of legislation. He even said the legislation was good precisely because it was a good way to hide a carbon tax--to hide a tax.

Mr. Bryson has repeatedly called for a national cap-and-trade system, and he has even put his money where his mouth is. But when someone says ``a good way to hide a tax,'' is that what the role of the Secretary of Commerce is, to hide a tax on American businesses to make them less competitive, to make it more expensive to do business? I think not.

According to the Daily Caller, Mr. Bryson's own company spent over $1 million lobbying for cap and trade.

So John Bryson believes in politicizing American investment. He has founded a radical environmental organization and has spent significant amounts of money lobbying for a policy that he openly acknowledges is a cover for a job-killing energy tax.

We need a Commerce Secretary. We need a Commerce Secretary who will work at making American businesses more innovative at home and more competitive abroad. We do not need a Commerce Secretary who is more interested in taking our hard-earned dollars than in creating jobs at home. The American people deserve a Commerce Secretary who is more interested in free trade than in cap and trade.

The President may believe John Bryson is the right man at the right time. I believe John Bryson is the wrong man at the worst possible time.

Thank you, Mr. President. I yield the floor.

Mr. President, I rise today to honor and express our Nation's deepest thanks to a brave young man and his family. On Monday, I received word that LCpl Sean M.N. O'Connor of Douglas, WY, had fallen on June 12, 2011, in the line of duty in support of Operation Enduring Freedom. Lance Corporal O'Connor was killed while supporting combat operations in Helmand Province in southern Afghanistan.

Lance Corporal O'Connor was assigned to the 1st Battalion, 5th Marine Regiment, Regimental Combat Team 8, II Marine Expeditionary Force FWD, 1st Marine Division, out of Camp Pendleton, CA. Sean's roots in the Marine Corps run deep. He was born at Marine Corps Base Camp Pendleton. Like his father, Lance Corporal O'Connor joined the U.S. Marine Corps in 2007 soon after graduating from Douglas High School. Sean was an avid reader, swimmer and shooter. He will be remembered as a fun loving son and friend who could always be counted on to lend a hand to those in need.

It is because of individuals like Sean O'Connor that all Americans are able to live our daily lives as free people. They put their very lives on the line every day, and because of their bravery and their families, our Nation remains free and strong. Freedom is not free. It carries a very high price. And that price has been paid over and over by many generations of men and women who answered the call to arms and willingly bear the burdens of defending our Nation. They deserve our deepest respect and gratitude.

The motto of the U.S. Marine Corps is ``Semper Fidelis.'' It means ``Always Faithful.'' LCpl Sean O'Connor lived up to these words with great honor. He made the ultimate sacrifice in the name of freedom for you and I to enjoy. He gave his life, that last full measure of devotion, for you, me, and every single American. Today we thank Lance Corporal O'Connor for serving and defending our country. He was always faithful to our country and its citizens, and to his fellow marines.

Lance Corporal O'Connor is survived by his parents Daniel and Dee O'Connor and his Aunt Sarah O'Connor. He is also survived by his brothers and sisters in arms of the U.S. Marine Corps. We say goodbye to a son, friend, neighbor, and a marine. The United States of America pays its deepest respect to LCpl Sean O'Connor for his sacrifice, so that we may remain free. Sean was the embodiment of honor, courage and commitment. All of Wyoming, and indeed the entire Nation, is proud of him. May God bless him and his family. Lance Corporal O'Connor, Semper Fi.

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

Madam President, I come to the floor again today, as I have week after week since the health care law has been passed, with a doctor's second opinion about the health care law. As you know, I have practiced medicine for 25 years in Wyoming, taking care of Wyoming families.

I have great concerns about this health care law that has been passed by this body as well as the House, signed by the President. The American people continue to learn more and more about this health care law, and the more they learn, the more concern they have about this law being bad for patients; bad for providers, the nurses and doctors who take care of the patients; and bad for the payers, the taxpayers of this country who are going to get hit with an incredible bill.

The main subject I wish to talk about today is a new report that has come out that says to me that the taxpayers are going to get hit with a bill much higher than they initially thought. It is a report from the McKinsey Quarterly called ``How U.S. health care reform will affect employee benefits.''

In the debate and speeches the President had given in the runup to the election and the vote on this bill, he said that if you had care you liked, you could keep it; that the American people, if they had a plan they liked, would be able to keep it. It was a promise he made to the American people, a promise the American people wanted to believe. But now this report shows that the American people were right in being skeptical, and, as we see, the more the American people learn about the health care law, the less they like it and the more they oppose it. What this report says is that a shift away from employer-provided health insurance will be vastly greater than expected and will make sense for many companies and lower income workers alike.

When we work our way through this report, what we see is that more and more private companies that today--today--provide health insurance for their employees will be much less likely to be willing to provide that insurance in the future. Why? Because it is going to be a lot more expensive to provide the insurance. The mandates, the quality, and the high level of expense involved with providing that insurance is going to be a significant burden to those companies. And if they don't provide the insurance at all, there are going to be other chances for those employees and it will actually be cheaper for the business to not provide insurance, give the people a raise, and pay the penalty of the health care law and leave people without the insurance.

When we take a look at this overall health care law, we see it as one where this body and this President raided Medicare. They took $500 billion away from our seniors on Medicare, not to save Medicare but to start a whole new government program. With the President's Payment Advisory Board, he additionally wants to ration Medicare--ration Medicare. They have raided Medicare and rationed Medicare. Is it any surprise that people on Medicare are having a much harder time finding a doctor as doctors refuse to see patients on Medicare?

So with all of this, now we get this report. This report says--and this is a very reputable national consulting firm. This report says they did a survey of 1,300 employers across the country--different industries, different geographies, different employer sizes--and the results ought to be a huge wakeup call for all workers and all families across the country, because what this group has seen from this study is that overall, 30 percent of all employers--30 percent of all employers--will either definitely or probably--so likely--stop offering employer-sponsored health coverage in the years after 2014. That is when ObamaCare goes fully into effect.

Among employers with a high awareness of how the program actually works for health care reform--who have actually studied what the law says--in that group, those who are most well informed, they are saying more than 50 percent and upwards to 60 percent will pursue other options. They will likely stop offering their employees health coverage. At least 30 percent of the employers would gain economically from dropping coverage even if they completely compensated the employees for the change of losing their insurance. This is very alarming for our country.

There was a well-written editorial in yesterday's Wall Street Journal by Grace-Marie Turner, and I ask unanimous consent that it be printed in the Record at the conclusion of my remarks.

Grace-Marie Turner is president of the Galen Institute and coauthor of a book called ``Why ObamaCare Is Wrong For America.'' Having read the book, I will tell my colleagues a lot of the things I have been talking about during the debate leading up to the vote on ObamaCare and that I have been talking about afterwards as a doctor's second opinion are included in her book. She specifically writes that no, you can't keep your health insurance. There are about 150 million Americans who get their coverage at work. We are not talking about people on Medicare; we are talking about nonelderly Americans who get their coverage at work.

The Congressional Budget Office, when we were debating the health care law, estimated that maybe 9 million, 10 million of those people, or about 7 percent of the employees who currently get their health insurance through work, may lose their health insurance at work, in spite of the fact that the President said if you like what you have, you can keep it. But this survey of 1,300 different companies-- organizations that provide health insurance--30 percent of them say I don't think we are going to follow that route. We are talking about a significantly larger number than the Congressional Budget Office had even anticipated. The numbers are astonishing.

In a study last year, Doug Holtz-Eakin, who is the former director of the Congressional Budget Office, estimated not what the current CBO said--maybe 10 million--he thought maybe 35 million workers would be moved out of employer-covered plans into subsidized coverage, paid for by the taxpayers, and he thought by getting to that number, it would add an additional $1 trillion to the estimate of what the real costs were going to be for the President's health care law. If these numbers are true, this newer, higher number of 30 percent pulling out--and maybe 50 percent once they find out what is actually in the law, in the mandates on these businesses--the additional costs, at a time when we are looking at 9.1 percent unemployment in this country, are going to go even higher with the significant subsidies that exist for families making up to $88,000 a year.

So I come to the floor to say that the more we learn about this health care law, the more unintended consequences we find; that many of the predictions made about this health care law from this side of the aisle are now coming true.

I have spoken in the past about waivers. We now are at a point where 3 million people who get their health insurance through work--3 million people covered with health insurance in this country--have gotten waivers. Whole

States have gotten waivers so they don't have to live under the mandates of the health care law, and they are going to be back for waivers again next year and the year after that.

We see additional concern with what is in this health care law. As Nancy Pelosi said, first you have to pass it before you get to find out what is in it. As more and more people find out what is in it, we are finding that more and more people who maybe had coverage they liked are not going to be able to keep that coverage and are going to lose that coverage, and the taxpayers are going to get stuck footing the bill.

That is why I come back to the floor week after week with a doctor's second opinion, because there is new information that comes out week after week, as this McKinsey & Company study and report came out this week. That is why I continue to say we need to repeal and replace this terribly broken health care law.

Thank you.

With that, I yield the floor.

Exhibit 1

[From the Wall Street Journal]

No, You Can't Keep Your Health Insurance

(By Grace-Marie Turner)

A new study by McKinsey suggests that as many as 78 million

Americans could lose employer health coverage.

ObamaCare will lead to a dramatic decline in employer-

provided health insurance--with as many as 78 million

Americans forced to find other sources of coverage.

This disturbing finding is based on my calculations from a

survey by McKinsey & Company. The survey, published this week

in the McKinsey Quarterly, found that up to 50% of employers

say they will definitely or probably pursue alternatives to

their current health-insurance plan in the years after the

Patient Protection and Affordable Care Act takes effect in

2014. An estimated 156 million non-elderly Americans get

their coverage at work, according to the Employee Benefit

Research Institute.

Before the health law passed, the Congressional Budget

Office estimated that only nine million to 10 million people,

or about 7% of employees who currently get health insurance

at work, would switch to government-subsidized insurance. But

the McKinsey survey of 1,300 employers across industries,

geographies and employer sizes found ``that reform will

provoke a much greater response'' and concludes that the

health overhaul law will lead to a ``radical restructuring''

of job-based health coverage.

Another McKinsey analyst, Alissa Meade, told a meeting of

health-insurance executives last November that ``something in

the range of 80 million to 100 million individuals are going

to change coverage categories in the two years'' after the

insurance mandates take effect in 2014.

Many employees who will need to seek another source of

coverage will take advantage of the health-insurance

subsidies for families making as much as $88,000 a year. This

will drive up the cost of ObamaCare.

In a study last year, Douglas Holtz-Eakin, a former

director of the Congressional Budget Office, estimated that

an additional 35 million workers would be moved out of

employer plans and into subsidized coverage, and that this

would add about $1 trillion to the total cost of the

president's health law over the next decade. McKinsey's

survey implies that the cost to taxpayers could be

significantly more.

The McKinsey study, ``How US health care reform will affect

employee benefits,'' predicts that employers will either drop

coverage altogether, offer defined contributions for

insurance, or offer coverage only to certain employees. The

study concludes that 30% of employers overall will definitely

or probably stop offering health insurance to their workers.

However, among employers with a high awareness of the health-

reform law, this proportion increases to more than 50%.

The employer incentives to alter or cease coverage under

the health-reform law are strong. According to the study, at

least 30% of employers would gain economically from dropping

coverage, even if they completely compensated employees for

the change through other benefit offerings or higher

salaries. That's because they no longer would be tethered to

health-insurance costs that consistently rise faster than

inflation.

Employers should think twice if they believe the fine for

not offering coverage will stay unchanged at $2,000 per

worker. ``If many companies drop health insurance coverage,

the government could increase the employer penalty or raise

taxes,'' according to the new study, authored by McKinsey

consultants Shubham Singhal, Jeris Stueland and Drew

Ungerman.

The case for repeal of ObamaCare grows stronger every year.

The massive shift of health costs to taxpayers thanks to the

disruption of employer-sponsored health insurance will add

further to the burgeoning federal budget deficit. Congress

can and must develop policies that allow the marketplace to

evolve and not be forced into ObamaCare's regulatory

straitjacket.

I note the absence of a quorum.

Mr. President, I rise today to submit for the Record an article written by Karen Budd-Falen and published May 28, 2011, in the Wyoming Livestock Journal. The article's title is ``Leveling the Playing Field: Support for the Grazing Improvement Act of 2011.''

The title of the article is instructive. Anyone living and working in rural communities knows the playing field is not level. The National Environmental Policy Act has become the preferred tool to delay and litigate grazing permit renewals for American ranchers.

Livestock grazing on public lands has a strong tradition in Wyoming and all Western States. Ranchers are proud stewards of the land, yet the permitting process to renew their permits is severely backlogged due to litigation aimed at eliminating livestock from public land.

During times of high unemployment and increasing food prices, we need to be encouraging jobs in rural economies. We need to be fostering an environment to raise more high quality, safe, American beef and lamb; not litigating less.

That is why I introduced the Grazing Improvement Act of 2011. This legislation will provide the certainty and stability public grazing permit holders desperately need in order to continue supporting rural jobs, providing healthy food, and maintaining open spaces for recreation and wildlife.

It is time to help level the playing field for hard working ranching families across the West. Their livelihood should not be held hostage by litigation and anti-grazing special interest groups. I thank my colleagues, Senators Enzi, Crapo, Hatch, Heller, Risch, and Thune, in supporting ranching families and this legislation.

Mr. President, I ask unanimous consent to have printed in the Record the article to which I referred.

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

Mr. President, as you well know, I come to the floor each week with a doctor's second opinion, and it specifically relates to the health care law, the law that was passed now over a year ago, with many promises made by the President, one of which was that if you like your coverage, you can keep it. We now know that is not the case, as he had promised. He also talked about this driving down the cost of health care. We have seen the cost of health care going up.

Last week, I came to the Senate floor and talked about something that is not known very well. It is a part of this law. It is called the so- called Independent Payment Advisory Board. I gave five specifics as to problems with this board. So today I wish to give another five specifics, and I think these are things every single American needs to know about the mandates that are part of this health care law and what is going to happen to them as more and more components and parts of this health care law are implemented.

People refer to this board as ``IPAB''--not ``iPod'' but ``IPAB''-- and it stands for the so-called Independent Payment Advisory Board. But I will tell you, this is a Washington board. It is not independent. I believe it is going to be very harmful in terms of the health of the American people.

This board often goes unnoticed, and one of the reasons is it actually does not become operational until after the 2012 elections, until 2013. But it is an extremely powerful and extremely dangerous part of the President's health care law. It is a Washington board. It empowers 15 unelected and unaccountable bureaucrats, 15 full-time Washington bureaucrats, who will decide how Medicare's dollars are spent. These Washington bureaucrats will use basically price controls, and they will use price controls to ration medical care and services all across the country.

You remember, Mr. President, when then-Speaker of the House Nancy Pelosi said first you had to pass the bill before you got to find out what was in it? Well, now, as more and more Americans learn about this rationing board, they will again voice their opposition to the President's health care law.

I will tell you, I want to pick up today where I left off last week. I want to share with the American people an additional five things they need to know about this board.

The No. 1 thing today is the President wants to keep this board under the radar. He and his administration simply want to disguise the long- term impact this board's price controls will have on our seniors on Medicare. If he does so successfully, the patients on Medicare will be the big losers.

He wants to promise the American people that the board will achieve great Medicare savings, but he does not want to explain to the American people exactly what those Medicare cuts will do and how the American people will ultimately pay the price in their health care.

The President and Washington Democrats have historically supported policies giving government the power to set health care prices. Make no mistake, the President is using this Washington board as a Trojan horse to accomplish that goal. This is exactly why this board is not going to be set up until after the 2012 elections. The American people will not face the true impact of this board and the cuts it is going to have on their loved ones until after the Presidential election next year. The President's plan depends entirely on keeping the true purpose of this rationing board well below the radar.

Here is a second concern; that is, the opposition to the President's payment advisory board, interestingly enough, is bipartisan. Even members of the President's own Party know that creating a Washington board to cut Medicare payments and ration medical services is bad policy when it comes to our seniors.

Even Representative Pete Stark of California, the ranking member of the House Ways and Means Health Subcommittee, said in an April 19, 2011, New York Times article:

In its effort to limit the growth of Medicare spending, the

board is likely to set inadequate payment rates for health

care providers, which could endanger patient care.

There you have a statement by a member with ranking stature of the Democratic Party in the House.

Now let's take a look at what someone else said. She announced her support for legislation which would repeal the President's Payment Advisory Board. This is Representative Allyson Schwartz of Pennsylvania. Actually, she is a strong champion for the health care law. She is also vice chairman of the New Democrat Coalition. She had a statement that came out on April 15, 2011--income tax day--saying:

Congress is a representative body and must assume

responsibility for legislating sound health care policy for

Medicare beneficiaries, including those policies related to

payment systems. Abdicating this responsibility . . .

undermines our ability to represent our constituents. . . . I

cannot condone the implementation of a flawed policy that

will risk beneficiary access to care.

Third, the President's payment advisory board sets prices and it gives Washington more power, not patients. In most cases, Medicare payments to doctors--and Members of the Senate from both parties understand this--are already well below market rates. That is why doctors often limit the number of Medicare patients they see. In more severe cases, doctors stop treating new Medicare patients.

Allowing a rationing board unlimited power to control Medicare prices is only going to drive Medicare payments lower, and it is going to drive more doctors away from seeing Medicare patients. My concern is the prices are going to be driven so low by this rationing board that the government will force doctors, hospitals, and other medical providers to stop offering any care to Medicare patients.

Random and punishing cuts to Medicare provider payments will not make this program any more efficient. It will not make people's health care better. But it will reduce the supply of medical care to our seniors on Medicare.

The Washington board's ability to set prices gives it unprecedented control over personal medical decisions, and that is wrong. Those decisions should be left to the patient and his or her doctor alone, without the interference of 15 Washington bureaucrats.

No Washington bureaucrat should ever have the right to stand between a patient and his or her doctor. At its core, the debate about the President's Independent Payment Advisory Board centers around a few questions: Do the American people want a Washington board of unelected people whom they do not know making their personal health care choices for them or do they want to have the freedom and choice to make their own health care decisions? Do they want Members of Congress, the people whom they send to Washington, to be able and to be held accountable--do they want those Members of Congress to explain exactly what spending cuts are being discussed and need to be made to ensure Medicare's solvency?

As we know, we all heard just last week, Medicare is going to be bankrupt even 5 years faster than it had been thought in the past. Interestingly enough--this is No. 4--President Obama doubled down on this, on the President's Independent Payment Advisory Board.

In his April 15 spending speech to the Nation, he doubled down on his commitment to this Washington rationing board. In the speech, he said he actually wants to give the Board more power to slash Medicare payments to providers. Apparently, expanding his rationing board is one of the only tangible proposals that the President has to reform Medicare and reduce the debt.

The American people sent us to confront our financial and fiscal crisis head on and to come up with solutions to solve the problem. They did not send us to cower behind boards and commissions and empty promises. They asked us to come to Washington with the courage, the strength, and the political will--the political will--to make tough spending decisions. Rather than stand up to the challenge, the President chose to go all in, placing his bet on 15 bureaucrats yet to be identified.

He asked the American people to trust him that this rationing board will squeeze out Medicare savings, at the same time, not impacting--he says--our seniors' access to medical care. But I do not think this is a bet our Nation's seniors should take or should be willing to take.

Finally, No. 5, members of my party, the Republicans, are working to repeal the President's Independent Payment Advisory Board. Senate Republicans are taking a stand against this rationing board, against more government control. Senator John Cornyn of Texas has introduced S. 668. It is the Health Care Bureaucrats Elimination Act. This bill repeals the President's Independent Payment Advisory Board, ensuring Medicare patients can get the care they need from the doctor they choose. I am proud to be a cosponsor, an original cosponsor of this piece of legislation.

That is why I come to you again on the floor with a doctor's second opinion, as somebody who, for a quarter of a century in Wyoming, has taken care of patients on Medicare--many patients on Medicare--to provide a doctor's second opinion that this health care law is bad for those patients. It is bad for providers, the nurses, and doctors who take care of those patients, and it is bad for the taxpayers.

I yield the floor.

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

Mr. President, I ask unanimous consent to speak for up to 15 minutes as in morning business.

Mr. President, I come to the floor, as I have week after week since we passed the health care law, giving a doctor's second opinion of the law. I come today because last month President Obama delivered a very big speech on spending. Unfortunately, it seemed to be more of a political attack than a substantive speech offering a detailed plan to attack the American debt crisis.

The President did, however, mention one bit of substance that really should raise a red flag to the American people. He said:

We will slow the growth of Medicare costs by strengthening

an independent commission.

Well, the Washington commission he is referring to is called the Independent Payment Advisory Board. This board may sound harmless, but let me assure you that the American people deserve to know and have a right to know more detail about the board and its work.

Many Americans may not remember that the health care law created this unelected, unaccountable board of Washington full-time bureaucrats. The sole purpose of the board is to cut Medicare spending based on arbitrary budget targets--not based on the number of people on Medicare or the number of seniors but based on arbitrary budget targets. These are cuts above and beyond the $500 billion already taken from a nearly bankrupt Medicare Program during the health care law--taken from our seniors--not to save Medicare but to start a whole new government program.

Now the President wants to slow the growth of Medicare costs by strengthening this independent commission. Well, this board empowers 15 unelected Washington bureaucrats to make these Medicare cuts, all without full transparency and accountability to the American seniors and also to elected officials.

Once again, this board proved that the President and the Democrats in Congress who voted for the health care law simply didn't have the political courage to make tough spending decisions. Instead, they took the easy road and pulled a classic Washington maneuver: they created a board and then punted the tough decisions to the board. Well, this forced Congress to abdicate two important congressional duties. First is the constitutional responsibility to manage Medicare spending. The second is the responsibility to explain to the American people why specific payment changes might be necessary to keep Medicare afloat-- all because the President and Washington Democrats refused to lead. They simply threw up their hands and said: Let someone else deal with it.

If expanding this independent board is--they call it ``independent,'' but I am not so convinced it is. It is called the Independent Payment Advisory Board. If expanding the board is the one and only concrete proposal the President has to reform Medicare and reduce the debt and most Americans have never even heard of it, then it is important that we take the time on the Senate floor today to discuss exactly how this board works and the impact it will have on medical care in America.

I call this the top 10 things you need to know about the Independent Payment Advisory Board. To me, this issue is so important that I plan to talk about five of them today, and I will come back next week, as part of the doctor's second opinion on the health care law, and talk about the next five.

No. 1, this board is how Washington will limit patient care.

When Congressman Paul Ryan offered his 2012 budget plan, the President and members of his party launched an all-out media assault on Medicare spending. The White House and Democrats used inflammatory and patently false statements to scare people about the Ryan plan. What they failed to mention, however, is that the President's own health care law actually has significant caps on Medicare spending. To enforce the caps, the President and Washington Democrats went with their tried- and-true solution: create another board.

What does this mean for people who are currently on Medicare and for future Medicare patients? A centralized Washington board will arbitrarily cut payments to Medicare providers--doctors, nurses, and other people taking care of patients. They are going to squeeze Medicare savings by cutting provider payments and treatment options, which will punish patients. Why? To start a whole new government program--not for the people who paid into Medicare but for a whole different group of people. Not only will medical professionals facing these cuts decide to simply stop seeing Medicare patients--and we see that now. Frankly, doctors are running away from Medicare, not wanting to see those patients. Individuals and families will watch helplessly as a Washington bureaucrat decides what kind of treatments that person can have.

No. 2, this board is going to make recommendations, and those recommendations will automatically become law.

How can it be that something the board does automatically becomes law? But their spending recommendations automatically become law-- unless Congress acts to stop it. If Congress would actually want to stop the board's policies, there are very few options. The options are severely limited. Overriding the board's recommendations requires a three-fifths majority vote in the Senate, a high hurdle to jump, or Congress can pass a different Medicare spending plan. But there is a catch. It still has to meet the same arbitrary spending target. So if Congress does nothing, then Health and Human Services Secretary Kathleen Sebelius will implement the board's plan.

Medicare consumes about 13 percent of the Federal budget, and former Office of Management and Budget Director Peter Orzag called this board ``the largest yielding of sovereignty from Congress since the creation of the Federal Reserve.''

The bottom line is that this board isn't making recommendations to Congress; this board is passing law. Well, Congress doesn't have to approve these policies of the board, and the President

doesn't have to sign them. They are law. This represents an unprecedented shift of power from the legislative branch of the Federal Government to an unelected board of 15 bureaucrats.

No. 3, the policies of this board cannot be challenged in court.

On April 19 of this year, the New York Times published an article entitled ``Obama Panel to Curb Medicare Finds Foes in Both Parties.''

This article explains that:

In general, federal courts could not review actions to

carry out the board's recommendations.

Well, there is an institute called Arizona's Goldwater Institute. They filed a lawsuit based upon this payment advisory board. Part of the lawsuit says:

Congress has no constitutional power to delegate nearly

unlimited legislative power to any federal executive branch

agency, much less to entrench health care regulation against

review, debate, revision, or repeal. . . . Such federal

overreaching must be rejected if the principles of limited

government and the separation of powers by the United States

Constitution mean anything.

That is what the lawsuit says.

Let's go to No. 4. This board's mission is to cut provider payments. The board is strictly limited in what it can do to achieve Medicare spending reductions. By law, the board cannot raise revenue by increasing taxes. It cannot increase patient cost-sharing methods, such as premiums, copayments, and deductibles. It cannot alter Medicare eligibility or benefit package.

What can it do? One thing and one thing only: It will adjust provider reimbursement rates. We all know Medicare payment rates are already well below market rates. That is why so many doctors are limiting the number of Medicare patients they see and, in more severe cases, refusing to treat Medicare patients at all.

Additional subjective cuts to Medicare will not make the program more efficient or more available. These measures will simply reduce the supply of medical care to the Medicare patients of America.

The Medicare Chief Actuary, Richard Foster, warned us that the health care law's Medicare cuts would cause providers to leave the program, and we are seeing that today. It is not because they do not want to treat Medicare patients; it is because the doctors know the payments will be too low to even cover their costs. Mr. Foster, the Medicare Chief Actuary, has said approximately 15 percent of our Nation's hospitals would drop out of Medicare in 10 years.

Then No. 5: This board could eventually impact all patients, not just Medicare patients. Washington Democrats have long supported policies that give government more power to set health care prices, not just in public programs such as Medicare, but also in the private sector. President Bill Clinton asked for this authority in a 1994 debate on what at the time was called ``Hillary care.'' It was one reason his effort failed. President Obama learned from that failure. Make no mistake, he wants to achieve the same objective. This time he is using this board as a Trojan horse to sell it.

If President Obama's health care law remains the law of the land, millions of Americans will have government-subsidized health insurance. Paying for this new entitlement program will cost trillions. It will be no surprise when we inevitably hear cries for increased cost control. This is when the President will make his move--proposing to extend this board's reach beyond Medicare to the new health care law's subsidized insurance premiums. Last month, the President opened the door to this strategy when he proposed in his speech to expand this board's power and its control over Medicare.

That is why I come to the Senate floor each and every week to deliver a doctor's second opinion about the health care law--a law that I believe is bad for patients, bad for providers--the nurses and doctors who take care of those patients--and bad for our taxpayers. I believe the more the American people discover about this so-called independent payment advisory board, the more unpopular the President's health care law will become.

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

Madam President, across this country Americans are feeling the pain at the pump. Gas prices are approaching $4 a gallon. Families are going to spend, on average, about $800 more on gas this year than they did last year. Unrest in the Middle East and a weak dollar are driving oil prices even higher. Now more than ever, we must produce more American energy. We need to do this to reduce our dependence on foreign oil.

Americans are looking to Washington for leadership. All you have to do is pick up today's USA TODAY to know how much--and I know you hear about it, too, when you are home on the weekends--this $4-a-gallon gas is impacting people in our States.

Here is one headline. ``Poll: Gas prices hurting many. $4 a gallon requires cutbacks.''

Let me read to you, Madam President:

As gas prices hover near $4 a gallon, nearly seven in 10

Americans say the high cost of fuel is causing financial

hardship for their families, a new USA TODAY/Gallup poll

finds. More than half say they have made major changes to

compensate for the higher prices, ranging from shorter trips

to cutting back on vacation travel.

The article goes on:

For 21%, the impact is so dramatic they say their standard

of living is jeopardized.

So here we have families all across the country, in your State as well as in mine, who are dealing with kids, bills, mortgages, and this sort of increase--$800 out of their ability to pay for other things this year--clearly impacts their quality of life. So Americans want answers and they deserve answers. They are asking: How am I going to pay my gas bill? When we have American energy, energy right here in this country, they are asking: Why are we so dependent on foreign countries for our energy? They want to know where the leadership is in Washington.

This very week, the President has finally said he understands the need to produce more American energy. Well, he has used that same line many times.

The actions of the Democratic Party today on the floor of the Senate do not track with the lines coming out of the White House. The administration wants Americans to believe the administration has seen the light, but Republican Representative Doc Hastings, a Member of the House of Representatives, has already called their bluff. Representative Hastings is the sponsor of legislation that would allow more energy production off the coast of Alaska. He said it is ironic that the White House is now supporting this idea because the White House just recently opposed the idea when he introduced it in the House of Representatives.

The Associated Press was even more direct. They said that all of the administration's ideas had come from three bills that were passed by the Republican-controlled House down the hall, and the Associated Press said the White House had opposed every single one of these bills.

So despite acting against the production of more American energy just a week ago, the President now wants us to believe he supports it just because this week he says so. Well, I hope his change of heart is sincere, but I have my doubts because, unlike energy, talk is cheap.

The administration is trying to use this sudden change of heart as a bargaining chip to pass legislation that was brought up by liberals in the Senate this past week. Unlike increased production, the bill brought to the floor by the Democrats will not help the American people. In fact, the bill is clear evidence that the Democratic Party has no plan to address high gasoline prices. Why do I say that? Well, the solution we hear for high gas prices is a tax increase. Since when did raising taxes lower the price of gasoline? Since when does raising taxes on one thing ever lower the price of that thing? To me, this is just another distraction. The nonpartisan Congressional Research Service has already told us there are some commonsense facts about energy taxes. They have told us that raising energy taxes will not lower the price at the pump. In fact, the Congressional Research Service says increasing energy taxes will increase the price of gas and increase our dependence on foreign oil.

This administration has consistently pushed policies that actually make the pain at the pump worse. Instead of supporting the all-of-the- above energy production across our country, they have been more focused on excuses about why we shouldn't use more American energy. If you look back over time, there is a clear pattern. In 2008, when he was a candidate for President, then-Senator Obama said high gas prices weren't a problem. He said the only problem is that they went up too fast. Interior Secretary Salazar, when he was a Member of this body, said he would not support more offshore drilling even if gas prices hit $10 a gallon. Even Secretary Steven Chu, who is our Energy Secretary, was quoted that same year as saying: We have to figure out how to boost the price of gasoline to the levels of Europe. Gas prices in Europe routinely hit $8 a gallon. With these individuals in charge of our energy policy, it is no wonder prices are way up--up over $1 from where they were a year ago.

This administration's shutting down of drilling in the Gulf of Mexico will drive American oil production down by 20 percent in 2012. Even former President Bill Clinton called the continuous shutdown ridiculous.

To make matters worse, President Obama appears to be more enthusiastic about importing oil from other countries than he is in terms of using our own. Brazil has discovered huge reserves of shale oil, and the President recently visited Brazil. He said he wants the United States to be Brazil's best customer for oil.

When it comes to oil consumption generally, the President's story continues to change. A few weeks ago, President Obama tried to make the case that Americans should decrease their consumption of oil. He said we only have about 2 to 3 percent of the world's oil reserves and we use 25 percent of the world's oil. According to the President's measurements, the United States has about 28 billion barrels of oil, but according to the Congressional Research Service, the United States actually has 163 billion barrels of oil. That is over five times as much as the President says we have, and the United States is currently the third largest oil-producing nation in the world.

President Obama has also said he wants to cut imports of foreign oil by a third. Well, his new proposal is definitely a step in the right direction, so why would he tie it to this bill that makes American production harder and more expensive?

Another of the President's goals is to make alternative energy the cheapest form of energy. He continues to talk about that, and I applaud that goal. But we need to make energy as clean as we can, as fast as we can, and do it in ways that don't raise the prices for American families. Regrettably, the President's method has been to make everything but alternative energy more expensive, and the bill his party is pushing right now is another step in that direction.

So the evidence is clear: The liberal energy strategy is not creating American jobs. No, it is not creating jobs here in America, it is not reducing the cost of gasoline in America, and it is not strengthening America's national security. Instead, Americans are paying more at the pump, they are living with high unemployment, and they are producing less American energy.

I hope the President will follow up on his promise to help America produce more oil. I also hope he will stop pushing the damaging legislation his party has put forward here this week.

It is time we have a true bipartisan approach on energy. Senator Manchin of West Virginia and I have introduced just such a bill. It is a bipartisan bill called the American Alternative Fuels Act. This bill truly would ease American's pain at the pump. It would repeal barriers to alternative fuels so American energy can thrive. It would promote the production of alternative fuels derived from American sources. This bill acknowledges the truth about our energy crisis. We need more American energy--we need it all.

In addition to the green jobs the President keeps talking about, we need red, white, and blue energy and red, white, and blue energy jobs. We must keep focusing on making our energy as clean as we can, as fast as we can, and do it in ways that do not increase the costs on American families.

The only way Americans can take the President's call for more energy production seriously is if he and the Democratic leadership abandon their fixation on raising taxes on producing American energy. That is the first step we need to take in helping relieve the pain at the pump.

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

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

Madam President, I ask unanimous consent to engage in a colloquy with my colleague, Senator Hatch of Utah for up to 20 minutes.

Madam President, I come to the Senate floor as a physician who practiced medicine in Caspar, WY, for about a quarter of a century, and I will talk about the concerns I have about the President's health care law, part of which has taken over $500 billion from our seniors on Medicare and taken that money not to help Medicare or to help save Medicare or to strengthen Medicare but to put a whole new government program in place.

They want to put about 16 million or so people on Medicaid. It is a program that is not functioning well now. Many doctors don't want to take care of patients on Medicaid. Yet as part of this health care law, there is something called the Medicaid maintenance of effort, and 33 Governors have written to the President saying they don't want this to apply to them.

I am delighted to be a cosponsor of a piece of legislation called the State Flexibility Act. I do that and come to the floor with that as a physician who practiced medicine, and I have been coming to the floor week after week with a doctor's second opinion.

Today, my second opinion is that this State Flexibility Act is a good idea. It gives States the flexibility they need to give the Governors the flexibility they have requested. It is a bipartisan effort in the sense that Governors, whether they be Republican or Democrat, are looking for more flexibility with this Medicaid Program, and specifically the Medicaid maintenance of effort.

I ask my colleague, the senior Senator from Utah, Mr. Hatch, if he could perhaps tell us a little bit about this effort that he has now introduced, which I have cosponsored, the State Flexibility Act.

I ask my colleague this: We are from neighboring States, Wyoming and Utah. I ask if the Senator could perhaps explain exactly how these Medicaid maintenance of effort mandates--and I believe they are onerous Washington mandates--directly impact Utah.

I appreciate the comments of my colleague. I have taken care of Medicaid patients over the years, and I know this is a program that is burdensome. I also served in the State legislature, and I know the mandates coming out of Washington make it harder for the people back home to take care of patients and harder for our State legislatures to deal with helping people on Medicaid, making it more difficult for physicians to take care of those patients, and making it more expensive. There is a lot of waste in the mandate.

When Senator Hatch talked about the comments from his Governor, I have comments from ours as well, Governor Matt Mead, who has been in office only just since January. He wrote and was one of the 33 Governors who signed a letter to President Obama saying that the costs of maintaining their Medicaid Programs are fast becoming a serious threat to the State's general funds.

We live in a State where we have to balance the budget every year. He went on to say that Wyoming needs to have flexibility, which is the key word and the title of the bill introduced by Senator Hatch, S. 868, the State Flexibility Act.

That is what Governors are asking for, flexibility, because with that flexibility they can do better for the patients, and they can do it cheaper. Wyoming needs the flexibility at the State level to ensure that the Medicaid Program is operated efficiently and effectively.

People do not believe they are getting efficiency and effectiveness out of Washington these days. They do not think they are getting value for their money. I agree with the American people. I have heard them loudly and clearly. I said it when I was practicing medicine and I say it as a Member of the Senate.

Our Governor goes on: Wyoming strongly supports the removal of these maintenance of effort requirements. This is why I come to the Senate floor every week to talk about this health care law, the implications of it, the impact on the people of this great country, and why I think this health care law is one that is ultimately bad for patients, bad for providers, the nurses and the doctors who take care of those patients, and also bad for the American taxpayers. At a time when we are borrowing 41 cents for every $1 we spend in this country, we cannot afford to continue to waste money.

Our problem in this country is not that we are taxed too little, it is that we spend too much and do not spend it well. We have to begin focusing differently, and one of the ways we can do it--my understanding from looking at this is actually the Congressional Budget Office, which does the scoring on legislation, scored Senator Hatch's State Flexibility Act as actually saving, I think, $2.8 billion total over 5 years.

Isn't that what we are trying to do: save money, help people, do it more efficiently, more effectively? That is why I am proud to cosponsor with my friend, Senator Hatch, the State Flexibility Act.

I appreciate the kindness and I appreciate the fact that Senator Hatch is allowing me to work with him. He has a long and illustrious career of leadership in the Senate, and he has been a champion over the years of the fact that States are better than Washington to make decisions because what works in one State may not work in another State. If we give States the flexibility, ultimately they will do it better. They are the laboratories of democracy. That is why we believe in limited government and making decisions at the local level as close to home as possible, which is why I know so many Governors across the country support the State Flexibility Act. I am hoping we get a successful vote in the Senate on it because whenever Washington makes a one-size-fits-all decision, it hardly ever works for most folks back home.

I thank Senator Hatch.

Madam President, I will tell you, I still believe this is a law that is bad for patients, it is bad for health care providers of this country, the nurses and doctors who take care of them, bad for taxpayers. I will be back at home in Wyoming over the weekend visiting with patients, as well as providers, as well as taxpayers, listening to what they have to say. I know the people of Wyoming have great concerns about this health care law and would like the kind of flexibility that is described in S. 868, the State Flexibility Act.

I yield the floor.

Madam President, I thank Senator Portman for the incredible job he has been doing as a champion of efforts to create more private sector jobs in this country, to make it easier and cheaper to create private sector jobs, for the private sector to create the jobs we need. Senator Portman showed significant leadership in his campaign last year in Ohio developing the Portman jobs plan. He went to factories and small businesses all across the State of Ohio because he knows small businesses are the engines that drive the economy.

Seventy percent of the jobs created in this country are created by our small businesses one at a time. When there are government rules, regulations, redtape, and increased expenses, it makes it much harder because it does not provide the certainty the small businesses of this country need to create those new jobs. They may not be willing to take the additional risk and additional expense because of the unknown concerns.

I think that is one of the points that is highlighted in this wonderful plan Senator Portman has put together, along with the members of the Republican Party. A big part of this plan has to do with the rules and regulations that come out of Washington, DC--rules and regulations that may not even be connected to laws that were passed in this body but rules and regulations put forward by this administration, by people who have a different view of how America works.

I was encouraged over 100 days ago when the President said he had an Executive order that would try to eliminate some of the redtape. Here we are 100 days later, and it is just another broken promise from this administration. The redtape continues to hold American small businesses hostage.

We are trying to cut through that redtape. The American people realize it. The administration may not realize it, but the American people realize it. When the American people were questioned just this last month about whether there are too few regulations or too many regulations and the impact on business, a majority said there are too many regulations on our businesses.

How much money does Washington spend on regulations? I will tell you, Madam President. Government spent a record $55 billion developing and enforcing rules last year--$55 billion developing and enforcing rules last year. That is just the spending of government. What is the impact on businesses around the country? For every $1 the government spends to put forth and enforce these rules, it costs businesses of this country $30. That is over $1.5 trillion expended by businesses across the country. That is a drag on our economy, making it harder for them--not easier but harder and more expensive for the private sector to create jobs. There is $30 of business expense for every $1 spent on rules and regulations out of Washington.

People are worried because it is going to get worse. There are still 224 rules in the pipeline that have been labeled as ``economically significant.'' What is an economically significant rule? It is a rule that has an impact on the economy of over $100 million. There are 224 of them coming down the line. Is it a surprise that the unemployment rate continues to be so high? It is because of the rules and regulations of this administration.

What do the American people believe about this situation? Over 70 percent of the American people believe several different things about the effect of the rules. I will tell my colleagues what they are. This is polling from just last month. They will tell you that additional environmental regulation increases the price of energy for items such as gasoline and electricity. Seventy percent of Americans believe the rules coming out of Washington increase the costs of items such as gasoline and electricity--the energy issues. How much is the pain at the pump costing the American family this year? About $800 per family this year in higher gasoline rates than last year. If you are a family, that has an impact on your quality of life. It has an impact if you are trying to deal with bills, kids, and a mortgage. But there are a lot of regulations out there. The American people see this.

Also, over 70 percent of the American people know in their hearts and believe that small businesses--the job creators of this country--are impacted much more than the large businesses of the country. But it is the small businesses we want to help.

The other point that more than 70 percent of the American people believe, in a poll by the Tarrance Group, is that if regulations make it too expensive to keep jobs in America, businesses will continue to move overseas. Businesses will continue to move overseas.

There is so much uncertainty with the rules and regulations coming out of this town that it is paralyzing the rest of our country. That is just on the rules and regulations aspect that people can see. There are so many rules and regulations that are still coming.

I was at a hospital in Cody, WY, talking about health care. I practiced medicine for 27 years, taking care of families all across the Cowboy State. I was visiting a hospital in Cody, WY, and they said they were trying to figure out one aspect of the health care law-- accountable care organizations. It is 6 pages of the 2,700-page law that was crammed through in the middle of the night, with Americans saying: No we don't want this. The people who do regulations took 6 pages of the law and came up with over 400 pages of regulations. They just came out about a month ago. The hospital administrator said: We are having to take money away from patient care, from helping with nurses and therapists to pay for consultants to try to explain these rules and regulations to us so we can abide by them.

Those are the kinds of regulations and rules on steroids that I continued to hear about as I traveled in the last week or so at home visiting with people, visiting the communities, listening to what people have to say and the concern and the uncertainty because what is coming out of Washington is a drag on our economy. It is preventing us from making it easier and cheaper for the private sector to create more jobs.

People all across the country are concerned, and that is why I am so happy to be here with Senator Portman today and his efforts, his leadership on a jobs plan that is one that focuses fundamentally on the things that will get government off the backs of the American people and let the American people get back to work. I thank Senator Portman for his leadership at a time when we see a government that is borrowing too much, spending too much, and growing bigger every day. I am very appreciative of his efforts to get things back under control and get the decisionmaking out of

Washington and back to the hometowns and States across the country.