Floor Statements

Mr. President, today I recognize the Aberdeen Federal Credit Union, AFCU, a member-owned not-for-profit financial cooperative located in Aberdeen, SD.

Chartered on April 11, 1935, this year marks the 75th anniversary of the AFCU. As a community charter, membership is open to all who live, work, worship, or attend school in Brown County. Building upon their mission of being responsive to their members' needs by providing competitive financial services, their membership has grown to nearly 10,000 Brown County residents. The AFCU has much to be proud of and I am confident that their success will continue well into the future.

As a credit union member myself, I understand firsthand the benefit of a credit union membership. Credit unions are a part of the community and they are well aware of the specific needs of their members. Their commitment to providing the best possible service is commendable, especially in the financial environment we are faced with today.

The AFCU will commemorate their 75th anniversary during their annual meeting held in Aberdeen, SD, on January 23, 2010. I would like to offer my congratulations to the leaders and membership of the AFCU on this milestone anniversary and wish them continued prosperity in the years to come.

Madam President, the Senator from Wyoming is correct. Of course, we would like to offer amendments. I know the Senator from Wyoming has deep experience in this field, being a practicing physician, someone who brings great knowledge and background to the debate and obviously has great insight about how this 2,100-page bill could be improved upon. What we have here is the 2,100 pages that we started with, and this represents one-sixth of our entire economy. We are talking about reordering one-sixth of the entire economy. Saturday we received an amendment, a 400-page amendment which nobody up until Saturday had seen. In fact, many of the Democrats hadn't seen it either, including members of the Democratic leadership. There was a discussion on the floor last week between Senator McCain and Senator Durbin in which Senator McCain said: They are writing this amendment behind closed doors. We don't have any idea what is in it. The Senator from Illinois, the No. 2 person in the Democratic leadership, said: I am in the dark just like you are. You had a handful of people who were adding 400 pages of content to the 2,100 pages we already have.

In addition, there is another amendment that adds another 300. We are talking about 2,700 pages that will reorder and restructure literally one-sixth of the entire American economy. Right now what we are being told is that we are not going to be allowed to offer amendments to that humongous piece of legislation. When you get this much legislation coming at you and receiving this on Saturday, not having the opportunity to read it for the first time, is why we have been saying we need to push this back and not try to jam it through before the Christmas holiday. You find all kinds of things in these bills. Sometimes people take credit for those being there. Sometimes they don't. We have had a debate about some of the provisions that benefit specifically Nebraska. You have this Medicaid provision that requires the taxpayers of the other 49 States to subsidize and pay the Medicaid matching share for the State of Nebraska which will cost millions and millions of dollars. The Senator from Arizona mentioned this late add, a $100 million item for construction of a university hospital which, again, is being reported as being inserted by the Senator from Connecticut. You have all these sorts of deals that get made to try and get that elusive sixtieth vote that are now coming to light. The American people have a right to know it. Frankly, Members of the Senate who have to vote on this have a right to know what is in these volumes of pages, 2,700 pages, that will spend $2.5 trillion. The original 2,100-page bill spent $1.2 billion per page, $6.8 million per word. It creates 70 new government programs. This is a massive overhaul of health care delivery.

What it ought to be about is driving down the cost of health care for people. In fact, we have heard a lot of discussion from the other side about how this drives down the cost of health care. This bends the cost curve down. They can say that, but the experts we rely on, the referees or the umpires, say otherwise. In fact, what the CBO has said is that the cost curve would be bent up by this bill. The blue line on this chart represents the increasing health care costs year over year if we do nothing. The blue line represents what we would be looking at if we continue on the current course which everybody here acknowledges is unacceptable. We all want to see the cost

curve go down and see overall health care costs go down. But the ironic thing is, according to the CBO, the red line represents what happens if the bill proposed by the Democratic majority actually becomes law. The cost curve is bent up. We will actually spend more on health care than we are spending today, even the year-by-year twice the rate of inflation increases in health care premiums today.

The Senator from Wyoming is absolutely right to be offering amendments to address the issue of premiums. This bill does not do anything to reduce premiums for most Americans. About 10 percent of Americans, because of the subsidies in the bill, would get their premium costs reduced, but 90 percent--we are told by the CBO--would see their premiums stay the same or go up. When I say stay the same, it means go up at the current rate of twice the rate of inflation. Worst- case scenario, if you are buying your insurance in the individual marketplace, you will see your insurance premiums go up above and beyond this by 10 to 13 percent. Health care costs for 90 percent of Americans, the best they can hope for, is the status quo which is year- over-year increases that are twice the rate of inflation. If you are one of the unlucky who buys their insurance in the individual marketplace, your premiums go up by another 10 to 13 percent. This ought to be about driving down health care costs and getting premiums under control.

The overall cost of health care in this country represents about one- sixth of our entire economy. If this bill passes, according to the Congressional Budget Office, according to the Actuary of CMS, health care spending will no longer be one-sixth of the economy; it will be more than one-fifth. Because if this bill passes, health care spending will go up to about 21 percent of our gross domestic product.

Tell me, what does this bill do then to get costs under control? If we are driving up the cost of health care for individuals in the form of higher premiums, if we are driving up the overall cost of health care as a percentage of our economy, why would we be jamming this thing through before the Christmas holiday, these 2,700 pages, spending $2.5 trillion of taxpayer money, raising taxes on small businesses, which obviously have weighed in on this, and the National Federation of Independent Business, which represents a lot of small businesses around the country, has said, if enacted, this bill would cost us 1.6 million jobs because of all the new taxes it imposes--you are raising taxes, when fully implemented, by about $1 trillion, cutting Medicare by about $1 trillion. After all that, what do you have? You have the same or worse insurance premiums for 90 percent of Americans. I argue that is a bad deal for the American people.

Coming back to the special deals, this is not the way to legislate. To carve out deals, to go and try and find or buy or however you want to characterize it that sixtieth vote is essentially what we are talking about. These are special goodies packed into this bill essentially because the majority decided that rather than trying to include Republicans and pass it with Republican votes, they had to pass it with all Democrats which meant that every one of the Democrats had tremendous leverage. Clearly, they decided to use it. There are lots of carve-outs, lots of special deals in this that cost the American taxpayers hundreds of millions of dollars in additional spending simply because they wanted to get this done by an artificial deadline and wanted to do it with all Democratic votes.

I say to my colleagues, this process itself, when the American people find out about particularly this latest deal, smells. I don't think they are going to like it. I don't think they are going to like the end product when they find out it will raise insurance premiums.

If the Senator will yield on that suggestion of small business health plans, doesn't that enjoy wide support among small businesses in this country?

If I might continue, the one thing that strikes me about this proposal that, as I said before, now is, in totality, 2,700 pages, is that it does not enjoy any support from any small business organization that I know of. Maybe there are some out there I cannot speak to. But I do know the organizations that represent small businesses that we are all well acquainted with--National Federation of Independent Business, the Chamber of Commerce, the National Association of Manufacturers, the National Association of Wholesalers and Distributors, builders and contractors, electric contractors, franchise associations--I can go right down the list--all say this does nothing to lower their costs. In fact, it increases the cost of doing business, increases the cost of doing health care.

What they have argued repeatedly is one of the suggestions the Senator from Tennessee mentioned, that small business health plans would drive their health care costs down, which is why they have been such strong advocates for this over the years.

I guess the other question I would ask of my colleague from Tennessee is, would an approach, a suggestion like small business health plans require tax increases that would hit small businesses?

Incidentally, the latest version with the managers' amendment, which we just received Saturday, increases the tax increases in the bill that were previously $493 billion and are now $518 billion. As the Senator mentioned, with the tax credit businesses get, they up that a little bit but not enough to help most small businesses in light of the $518 billion in tax increases in the first 10 years, and when it is fully implemented it will be about $1 trillion. But the payroll tax that is going to hit a lot of small businesses was increased dramatically in the managers' amendment. The individual mandate was almost doubled in the managers' amendment. So the taxes in the bill go up with this proposal.

I guess my question is, with all these tax increases that are going to have a crushing impact on small businesses, does a suggestion such as the one made by the Senator from Tennessee for small business health plans require tax increases or Medicare cuts, which is what is going to be necessary to finance this 2,700-page behemoth?

I appreciate the Senator for his work on that issue. It is a view I share, a proposal I have been a big advocate of going back to my days in the House of Representatives and one which, as the Senator from Tennessee noted, has tremendous support among small businesses across the country. About the only place it does not have majority support is here in the U.S. Congress because maybe it makes too much sense.

But it seems to me there are suggestions and solutions out there which do not require $\1/2\ trillion of tax increases on small businesses, which every small business organization has come out and said: It is going to drive up our cost of doing business, and at the end of the day, it is going to raise our health care costs--and does not require these steep Medicare cuts that the Senator from Wyoming has alluded to over and over again and the impacts those will have on the delivery of health care to seniors across this country but, rather, it would bend the cost curve down without tax increases and Medicare cuts.

Another example of that, I would argue, would be allowing for interstate competition, allowing people to buy their insurance across State lines, which is a suggestion we have made over and over on our side of the aisle. According to the Congressional Budget Office, both small business health plans and buying insurance across State lines actually would reduce health care costs and would do it without raising taxes or cutting Medicare, which, to me, would make a lot of sense, especially when you have an economy in recession, 10-percent unemployment, a $1.5 trillion deficit last year and another $1.5 trillion deficit this coming year, and when you are talking about a $2.5 trillion cost in the growth of government here in Washington, DC, to implement these 2,700 pages.

Some suggestions along the lines of the one mentioned by the Senator from Tennessee and some of these others would make a lot of sense, and I think they would enjoy tremendous support among small businesses, which create the jobs in this country, as well as among the American public.

So I thank the Senator from Tennessee for pointing out one of the many things Republicans are for and which we have tried to get in the debate.

I know the Senator from Wyoming has advocated for many of these same types of initiatives and solutions. As he mentioned earlier, he was prepared to offer an amendment to address the issue of premiums, but it looks as if we are going to be prevented from doing that.

If the Senator from Wyoming would yield on that point, that is why I think day after day after day--and I have said--there is a pattern emerging here in the Senate where the majority comes down and establishes the need for health care reform, which we all acknowledge, and illustrates examples of those who have fallen through the cracks, which we all know examples exist--all of us have dealt with those in our individual States--and then proceeds to attack Republicans for not having their own ideas, which we have just mentioned there are lots of good Republican ideas which do not raise taxes, which do not cut Medicare, and actually do something to reduce premiums. But that seems to be the strategy employed and the pattern that emerges in the rhetoric day after day down here from the other side.

The one thing I do not hear is them coming down here and talking about what this 2,700-page bill is going to do to reduce health care costs, because if we all submit to the experts on this--which, as I said earlier, the Congressional Budget Office is sort of the referee. They do not have a political agenda, or at least they are not supposed to. The Actuary at the Centers for Medicare and Medicaid Services does not have a political agenda, or at least they are not supposed to. They are sort of considered to be an umpire on this. The Joint Committee on Taxation, which looks at the distributional impacts of tax policy, is a referee and is not supposed to have a political agenda in all this. They all come to the same conclusions with regard to premium increases in this bill.

So if the overall objective is to reduce the cost of health care, and if, in fact, your legislation, according to all the referees, all the umpires, all the experts, not only increases premiums for most Americans but increases the overall cost of health care, which is what they all conclude, it is pretty hard to come down and defend this product. That is why I think day after day they try to create distractions and counterattacks as opposed to actually coming down and talking about the substance of the bill because the substance of the bill does not accomplish the stated objective, which is to reduce the overall cost of health care and get premiums under control for families and small businesses in this country.

It is also hard, I would argue, because of the $518 billion of tax increases that are in here and the unified opposition of the entire small business community, which creates 70 percent of the jobs in this country, to talk about how this can be anything but detrimental to job creation. This is going to cost us jobs. I think every business organization has made that abundantly clear. And all the analysis of this legislation that has been done comes to the same conclusion.

Mr. President, today I recognize the South Dakota School of Mines and Technology, which will celebrate their 125th anniversary in 2010.

Located in Rapid City, the South Dakota School of Mines and Technology has been a national leader in preparing world-class engineers and scientists since 1885. Graduates design, construct, and operate the most modern technology to meet complex challenges such as climate change, bioenergy, mineral extraction and processing, advanced materials, environmental quality, and national defense. School of Mines alumni are held in the highest regard by their fellow leaders in industry, consulting, government, health, research, and education.

The School of Mines is proud to be a leading partner in bringing the Deep Underground Science and Engineering Laboratory, DUSEL, from an extraordinary vision to a phenomenal reality. The longstanding connections between the School of Mines and the Homestake Mine began in 1885 when the university was established to meet the growing research needs of the mining industry, led by Homestake. These connections continued when nearly a decade ago, the School of Mines helped champion the conversion of the mine into a national laboratory. Today, as we continue to prepare leaders in engineering and science, we are collaborating with our colleagues to transform Homestake into a world- class laboratory to further exceptional research and discoveries not yet imagined.

Rugged individuals and pioneers in engineering and science founded the School of Mines' intellectual environment more than a century ago. The university's faculty, staff, students, and alumni carry on that tradition today. In 2010, the School of Mines celebrates 125 years of award-winning faculty, staff, and students collaborating to solve issues of critical importance to South Dakota, the nation, and the world. Please join me as we celebrate their legacy of educating the leaders of tomorrow.

Mr. President, I appreciate the comments of my colleague from Texas, and my colleague from Wyoming prior to that. Many have come down here, as our colleagues on our side have, day after day, time after time, and continue to point out what we believe is wrong with the approach that is being taken by the majority, and also pointing out where we would do things differently.

Remember, this is the first bill: 2,100 pages long; $1.2 billion per page; $6.8 million actually per word. Then yesterday, we got the managers' amendment: another 400 pages. You add yet another amendment that is going to go on this stack, and you are talking about 2,700 pages of bill language.

What I think is interesting--and I see a pattern emerging here almost every single day--it is like deja vu all over again. The other side comes down here and talks about the need for health care reform, which we all concede. We all believe we need to reform health care in this country. We all hear from our small businesses. We all hear from individuals and families who are having a difficult time keeping up with the high cost of health care. So that is something on which there is broad agreement on both sides. Yet that seems to be sort of the MO for the other side, to come down here and talk about how we need to do health care reform. We agree with that.

The other strategy is to come down here and attack Republicans for not having their own ideas. We have been trying to offer amendments to this bill forever. We had several amendments offered today. We asked consent to bring up amendments, to get them pending, to get them voted on. They were blocked by the other side. We have full alternatives to the current bill. Senator Burr and Senator Coburn have an alternative, a comprehensive alternative they would like to offer, being blocked by the other side.

So the recurring pattern that has emerged day after day in the debate in the Senate is Democrats come down here and talk about how bad the current system is and point out examples of those who are falling through the cracks in the current system. Exactly. We agree with that. We have acknowledged there is a problem. They come down here and attack Republicans for not having alternatives. In fact, the Senator from Rhode Island this afternoon essentially said that Republicans have been coming down here and telling lies.

What the Republicans have been doing day after day after day is coming down and talking about the bill and the impact the bill would have on health care delivery, the impact the bill would have on the economy, the impact the bill would have on small businesses and their ability to create jobs. We have been talking about the Congressional Budget Office report that describes the cost of the bill and goes into great detail about how it will impact individual families as well as the overall cost of health care in this

country. We have come down here day after day to talk about the CMS Actuary's report, the Center for Medicare Services, about the cost of the bill and how it would impact the cost of health care in this country. So we continue to come down here and talk about the bill.

The other side--the one thing they don't do is they don't come down here and talk about the bill. I don't hear Democrats coming down here and offering full-throated defenses for this bill, because the bill is indefensible. It is 2,700 pages, and it doesn't do anything to lower the cost of health care, according to the Congressional Budget Office.

So we come down here day after day and talk about the Congressional Budget Office report, come down here and talk about the CMS Actuary's report. They come down and talk about how bad the current system is, say this is going to fix it, but then when they are challenged on the CMS Actuary's report and the Congressional Budget Office report, they can't defend that.

What they should be doing instead of accusing the Republicans of telling lies and attacking Republicans is accusing the CMS Actuary and the Congressional Budget Office. They ought to be coming down and attacking them because all we are doing is pointing out the facts as they pertain to the current bill that is before the Senate, this 2,700 pages right here.

What I would like to point out are some of the promises that have been made by the President and by Democrats with regard to this bill.

The President made it very clear, when he was running for President:

I can make a firm pledge: Under my plan, no family making

less than $250,000 will see their taxes increase--not your

income taxes, not your payroll taxes, not your capital gains

taxes, not any of your taxes.

Yet the Joint Committee on Taxation analysis--by the way, that is another report, and maybe they ought to be coming down here and attacking that report rather than attacking Republicans who are quoting from the report. The Joint Committee on Taxation analysis shows those people earning less than $200,000 a year will see a tax increase under the Reid bill. Even after you account for taxpayers who are going to receive the premium tax credit, 24 percent of tax returns under $200,000 will, on average, see their taxes go up. There are 42 million Americans who are going to see higher taxes who make less than 200,000 a year. So the no tax increase for the middle class we would have to say is a broken promise.

The second thing they say is that it will lower health care costs. We all know--and the President said this as recently as June 23:

And I've said very clearly: If any bill arrives from

Congress that is not controlling costs, that's not a bill I

can support. It's going to have to control costs. It's going

to have to be paid for.

So the Democrats have shifted the benchmarks about what that means and what impact it is going to have on America's health care premiums.

The President's first promise, going back to the campaign, was that the typical family's premiums would go down by $2,500 per year--a $2,500-per-year reduction, according to the President when he was campaigning--and that everybody would be covered. Well, we all know that even this bill, which is touted as expanding coverage--well, it does expand coverage. It puts 15 million more people on Medicaid; that is one way it expands coverage. But under this bill, there are still 23 million Americans who don't get health insurance coverage. So the President's promise that he was going to cover everybody, that he was going to lower health care costs, again, you would have to say it is a broken promise.

I want to show my colleagues how this would impact a typical family's insurance costs. If you are a family who is paying $13,300 today and you are getting your insurance in the large employer market--in other words, if you work for a large employer, you get it in the large group market--and you are looking at the year 2016, you are going to be paying over $20,000 a year for insurance. That doesn't lower health care costs; that increases health care costs.

What they will say is: Well, this is better than it would have been if we had done nothing. The honest truth is that if we do nothing, we still would have 5 percent to 6 percent increases year over year in the cost of health insurance for most Americans whether you get your insurance in the large group market or the small group market. You are still going to have a 5- to 6-percent increase in the cost of your health insurance if this bill is passed. You don't see any improvement. The best you can hope for is the status quo, which is year-over-year increases that are twice the rate of inflation. That is the impact on an average family. So the whole notion that this is going to lower health care costs just doesn't pass the truth test, according to the Congressional Budget Office.

The next promise that was made is that it would bend the cost curve down. What is interesting about that--and, of course, this was the President in the joint session of Congress on September 9 of this year:

The plan I am announcing tonight . . . will slow the growth

of health care costs for our families, our businesses, and

our government.

Well, according to the Congressional Budget Office, again--and if my colleagues want to attack us, let's have them attack the Congressional Budget Office, the CMS Actuary, the Joint Tax Committee, because everything I am saying tonight I am quoting from those reports. According to the Congressional Budget Office analysis of the Reid amendment, the cost curve bends up, not down. In fact, in the first 10 years, the net increase would be about $200 billion a year in overall health care costs.

This is an outdated chart, I have to say, because this is the chart we used before this amendment was added. This is the managers' amendment, the 400-page amendment I alluded to earlier that was just added to the 2,100 page bill. In the 2,100 page bill, the Congressional Budget Office said the cost of health care in this country is going to go up, not down, by $160 billion.

So what is the cost of doing nothing? The blue line represents the cost of doing nothing. That is Federal health care spending today and what it is projected to be into the future if we do nothing. The red line, according to the Congressional Budget Office, represents what health care costs would do if the Reid bill passes. The ironic thing is that with the 400-page amendment that was added yesterday, this number gets bigger, not smaller.

I said this is an outdated chart. This only represents a $160 billion increase in the cost of health care. According to CBO's analysis on the amendment, it increases the cost of health care by $200 billion. The CMS Actuary came to a slightly different conclusion. They said health care costs would go up in the next 10 years by $234 billion. So you have all the experts--the Congressional Budget Office, the CMS Actuary--all coming to the same conclusion; that is, health care costs go up, not down. So we would have to say that is yet another broken promise.

The other thing that has been said throughout the course of this debate is that you could keep the insurance you have. In his joint session of Congress address on September 9, the President said:

Nothing in our plan requires you to change what you have.

Well, interestingly enough, according, again, to the Congressional Budget Office, between 9 million and 10 million people who would be covered by an employment-based plan under current law would not have an offer of such coverage under the proposal, the Reid proposal. So we have 10 million people, according to CBO, who are going to lose their employer-based coverage, and you also have the 11 million people who get Medicare Advantage which is being cut. They aren't going to be able to keep what they have. You can argue that maybe their benefits are too rich today. That has been the argument made by the other side. But you can't say they are going to be able to keep what they have. If you are going to cut $118 billion out of Medicare Advantage, the 11 million people in this country who get Medicare Advantage are going to see their benefits cut. They are not going to be able to keep what they have.

In fact, the Senator from Pennsylvania, Mr. Casey, said recently on these Medicare Advantage cuts:

We are not going to be able to say if you like what you

have you can keep it, and that basic commitment that a lot of

us around here have made will be called into question.

Eleven million people who get Medicare Advantage aren't going to be able

to keep what they have, nor are the 10 million people, according to the CBO, who are going to lose their employer-based coverage if this plan passes--another broken promise.

No cuts to Medicare--we all know about that. We talked about that for about a week here and offered amendments to get rid of the Medicare cuts.

The President said when he was running for office:

I want to assure [you] we're not talking about cutting

Medicare benefits.

He reiterated that in his State of the Union Address.

This bill, as we know, cuts $470 billion out of Medicare in the first 10 years, and when it is fully implemented, it cuts over $1 trillion out of Medicare. In the first 10 years, $135 billion out of hospitals; $120 billion, as I said earlier, out of Medicare Advantage; $15 billion out of nursing homes; $40 billion out of home health care; and $7 billion out of hospice care--these are all Medicare cuts. These are all going to affect people in a very real way whether you get Medicare Advantage or whether you are a provider.

These are just the facts of this legislation. I am talking about the bill. I am talking about the bill, and I am talking about what the experts have said about the bill. So we would have to say, another broken promise.

The first of the last two here: open and transparent process.

We all know that when the President campaigned, he said:

We'll have the negotiations televised on C-SPAN so that

people can see who is making arguments on behalf of their

constituents and who is making arguments on behalf of the

drug companies or the insurance companies. And so that

approach I think is what is going to allow people to stay

involved in this process.

That was what the President said when he was campaigning.

We all know this bill, almost in its entirety, has been written behind closed doors. We just saw this 400-page amendment yesterday. It was interesting; earlier--it was last week, I guess--in a discussion on the floor between Senator McCain and Senator Durbin, Senator Durbin, the No. 2 Democrat in the leadership on the Democratic side, said:

I would say to the Senator from Arizona that I am in the

dark almost as much as he is and I am in the leadership.

Even some of the leaders on the other side--there are only three people, four people sitting in a room writing this bill, and what is the most offensive thing about this came out yesterday when we found out that the Senator from Nebraska had carved out a special sweetheart deal with a goody for his State that all the rest of the States get to pay for. He gets his Medicaid for his State paid for entirely by the Federal taxpayers, and no other State gets that particular arrangement. So the Federal taxpayers in every other State, in my State of South Dakota--Nebraska borders South Dakota. I think the people in our part of the country are going to say this really smells. This is the way they are doing business in Washington, DC? This is business as usual.

The final thing I will say is this: The argument was that it won't add a dime to the deficit. Well, here I give the Democrats a little bit of credit because they did raise taxes enough and cut Medicare enough that they could actually raise quite a bit of revenue. But saying it won't add a dime to the deficit assumes there isn't going to be any payment to physicians. The physicians' fee fix, which takes about $250 billion, was completely cut out of here. They are going to have to fix that at some point. So we are not counting that.

We are counting $72 billion from a program called the CLASS Act which the chairman of the Senate Budget Committee, the Democrat from North Dakota, Kent Conrad, called a ``Ponzi scheme of the first order,'' something Bernie Madoff would be proud of. The CBO says of the CLASS Act:

The program would add to future budget deficits in large

and growing fashion.

Even the Washington Post has editorialized about this, and they came to the same conclusion:

The CLASS Act is a gimmick designed to pretend that health

care is fully paid for.

It goes on to say:

The money that flows in during the 10-year budget window

will flow back out again. These are not savings that can

honestly be counted on the budget sheet of reform.

Then we all know we have 10 years of revenue coming in, with only 6 years of spending in the first 10 years. Phony budgeting, gimmicks--all of these things are used to mask the true size of the cost of this program: $2.5 trillion over 10 years when it is fully implemented.

So if you do not use the gimmicks, if you do not use the CLASS Act, if you discount the doc fix and don't count that in there, sure, you can make it look like it doesn't add to the deficit, but the American people know better, and they have come to the conclusion this is going to add to the deficit. Even David Broder, who is the Pulitzer Prize winner for his commentary, said:

While the CBO said that both the House-passed bill and the

one Reid has drafted meet the test by being budget-neutral,

every expert I have talked to says that the public has it

right. These bills, as they stand, are budget-busters.

This is going to add to the deficit. These are all broken promises. That is why this bill needs to be voted down. We need to vote it down tonight. I am hoping there is a courageous Democrat or two who will join us and defeat this bad legislation and move forward to something we can pass that will meaningfully lower health care costs for the American people.

I yield the floor.

Before the Senator from Oklahoma leaves--and I understand the staff needs to get out of here, and the weather is not cooperating in Washington today--I am interested in his discussion and the points he was making about the liabilities we continue to rack up and how that is going to impact future generations.

I wonder if the Senator from Oklahoma might respond to a question with regard to the current debate. Because it strikes me, in light of all the spending and borrowing the country is doing, the concerns it is now creating about not only the economy in the near term but also the impact this could have on our country's strength in the long term, the way some of our creditors, the people who actually buy our debt, are viewing the debate about health care--in fact, when the President was in Asia recently, the discussion with the Chinese was more about, their interest was about what is going to happen with health care in this country, not because they cared about whether there was a public option in the bill, not because they cared about whether it was universal coverage, but because they were interested in what it was going to do to the debt, what it was going to do to the deficit. They were worried about their investments.

I think it is fair to say having this last fiscal year rack up a $1.5 trillion deficit--and looking to be somewhere in that ballpark again this year--that we cannot sustain over time this pace we are on of borrowing, spending, and continuing just to mortgage the future of future generations, and that bears on the debate we are having today. Because under the best case scenario, this health care expansion, when it is fully implemented, is going to be a $2.5 trillion expansion. And the managers' amendment, which was laid down today, actually increases the cost.

I do not know if the Senator from Oklahoma has--I am sure he has

looked at this, but it was $848 billion, and now it is $871 billion. That is their first 10-year number, which I suspect means the fully implemented number, the $2.5 trillion number --

--is equally larger. The tax increases went up as well. The taxes that were in the original bill were $493 billion. It is now $518 billion. The Medicare payroll tax, which was going to be a half a point increase is now nine-tenths of a point. That, of course, impacts the Medicare trust fund, for which this will be the first time I think that a payroll tax will be levied that does not go to the trust fund; it actually goes to create a new entitlement program.

But I just wonder what the Senator from Oklahoma thinks about how the health care debate and the spending that is going to be associated with that is going to impact the scenario he was describing, the fiscal condition of our country as we head into the future, and whether we will be able to really keep the cost at the $2.5 trillion, and whether the tax and the Medicare cuts--which the CMS Actuary says it is unlikely, on a permanent basis, that those cuts will be sustainable-- how does this thing get paid for? It seems to me it gets paid for by putting more on the debt, by putting more on future generations.

I am interested in the reaction of the Senator from Oklahoma to that.

If the Senator from Oklahoma would yield for another question, does the CMS Actuary and the Congressional Budget Office conclude, when it is all said and done, that the overall cost of health care goes up, not down? It seems to me, at least, that as to the points the Senator mentioned, if we were sincere about reforming health care in this country, what most small businesses, what most individuals, what most families want to see is health care costs going down. This actually bends the cost curve up, according to the CMS Actuary, with a $234 billion increase in health care costs over 10 years.

According to the Congressional Budget Office, it is a $160 billion increase in health care over 10 years. So there is a slight difference in terms of their analyses, but both conclude that health care costs will go up. The amount we spend on health care as a part of our total economy in this country----

--will be 21 percent. It is currently about 17 percent or in that ballpark. So it seems to me, at least, we have done very little----

If anything, to address that problem.

So I simply would ask the Senator from Oklahoma, some of the things the Senator talks about in terms of actually attacking the disease could be the basis upon which we could put together a consensus bill around here that actually does reform health care in a way that drives down the cost rather than raise it and does not rely on all these tax increases, does not rely on the $1 trillion in Medicare cuts, which the CMS Actuary says are unlikely to be substained on a permanent basis, therefore, again putting more and more of the burden of the cost of this new expansion on future generations.

I just see this as a very dangerous path to be on when you are running $1.5 trillion deficits, when you have an economy in recession, and unemployment is about 10 percent. We are talking about tax increases that are going to be passed on in the form of higher premiums for most Americans.

To be fair, there will be some Americans who will benefit. Most will not. Most will see their premiums go up. We are going to see Medicare cuts. The program will be cut, but not to reform it or make it more sustainable or extend its life but, rather, to create a new entitlement program.

How can we move forward with legislation such as this and call it reform? Wouldn't it be fair to suggest that if our colleagues on the other side were serious about reforming health care, they would sit down with us in a way that is constructive that would actually represent the common ground we could find and not write these bills, as they have, behind closed doors and then spring it on us today on a Saturday morning, and try to push this thing through to passage before Thursday of next week or Friday on Christmas Day?

Mr. President, if I might say, the Senator from Oklahoma has put forward a comprehensive approach to health care reform. It has been argued here many times on the floor that Republicans do not have their own ideas. We have argued throughout the course of this debate that we ought to be approaching this not in sort of a radical overhaul of an expansion of the Federal Government's role in our health care delivery system, which this legislation would do, but, rather, look at ways we can provide more competition and create a more robust private sector health care delivery system. Instead, this approach relies heavily on growing the government footprint with regard to health care, as is evidenced by the $2.5 trillion cost of the legislation.

But the Senator from Oklahoma and our colleague from North Carolina have come up with a comprehensive solution, which is very, in my view, bold and does represent true reform that moves us away from the system we have today, which has demonstrated, as the Senator from Oklahoma has pointed out, that it continues to increase in cost and continues to probably--I think it will be argued--deliver less in terms of quality and makes the failures in the current system even bigger and worse, without doing anything to address the fundamental underlying problem or disease.

So I would say that inasmuch as the Senator from Oklahoma has a comprehensive solution, we also support what I would call more step-by- step approaches. One, of course, is interstate competition, allowing people to buy insurance across States lines. One would allow pooling, allowing small businesses to join a larger group, thereby getting the benefit of group purchasing power.

As the Senator from Oklahoma mentioned, medical malpractice reform is something we all believe needs to be done. The Congressional Budget Office, by the way, has said all these various solutions bend the cost curve down, not up. But those are all things we could be doing to improve upon the system we have today.

Frankly, I think we need to have a fair debate of the proposal of the Senator from Oklahoma, which is a comprehensive approach, which does take us away from the employer-based system, which empowers individuals through the form of tax credits to buy their own health insurance to make them more informed consumers. We always talk about a consumer- driven model. That is exactly the approach that his legislation and his reform proposal would employ.

So I would like to see us have an opportunity to debate that. We are not going to get that chance, I do not think, because it sounds as if the amendment tree has been filled. The bill that is before us now with the managers' amendment will prevent other alternatives, other amendments from being offered. That is unfortunate because I think the direction we are headed is a train wreck, as has been described by many, because it leads to more spending, more taxing, Medicare cuts, and I would argue, in the end, more borrowing, frankly, does little to solve the underlying problems that exist in our health care system today.

I am happy to yield.

I appreciate that. I appreciate and share the Senator's view with regard to the changes or proposal that was unveiled this morning and how it treats the issue of abortion.

As was noted, the House of Representatives and Congressman Stupak came up with a clear, unequivocal policy position that extends the policy, essentially, that has been in place now for the past 30 years in this country regarding the use of taxpayer funds for abortions. The language that supposedly was negotiated between the Senator from Nebraska and the Democratic majority does not follow through or maintain that policy and, in fact, opens the door to allowing Federal funding to be used for abortions.

Irrespective of which side you come down on, on this issue, there has been widespread and broad American support for a very long time. I think it is something both Republicans and Democrats have agreed upon, and we should not deviate from that. The American people have made it very plain that they believe--60 to 70 percent, in most surveys--the Federal Government should not be using taxpayer funds to finance abortions. The funding is clearly in the Senate version that now has been negotiated. As the Senator from Oklahoma mentioned, the opposition comes from the Catholic Bishops, the opposition comes from the National Right to Life. It is very clear that this provision that is now included in the managers' amendment does not maintain the long-held policy we have had in this country supported by so many Americans that we not use taxpayer funds for abortions. So that, too, is something this bill falls short on, along with all of the other many things I have mentioned.

I think we are going to have many opportunities over the course of the next several days to continue to discuss this issue. We just received the managers' amendment this morning, and I think it is important, as the debate over the managers' amendment begins and we have some votes that are going to be coming up in the next few days, that we continue to talk about why this is the wrong approach for America, why it is the wrong approach for health care, why it is the wrong approach for our economy, and why it is the wrong approach for jobs. We can do so much better by the American people. This needs to be done in a step-by-step way. It needs to be done right. This legislation takes us in the wrong direction for the future of this country.

Mr. President, I yield the floor.

The Senator from Texas has touched on a very important issue. The motion she offers, and which I cosponsor, does lay out what is a simple principle of fairness that most Americans understand. When you implement public policy, if you are going to raise taxes, you ought to align the tax increases and the benefits so they start at essentially the same time. What this bill does is it starts collecting taxes, increases taxes on Americans 4 years before the major benefit provisions kick in. On January 1 of 2014, 99 percent of the spending under the bill kicks in. But the tax increases begin less than 3 weeks from today. Sixteen days from now is when the tax increases in the bill start. A tax on prescription drugs, a tax on medical devices, a tax on health plans--all begin 16 days from now. A lot of those taxes will be imposed upon the American economy and passed on to people and small businesses in the form of higher premiums. People are going to get higher premiums 4 years before they are likely to see any benefit. Ninety-nine percent of the spending under the bill doesn't kick in until January 1, 2014, or 1,477 days from now. Most Americans, as they listen to the debate, believe as I do, as a simple principle of fairness, you ought to align the benefits and the taxes. We had a vote yesterday on the Crapo motion that would recommit all the tax increases. Many of us believe raising taxes on small businesses when you have an economy in recession is not a smart thing to do; it is going to cost us a lot of jobs. Small businesses have made that clear. I also think, in addition to the principle of fairness that is at play, when it comes to raising taxes 4 years prior to the benefits kicking in, you also need to have a transparent sort of understanding about what the cost of the bill is going to be.

One of the reasons the revenue increases, the tax increases were begun immediately or 16 days from now, but the majority of the spending, 99 percent, doesn't occur until January 1 of 2014 and beyond is to understate the true cost. They wanted to bring the cost of the bill in under $1 trillion.

If you can see, starting this year and going through 2019, it ends up at about $1 trillion or $1.2 trillion on this chart. But if you look at the fully implemented period; that is, 2014, when the benefits and spending begin, and take that through the next 10 years, the total spending in the bill is $2.5 trillion over a 10-year period.

That is one thing the American people need to know. One of the reasons this is being done, tax increases starting January 1 next year or 16 days from now, most of the benefits not starting until 1,477 days from now, is so they can say this is only a $1 trillion bill or under $1 trillion, the way it has been advertised, when, in fact, it is going to cost $2.5 trillion when fully implemented.

We are here 16 days before the Christmas holiday, and there are things Congress needs to do. There are a number of fairly urgent matters that need to be dealt with before the end of the year, some of which have been mentioned this morning. But trying to jam through a new health care program, a $2.5 trillion expansion of the Federal Government in Washington, 70 new government programs, trying to jam it through in the next 9 days or so before Christmas seems to be done more out of a political necessity, the need for a political accomplishment or a political victory, than it does with making good public policy. As the American people are approaching this holiday season, the best thing we can do, the best Christmas gift we could give the people, frankly, is for Congress to adjourn and go home before passing this $2.5 trillion expansion.

What does it mean? If you are a small businessperson, the Christmas gift you get this year is a big lump of coal from the Congress in the form of higher taxes. If you are a senior citizen, 1 of the 11 million who are on Medicare Advantage and this bill passes, your Christmas gift this year is benefit cuts. The same thing applies to many of our providers--hospitals, nursing homes, home health agencies, hospices. If you are an average American family who is worried about the high cost of health care, your Christmas gift this year is, if this bill passes, that your health insurance premiums will continue to go up year over year at twice the rate of inflation. You lock in higher premiums for most people across the country, you raise taxes on small businesses, you cut benefits to Medicare beneficiaries and, for future generations, you create a $2.5 trillion new entitlement program they will be paying for, for as far as the eye can see.

The CMS Actuary, last week, said, in addition to all the other things they mentioned--the overall cost of health care is going to go up, 20 percent of hospitals will close--that the Medicare cuts that are being proposed cannot be sustained on a permanent basis. If that is true, how will this be financed? Either with more taxes or borrowing, putting it on the debt and handing the bill to future generations. That is what we are left with. Once you lock in a $2.5 trillion expansion of the Federal Government, it is going to be hard to reduce the cost. The spending is not going to go away. The way it will be paid for, if the Medicare cuts are not sustainable, is the tax increases. The increases that are already in here would have to be increased even further or, worse yet, for future generations, if you are a young American, it will be put on your bill.

The Senator from Texas and my colleagues who are here this morning all voted yesterday to get rid of the tax increases in the bill. But the motion she offers and that I cosponsor would at least, as a principle of fairness, make sure those tax increases don't begin before the benefits do.

I will say to my colleague from Texas, as to the taxes, the fees, the tax increases, everything in our motion very simply states they ought to be aligned with the beginning of the benefits. The benefits and the exchanges and, frankly, all the major policies--the substance of this bill--begin in 2014; the individual mandate, the State exchanges, the subsidies, as I said, premium tax credits, Medicaid expansion, the employer mandate, 2014; the government plan, 2014. The substance of this bill begins in 2014. Unfortunately, the tax increases begin 4 years earlier, 16 days from now. Sixteen days from now, January 1 of this

coming year, is when the taxes start being raised. And, of course, the CBO has said those tax increases are going to be passed on in the form of higher premiums to people across this country. The benefits start 1,477 days from now.

So what we simply say in this motion is, let's commit this bill and bring it back out with the tax increases--if there are going to be tax increases; and many of us believe there should not be any, which is why we voted for the Crapo motion yesterday--but if you are going to raise taxes on America's small businesses, families, and individuals, at least align those so the policy, the substance of this bill, which begins 4 years from now, is synchronized so we are not slapping a huge new tax increase on America's small businesses in the middle of a recession and passing on those higher costs, which is what they will do, to people in this country in the form of higher insurance premiums.

So I say to the Senator from Texas, this is a very straightforward, simple motion. I hope our colleagues on both sides will support it. It is a matter of principle, of fairness when its comes to making policy that I think the American people have come to expect. We ought to be honest and give the American people a complete understanding of what this bill really costs. Because they have done what they have done--by instituting the tax increases immediately and the spending 4 years from now--it understates the overall cost of this legislation. The American people need to know this is a $2.5 trillion bill when it is fully implemented. The only reason they can bring that in under that number is because they start raising taxes immediately and do not start paying benefits out for another 4 years.

So I say to the Senator from Texas, I hope when we get to this vote, it will be a big bipartisan vote in the Senate, and I hope we will make a change in this legislation that implements some semblance of fairness and also gives us a true reflection of what the bill really costs.

My colleague from Texas is exactly right. Her motion and the motion I am cosponsoring, which we hope to vote on next, will be a follow-on motion to the motion the Senator from Idaho is offering.

It seems a basic principle and a matter of fairness to the American people that if you are going to create public policy, that you do it in a way that treats people fairly and does not raise their taxes before a single dollar of the premium tax credits and the exchanges that are designed to create the new insurance product for people would take effect. That is what this bill does.

The motion of the Senator from Idaho commits all of the tax increases--and I will support that wholeheartedly, and I hope my colleagues in the Senate will do the same because these tax increases are the absolute worst thing we can do at a time when we have an economy in recession and we are asking small businesses to lead us out of the recession. Seventy percent of jobs in the country are created by small businesses. It is much higher in my State of South Dakota. These tax increases could not be more poorly timed in terms of getting the economy restarted and creating jobs for Americans and getting them back to work. Since most people get their insurance--at least currently-- through their employer, one of the best things you can do to provide insurance is to put people back to work. This bill has the opposite effect. It is a job killer because of all of the tax increases. Every small business organization has said that. That is why it is so important we support the motion of the Senator from Idaho.

Senator Hutchison and I will also offer a motion--hopefully, we will get a vote on it later--that at least will delay the tax increases until such time as the benefits begin. It essentially aligns the revenue increases and the benefits so they are synchronized and you do not have this period of 10 years where you are taxing people for 10 but only delivering a benefit for 6. Again, I think that violates a basic principle of fairness most Americans should expect when it comes to their elected leaders making public policy which will have a profound impact on them and their lives. I certainly hope we get a vote on that motion, and I hope our colleagues will support it. To me, it is unconscionable that you would raise taxes by $72 billion, which is what this does, up until the year 2014 before the premium subsidies and the exchanges kick in which would deliver the benefits that are supposed to be delivered under this bill. The Senator from Texas and I look forward to getting a vote on that motion.

I hope we can win on the Crapo motion later today.

I appreciate my colleagues being here to point out how important it is that we have public policy that is fair and also that we not do things that are counter to job creation at a time when we are asking small businesses to get out there and create jobs and make investments.

My understanding is, those premium tax credits actually go to the taxpayer. When you say this is a tax cut for people, does it end up in the pockets of the average taxpayer?

That is precisely why the arguments made by the other side that somehow this is a tax cut sort of defy what I think most Americans have come to expect when they get a tax cut; that is, that they get to keep more of what they earn. What we are talking about is a payment that will be made to an insurance company, a tax credit for premium subsidies that will go to an insurance company. There will be very few Americans, as a percentage of the total population, who will actually derive any sort of benefit. My understanding is, about 10 percent of all Americans will get some benefit from the premium subsidies that will go to the insurance company, not directly to the taxpayer; is that correct?

So we have a very small number of Americans who will derive a benefit. But you have a whole lot of Americans who will actually be paying the freight. The Senator mentioned earlier--I saw his chart--that 73 million Americans are going to end up with higher taxes as a result. Many of the premium tax credits, if you could give credit to the taxpayers receiving this, which you can't because it goes to the insurance company, but if you could, three-quarters of that will go to people who currently have no income tax liability. It seems as if the advertising on this is very inconsistent with reality and the facts. The fact is, most Americans will see taxes and premiums go up. Very few Americans are going to get some premium tax credit to help subsidize their premium cost, and that will go directly to the insurance company. I understand the Senator from Idaho and the Senator from Nevada are both members of the Finance Committee. They have been involved with this from the beginning. That is my understanding of this, which is hard to fathom how that constitutes a tax cut.

Madam President, I wish to start by referring briefly to the remarks made earlier by the Senator from Alaska. She indicated earlier on the floor that she is going to be offering a motion of disapproval for a set of

regulations that are not final yet but have been announced by the EPA that they are coming forward with, the so-called endangerment finding. I wish to indicate that I intend to support her on that resolution.

I cosponsored the amendment she tried offering earlier this year to one of the appropriations bills that would have prevented the EPA from moving forward with the endangerment finding for a year, which would have allowed Congress an opportunity to examine this issue and perhaps approach it with a legislative solution as opposed to having the EPA move forward in a way even they acknowledge they don't have statutory authority to do.

I might say that the end result of what is being proposed at EPA--if they are successful--is they will implement a cap-and-trade program, only it will be a cap without the trade.

The reason they are moving forward, in my view, is because there isn't the political will in the Congress to pass a punishing cap-and- trade proposal this year. The House of Representatives passed it narrowly this year. There are a number of Members of the House who I think would like to have that vote over again. I know there aren't the votes in the Senate because many Senators on both sides realize the impact it would have on the economy--the number of jobs that would be lost in our economy and how it would punish certain parts of our country with crushing energy costs, at a time when we don't need to pile costs on small businesses and consumers who are trying to come out of a recession.

This is a wrongheaded move by the EPA. It is something they should not be acting on independently. This should be resolved by the Congress of the United States. Honestly, if the EPA moves forward, there are a number of industries in South Dakota that will be impacted and a number of businesses in my State. If the litigation is successful--and, inevitably, there will be lots of lawsuits filed--and if the 25,000-ton number is reduced to the 250-ton number that is used as a threshhold in the Clean Air Act, there will be literally millions of entities that will be covered--hospitals, churches, farmers, ranchers, and small businesses.

In South Dakota, we have a lot of farmers and ranchers who make their living in small businesses that would be adversely impacted were these regulations to be enacted and then move forward with regulating and putting the caps in place. If the litigation is successful, we know what will be subsequent to that.

I say that as a lead-in to talk about impacts on small businesses. There are so many things happening right now in Washington that have an adverse and detrimental impact on the ability of small businesses to create jobs. I have heard the President talk about creating jobs--that is his No. 1 priority--and we need to give incentives to small businesses to create jobs. I have heard my colleagues on the other side talk about how important job creation is. Yet everything coming out of Washington, whether it is in the form of heavyhanded regulation, such as this endangerment finding coming out of EPA, or in the form of a cap-and-trade proposal or whether it is this massive expansion of the Federal Government--the $2.5 trillion expansion to create a new health care entitlement--all these things are raising clouds over the small business sector of our economy, which creates about 70 percent of the jobs.

We are essentially telling small businesses that you may end up with these massive new energy taxes or with this employer mandate that will cost you up to $750 per employee if you don't offer the right kind of insurance; you are going to be faced with all these taxes imposed on health insurers and prescription drugs and medical device manufacturers that will be passed on to you.

Then we are saying go out and create jobs, in light of all this policy and uncertainty in Washington, all these proposals to tax and spend and borrow more money by the Federal Government. You cannot blame small businesses for acting with a little bit of hesitancy when it comes to making major capital investments and when it comes to hiring new people.

Those are the very things we want small businesses to do. We want to encourage that type of behavior. We want to encourage that kind of investment. We want to encourage job creation. Unemployment is at 10 percent. We have lost 3.3 million jobs since the beginning of the year. Who will put people back to work? It will be the small businesses in our economy. In South Dakota, they are about 96 percent of the game, when it comes to employment in South Dakota. Here we are debating a health care reform bill which, in addition to spending $2.5 trillion to create this new health care entitlement, raises taxes on small businesses, cuts Medicare, and at the end day, according to the experts--the CBO and the Chief Actuary at the CMS, which is the so- called referee in all this, who tells us what these things will cost and their impact--they have all said premiums will either stay the same or go up. So the best small business can hope for under this is the status quo.

I hear my colleagues on the other side coming down here, day after day, making statements, saying this is going to be good for small businesses, and this will help small businesses deal with the high cost of health care.

The problem with all their arguments is one thing: They are completely and utterly divorced from reality. You cannot look at this health care reform proposal and come away from it and say this is a good thing for small businesses, when small businesses are saying this will drive up their cost of doing business, it will raise health care costs, and these taxes you are going to hit us with will make it harder to create jobs.

Why do we proceed in the face of this and then deny what all these small businesses are saying, what the experts are saying, and what increasingly the American people are saying, which is that this is a bad idea. So why don't you reconsider this and start over again and do some things that will actually lower health care costs. That is what small businesses are saying.

We have people down here saying this is good for small business. What are small businesses saying--and large businesses, for that matter. The NFIB represents small businesses all over the country. They said:

This bill will not deliver the widely promised help to the

small business community.

They say:

It will destroy job creation opportunities for employees,

create a reality that is worse than the status quo for small

businesses. It is the wrong reform at the wrong time, and it

will increase health care costs and the cost of doing

business.

That is the National Federation of Independent Businesses, as I said.

How about large businesses? The Chamber of Commerce expressed their disappointment with the Senate health care bill and has weighed in with strong opposition against it. That includes the National Association of Wholesaler Distributors, the Small Business Entrepreneurship Council, the Association of Builders and Contractors, the National Association of Manufacturers, the Independent Electrical Contractors, and the International Franchise Association. The list goes on and on. The Small Business Coalition for Affordable Health Care--50 organizations around the country that are members of the group--including many that have members in South Dakota, not the least of which is the American Farm Bureau Federation. That represents farmers and ranchers who are still businesspeople out there trying to make ends meet. They said this:

Our small businesses and self-employed entrepreneurs have

been clear about what they need and want: lower costs, more

choices, and greater competition for private interests.

They say:

These reforms fall short of long-term, meaningful relief

for small business. Any potential savings from these reforms

are more than outweighed by the new tax, new mandates, and

expensive, new government programs included in this bill.

That is what small businesses across the country are saying. The reason they are saying that is because, as I mentioned, not only are they hit with these taxes every year, there is a tax on health plans that will amount to $60 billion over 10 years, which will be passed on to small businesses. There is a new payroll tax, Medicare tax, which incidentally, for the first time ever, instead of going to Medicare, will be used to create a new entitlement program. That will hit about one-third of small businesses in this country, we are told.

As I said earlier, they have the employer mandate, which is going to hit a whole lot of small businesses--another $28 billion that will hit small businesses across this country. So you have all these new taxes heaped upon our small business sector. The small businesses are saying: What do we get out of this? What is this going to do to affect our health care costs?

I will show you. This chart represents what the CBO has said health care costs would do if this bill is enacted. The blue line represents the cost of essentially, if you will, doing nothing. In other words, the blue line represents what will happen if Congress does nothing, the year over year increases we are already seeing. It represents the status quo. We have heard people from the other side say we have to do better than the status quo. The President and the Vice President say that and our Democratic colleagues say that. You cannot accept the status quo and then attack Republicans for being in favor of status quo. The blue line represents the status quo. The blue line is what will happen year over year, in terms of increases in health insurance premiums that small businesses and individuals will deal with.

It doesn't matter where you get your insurance--the small business group market or the large business employer group market or the individual market. If you get it in the individual market, your rates will be 10 to 13 percent higher. I ask unanimous consent to extend my remarks for another 5 minutes.

It doesn't matter which market you get your insurance in, except if you are in the individual market, you will pay much higher insurance premiums than the status quo, which is locking in double the rate of inflation premiums for the foreseeable future.

The red line on the chart represents the spending under this bill. This is what the CBO says will happen. You will see the cost curve bent up, not down. You are going to have more money coming out of our economy to pay for health care than you do today. That is what small businesses are reacting to. That is why they are coming out strongly and adamantly opposed to this legislation. It bends the cost curve up, increases the cost of health care, rather than bending it down. We heard the same thing come out of the Actuary of the CMS just last week.

Again, the experts are saying--the referees, the people who don't have a political agenda--repeatedly, that this will increase the cost of health care. This will drive health insurance premiums higher.

The other point I wish to make, because after I have shown you how health care costs will go up under this legislation, the other amazing thing about it--this is, again, one of those phony accounting techniques or gimmicks that Washington uses, the same old business in Washington, the Washington smoke and mirrors, the ways of disguising what this really costs: In order to bring this thing in at about $1 trillion, which is what the majority wanted to do, they had to use budget gimmicks.

The Senator from New Hampshire knows all about this because he has followed this closely as chairman of the Budget Committee for many years. He can attest to the fact that one of the things they will do is start the tax increases immediately. So on January 1 of next year-- which is now 18 short days away--all these businesses across the country are going to see their taxes go up--in 18 days. But the amazing thing about it is, many benefits don't get paid out for another 1,479 days. So they front-load all the tax increases; the tax increases will be passed on immediately. By 2013, every American family will be paying--starting next year--$600 a year. So every American family will feel the brunt of the additional costs for taxes and the premium increases that will follow from those.

The remarkable thing about it is, they structured a bill that would punish small businesses and people who will pay these taxes on January 1 of 2010--18 days away. They don't pay out benefits for another 1,479 days. What does that do? In the 10-year window they use to measure what this will cost, it dramatically understates the cost of the legislation. So we are faced with not a $1 trillion bill but a $2.5 trillion bill, when it is fully implemented and when all the budgetary gimmicks and phony accounting is actually taken into consideration. This is a bad deal for small businesses. That is why all the small business organizations have come out opposed to it.

You cannot get up, day after day, and defy reality, logic, reason, and facts. That is what those who are trying to push this huge government expansion and huge takeover of health care in this country are trying to have the people believe. They are dead wrong.

I believe the American people are tuning in to that, which is why, increasingly, in public opinion polls, they are turning a thumbs down on this by majorities of over 60 percent.

I see the Senator from New Hampshire. I appreciate him indulging me for an extra few minutes.

I yield the floor.

Madam President, will the Senator from Minnesota yield for a question?

Did the Senator understand that what I was pointing out on the chart--the point I was making--was that the tax increases start 18 days from now, and the benefits--the spending benefits under the bill, which are the premium tax credits and the exchanges that are designed to provide the benefits delivered under this bill--don't start until 2014. Did the Senator miss that?

If the Senator missed that point, I can get the chart out.

Will the Senator yield for an additional question?

Would the Senator from Ohio yield for a question?

Will the Senator yield for a question?

I appreciate the Senator from Arizona yielding and the discussion of all our colleagues on the Senate floor this evening, pointing out how flawed this process is and that it is being conducted behind closed doors in contradiction of all the promises and commitments that were made that this would become a transparent and open process. I think the Senator from Arizona has been great at holding the other side accountable when it comes to all these pronouncements about how this was going to be an open, transparent process, and that is just not the case. There is something going on right now that we are not privy to, and I think at some point they are going to throw something, as the Senator from Arizona said, at the wall, hoping that the latest thing will stick.

But I do want to make an observation with regard to the discussion held earlier today because a Member from the other side--the Senator from Minnesota--had indicated that he thought this chart was somehow inaccurate or misleading, and I want to point out again, Madam President, that the chart is very accurate. In fact, the taxes in the bill begin 18 days from now, on January 1 of next year. January 1, 2010, is when the taxes in this bill begin.

In fact, almost $72 billion of taxes will have been collected before the benefits that start to kick in will be paid out--the premium subsidies that are going to support the exchanges, that are supposedly going to help those who don't have insurance get access to it. That is 1,479 days from now.

The Senator from Minnesota got up and said, and I quote: We are entitled to our own opinions; we are not entitled to our own facts. The fact is, benefits kick in on day one. The large majority of benefits kick in on day one, and we shouldn't be standing up here with charts that say the exact opposite.

Well, Madam President, it is not me saying this; it is the Congressional Budget Office. The Congressional Budget Office has said that 99 percent of the coverage spending in this bill doesn't kick in until January 1, 2014--1,479 days from now.

Now, I ask my colleagues, and most Americans around this country: Do you think it is fair to construct a bill that in order to understate its total cost starts raising taxes in 18 days, but doesn't start delivering 99 percent of the coverage benefits until 1,479 days from now?

If the other side wants to have an argument about whether 99 percent of the coverage benefits kick in in the year 2014 or 100 percent, I am happy to have that argument. The point is simply this: Taxes start 18 days from now--tax increases--so that $72 billion in taxes will have been imposed upon the American people, and the benefits 1,479 days from now.

So, Madam President, I want to make that point and refute the argument that was made by the Senator from Minnesota that a large majority of benefits kick in on day one. Ninety-nine percent of the benefits don't kick in until later.

Incidentally, I have an amendment on which I hope we will get a chance to vote that delays the taxes until such time as the benefits begin. We think it is only fair to the American people that we synchronize the tax increases with the benefits. Many of us don't support the tax increases in the first place, which is why we will be supporting the Crapo amendment to recommit the tax increases back to the committee to get rid of them. But if you are going to have tax increases and start raising revenue immediately, you ought to start paying out the benefits today, or at least delay the tax increases so the benefits and the tax increases are synchronized. That, to me, is a fair way to conduct and do public policy for the American people.

The reason it was done this way, let's be honest about it--and the newspapers have made it pretty clear in some of their statements--for instance, the Washington Post states:

The measure's effective date was also pushed back to the

year 2014. That projection represents the biggest cost

savings of any legislation to come before the House or Senate

this year.

The measure's effective date was also pushed back. They keep pushing the date back to understate the cost. The reason they want to start collecting revenue right away and not start spending until later is because they know if they start the spending early on, they are going to start inflating significantly the cost, and the goal was to try to keep it under $1 trillion. We all know now, and they have acknowledged, the 10-year, fully implemented cost of this isn't $1 trillion, it is $2.5 trillion.

The American people deserve to know the facts. That is the fully implemented cost. The only reason they can say in the 10 years it comes in at $1 trillion or thereabouts is because the tax increases started January 1, 2010, and the benefits--99 percent of the benefits--don't start kicking in until January 1, 2014.

So I thank the Senator from Arizona for giving me the opportunity to clarify that. It is important we make this debate about the facts. I have tried to do that when I speak, and I am happy to have the opportunity to restate the facts as they exist and as they have been presented to us by the experts--by the Congressional Budget Office and by the CMS Actuary, both of whom have concluded the same thing when it comes to the benefits and the impact this will have on premiums in the country. I think that is probably the most devastating blow to the argument the other side has made in support of this bill--when the CMS Actuary came out last week and said this is actually going to increase the cost of health care in this country by $234 billion over the next 10 years.

So, Madam President, I am happy to yield. I see a number of our colleagues on the Senate floor, and the leader is here as well, and I would certainly yield time to the leader.

Would the Senator from Arizona yield? I see a number of our colleagues and the leader.

I would simply add that this idea of expanding Medicare, which just emerged last week, was a bad one, and one even I think a lot of the Democratic Senators have come out in opposition to, which is why we are now back to the drawing board. But this relentless effort to try to tweak this bill around the edges, to somehow get that 60th vote, doesn't do anything to change the fundamental features of the bill, which the leader and the Senator from Arizona have been talking about, and that is the tax increases and spending.

Madam President, the Senator has been the mayor of a good- sized city, a small businessperson, actually probably bigger than a small businessperson. But if you were running a business and you were in an environment such as we are in today, a tough economy, trying to figure out ways to cut back on your costs and figure out a way to sell a little bit more of whatever it is you are making or doing, and somebody comes to you and says: We are going to reform health care and we want to do something that will get health care costs down and yet what they are selling is going to raise your taxes and, according to the referees--the Actuary at the Center for Medicare Services is sort of a referee in all this; they don't have a political objective; they simply want to get the facts out. Of course, that is the role that is played traditionally in Congress by the CBO, both of which now say--the CBO says it is going to increase health care spending by $160 billion over the first 10 years and the CMS Actuary is now saying it will increase health care costs by $234 billion over the first 10 years. You also have now the CMS Actuary saying it could close 20 percent of the hospitals, that 17 million people who get their insurance through their employers are going to lose it, that the Medicare cuts are not sustainable on a permanent basis in this legislation, and that a lot of these tax increases are being passed on in the form of higher premiums which will mainly be borne by people trying to provide insurance. If you are sitting there as a businessperson--and you have been there--and you are looking at that balance sheet and that income statement and somebody is trying to sell you on an idea about health care reform that has the features I mentioned, how do you react to something such as that? I see what small business organizations are saying, but the Senator has been there. Tell me how you view it.

The Senator has made a payroll. He knows what this is like, how hard these decisions are when it comes to making decisions about whether you are going to hire somebody and to try and squeeze those costs down so you can buy a new piece of equipment. I think all small businesses are dealing with that. The Senator from Wyoming mentioned the National Federation of Independent Business which, of course, is a very business-oriented organization that represents a lot of small businesses across the country, indicating the employer mandate would cost about 1.6 million jobs so the job issue is so absolutely pertinent to this debate. That is why NFIB and the Chamber of Commerce and every business organization I think I know of in this country, including organizations such as the American Farm Bureau organization, which represents a lot of farmers and ranchers in my State, those are the organizations that speak for these various small businesses. They have all weighed in, and they weighed in heavily, in no uncertain terms, that this sets us back. This does not move us forward. You talked about getting that cost curve down. Every analysis that has been done, including by the referees--the Congressional Budget Office, the Actuary at CMS--all come back with the same conclusion.

The Senator from Alabama also probably has a lot of small businesses in his State, members of the National Federation of Independent Business, the Chamber of Commerce, the Association of Wholesale Distributors, the National Association of Manufacturers, lots of these organizations that have weighed in. It seems to me they have looked at this carefully, and they have come to the same conclusion. I would be interested in what the Senator from Alabama might be hearing from the small businesses he represents, with regard to the impact this would have on jobs.

I think we have to wrap up. But I just want to make one point in closing and say to the Senator from Tennessee, the Senator from Wyoming--the leader is here from Kentucky--that the citizens in my State of South Dakota, and I think most citizens, would expect that if we are going to reform health care, we do something about their cost, which clearly that point has been made very clear, repeatedly, here-- that all the studies say that does not happen.

The other thing I will mention is, I cannot imagine any of our constituents would say that if you are going to implement public policy, you should raise taxes in 3 weeks and not start the benefits until 4 or 5 years later. It just seems to me the average American out there has to be saying: OK, that is like me going to the bank and taking out a mortgage, but I can't move into the house for another 4 or 5 years, and in the meantime I will be making payments.

I thank my colleagues from Tennessee, Wyoming, Alabama, Kentucky, and Arizona, all who have been here.

In closing, I will quote the Associated Press:

In part to reduce costs, the legislation would delay until

Jan. 1, 2014, creation of so-called insurance exchanges in

which individuals and small businesses could shop for

affordable coverage.

All done to disguise the bill's real cost of this, which it is being acknowledged now widely by the Democrats as well. This is not a $1 trillion bill; this is a $2.5 trillion bill. It is a job killer. It cuts Medicare, raises taxes, and raises premiums for most of the American people.

I yield back our time.

Mr. President, I want to address the issue of health care reform, of course, which is the main reason Congress is here this weekend and was here last weekend, and in all likelihood will be here next weekend. But I also think it is important we put these things into an overall context and take a look at the bill we are voting on right now.

We are going to have a vote on final passage tomorrow. We had a cloture vote this morning on a spending bill, and the spending bill-- which represents six, I think, appropriations bills that did not get done earlier this year--represents a package of spending that overall increases by 12 percent over last year.

That is an interesting number, given the fact that the Consumer Price Index--which is the sort of, if you will, conduit to which a lot of these decisions that are made around here is tied; in other words, the CPI is what we view to be inflation; and sometimes we say we mark up bills at inflation or inflation plus this or inflation plus that--where the CPI was, ending on October 1 of this year, about two-tenths of 1 percent but in the negative column.

So you have a CPI that is actually negative, an inflation index that is actually negative for most Americans. This, again, is representative of the totality of our economy and what things cost, and that is a lot of times how appropriations bills are measured.

So you have a CPI, Consumer Price Index, that is running in the negative, and yet you have appropriations bills--this one representing, again, as I said earlier, six appropriations bills, individual appropriations bills that did not get done earlier--packaged into one big spending bill that is a 12-percent increase over the previous year.

How can we go to the American people and justify year-over-year spending increases that are 12 percent, when they are having to balance their budgets and tighten their belts and live in an economy where some people are losing their jobs? But certainly everybody is trying, struggling to survive out there. That is true for small businesses. That is true for families. That is true for pretty much everybody, it seems, except the Congress.

Here in Washington, DC, we seem not to be listening to what is happening in America. We are marking up spending bills at 12 percent over last year's level, at a time when the CPI is actually running in the negative--when you have negative cost-of-living increase. Yet we are marking up appropriations bills that represent a 12-percent increase over last year's spending level?

Put that on top of a stimulus bill that passed earlier this year that, with interest, is a $1 trillion spending bill. So you have a $1 trillion spending bill with interest passed earlier this year, much of which went to the very same

Federal agencies that are going to benefit from this 12-percent increase over last year in annual appropriations. So you have a $1 trillion stimulus bill, you look at appropriations bills--again, this being representative of most of the bills this year--that year-over- year increase at 12 percent, at a time when most Americans are having to tighten their belts.

We hear that. We also hear that TARP is now going to be used as a slush fund, so to speak, to pay for all kinds of other government spending. In other words, they have decided--at least, I think the administration has--to use the TARP fund as sort of a ``pay for'' for lots of things they want to do.

Most of us know that the TARP fund was created specifically to stabilize our financial markets, to prevent what we thought at the time was going to be an imminent financial collapse. That purpose has been served. I have a bill that would end TARP at the end of this year on December 31. If it is not allowed to expire at the end of this year, when it is set to expire--if it is not allowed to expire, if it is extended and it goes well into next year--it can be used, as I said, for all these other things that politicians have designs on doing.

So my legislation would end it at December 31 of this year, as was intended, and make sure any funds that are paid back in from loans that have been made or assets that have been acquired actually go back to the Treasury to pay down the Federal debt. Because that is what, in fact, TARP was intended to do. Once the job was accomplished, it was not to become a ``grab bag'' and ``found money'' for Congress to use for all these other things.

You have the TARP fund now morphing and evolving into this sort of political slush fund to be used for all these other spending priorities. You have the stimulus, this $1 trillion stimulus bill, out there. You have this appropriations bill with a 12-percent year-over- year increase over last year's level. On top of all that, we pile on a $2.5 trillion expansion of the Federal Government in Washington to pay for a new entitlement program with the health care reform bill that has been, is being debated in the Senate in the last week and in the week to come.

So at some point you have to say--and I think the American people look at us and say--enough already. I think that is what they are saying. I think the reason we are seeing these public opinion polls that are turning a thumbs-down on this massive expansion of the Federal Government here in Washington to fund health care is because the American public is becoming increasingly uncomfortable with the idea that the Federal Government continues to run the credit card up.

The stimulus money was all borrowed money. The TARP money is borrowed money. The appropriations bills, for the most part, this year are--or for a large part, at least--borrowed money. Mr. President, 43 cents out of every dollar the Congress spent in the last year--the fiscal year ending September 30--was borrowed money.

We continue to borrow and borrow and pass on the debt to future generations. We cannot continue to do that and expect to have a future that enjoys the same level of prosperity and the same level of economic growth and vitality we have experienced in the past. You cannot continue to pile up these massive amounts of debt. The Federal debt is going to double in 5 years, it is going to triple in 10, if we continue on the current path. Right now, I do not see anything that is going to put any brakes on this.

The capacity and the appetite and the willingness and the inclination of Washington, DC, and politicians here to continue to spend and spend seems to be unlimited. At some point, we have to put the brakes on. We have people who have a foot on the pedal. The Democratic majority in the House of Representatives, the Democratic majority here in the Senate, the White House, all have their feet on the accelerator. Somebody has to put on the brake. That is what we are trying to do.

That is why I think it is important we end TARP before it gets misused and spent for all these other things and why it is important we rein in these appropriations bills. We are doing everything we can to stop this appropriations bill from being passed at a 12-percent increase over last year's level. And we are doing everything we can, I would say, to stop this massive expansion--$2.5 trillion expansion--of the Federal Government to fund the new health care entitlement, at a time when we have all these other debt problems and deficits, as far as the eye can see.

So I wanted to, in shifting gears, paint that as sort of the context against which this whole health care debate is occurring. But I want to shift, if I could, to some of the more recent developments with regard to the debate over health care.

I think there are a couple things that, to me, are game changers in terms of the debate. One of those, of course, is the study that came out yesterday from the CMS, or the Centers for Medicare & Medicaid Services, the Actuary who points out the health care reform bill that is currently before the Senate will not drive health care costs down but will, in fact, increase health care costs by $234 billion, and that today, about one-sixth of every dollar we spend is on health care; that 10 years from now, in 2019, that will be almost 21 percent--that is what the CMS Actuary said--that the total amount we spend on health care in this country--which today is about 17 percent--10 years from now will be almost 21 percent. So the amount spent on health care as a percentage of our gross domestic product goes dramatically up, not down. And $234 billion is what the CMS Actuary said health care costs would go up by in the next 10 years.

Of course, we had previously the CBO essentially saying the same thing. The Congressional Budget Office--for those who live outside of Washington, DC--is sort of the nonpartisan estimator, if you will, of what a lot of these Federal programs are going to cost.

The Congressional Budget Office said that under the bill put forward by the Senate majority here, the Democratic leadership in the Senate, you would actually increase health care spending by $160 billion over the next 10 years, again bending the health care cost curve up, not down. So now you have the experts--the Congressional Budget Office, the Centers for Medicare & Medicaid Services Actuary--all saying health care costs are going to go up, not down, and significantly up.

You have the small business organizations out there saying--the National Federation of Independent Business, the Chamber of Commerce, the National Association of Wholesalers and Distributors, and I might add there is another group that has been formed called the Small Business Coalition for Affordable Healthcare, which represents 50 different business organizations--this health care reform bill will increase the cost of doing business in this country and will drive up health care costs. So they have come out in opposition to it, as have all the other business organizations I mentioned, for the same reason. They realize health care reform ought to be about getting their costs down and improving their ability to create jobs. By the way, three- quarters of the jobs created in our economy are created by small business.

So what are we going to do to small businesses? Pile on a bunch of new taxes to pay for this expansion, this $2.5 trillion expansion of the Federal Government in the form of this new health care entitlement. All for what? So they can see their health care costs continue to go up. You pile on the new taxes, you cut Medicare to all the providers out there. And I want to draw them into this too because not only have the small businesses said this is going to drive health care costs up-- and they have come out opposed to it--not only has the Congressional Budget Office said that, not only the Centers for Medicare & Medicaid Services Actuary said that, you have academics saying that, but now you also have the providers saying that.

Hospitals and physicians groups are coming out and saying this latest proposal by the Democratic majority to expand Medicare will put hospitals out of business. Because hospitals get underreimbursed by Medicare, and so do physicians. So what do they do? They shift costs over to the private payers, which is everybody else in this country, and everybody else sees their premiums go up. It shrinks the number of private payers, expands the number of government payers, and for these

hospitals in places such as South Dakota--I see my colleague from Wyoming on the floor--that are very dependent on Medicare, they are going to see less and less reimbursement coming into their facilities, which does not cover their costs, and very soon you will have a lot of hospitals, particularly in rural areas, going out of business. That has been stated. The chairman of the Senate Budget Committee, Senator Conrad from North Dakota, came out and said that basically this latest proposal would bankrupt a lot of hospitals in his State. I think that is true for a lot of States and particularly in rural States such as mine and the Senator from Wyoming.

We have small businesses saying: We can't sustain these increases. We think this is a really bad deal. We have the experts, the analysts, the Congressional Budget Office, and the Center for Medicare and Medicaid Services saying this increases costs for health care in this country. And now we have the American people weighing in and saying: We think this is a bad deal. We think it is going to increase our health care costs. The CNN poll that came out 2 days ago said 61 percent of Americans oppose the health care reform bill that is pending right now in the Senate. Other polls show similar results. So we have a very sizable majority of the American people who have now weighed in saying this is a bad deal because it cuts Medicare, it raises taxes, and at the end of the day, it raises premiums.

So who is for this? Who thinks this is a good thing? Well, apparently a number of Democrats here in the Senate, but that is an increasingly shrinking universe of people.

The American people have said it is a bad deal. The experts say it is a bad deal. Small businesses say it is a bad deal. Providers say it is a bad deal. What is left?

Well, I am hoping there are a couple of courageous Democrats who are going to step forward, agree with the American people, and say: We are listening to the American people. We are listening to the experts. We are listening to small businesses that create two-thirds or three- quarters of the jobs in our economy. And we agree we are going to stop this train wreck from happening, sit down, start over, do this right, work with Republicans, and write a bill that actually does constrain costs, that drives the cost curve down and provides access for more Americans. I hope there are a few Democrats out there who will do that because I think on our side we have all concluded, based on what we hear from the American people, what we hear from the experts, what we hear from the business community, what we hear from the provider community, the hospitals and the physicians, that this is a really bad deal. At the end of the day, after all of this new spending, after all the new taxes, after all the Medicare cuts, what are we left with?

What everybody says they want out of health care reform is lower costs. Our colleagues on the other side come down here repeatedly and say we have to do something about the cost of health care. People in this country are struggling with health care costs, absolutely. We could not agree more. What they will do with this bill if it passes is make matters worse, not better, by increasing costs for most Americans.

I wish to show my colleagues exactly what I mean. If you are a family of four--and this is, again, according to the Congressional Budget Office, which looked at this and analyzed these bills and said: If you are in the small group market or large group market, you are going to see year-over-year increases in health care costs, which is somewhere between 5 and 6 percent, which is what we are seeing today--and by the way, that is twice the rate of inflation historically--but a 5- to 6- percent increase in health care premiums. If you are in the individual marketplace, you are going to see your premiums go up anywhere from 10 to 13 percent beyond that. So if you are in the individual market, it gets much worse. But if you are in the small group or large group market, here is what it says: If you are in a family of four today and you are receiving your insurance through your employer and they are getting their insurance through a large group market, you are paying about $13,000 a year. In 2016, 7 years from now, you are going to be paying over $20,000 a year for health insurance coverage.

So your health insurance coverage is going to go up under this bill, not down, according to the Congressional Budget Office. It is going to go up at a rate that is double the rate of inflation. Again, this is for people who get their insurance in the large and small group markets. The yellow line represents the large group market, the red line represents the small group markets, but the result is the same. It is an upward trajectory. It is a spike up in the cost of health insurance for people who get their coverage for health insurance in one of those two markets. Again, as I said before, if you are in the individual marketplace, you could spike this thing like this because their costs are going to be 10 to 13 percent above and beyond what you are seeing here in the large group market. That is according to the Congressional Budget Office.

So 90 percent of Americans, according to the Congressional Budget Office, are going to see their health insurance premiums stay the same, and by ``stay the same,'' I mean go up by twice the rate of inflation-- in other words, locking in the status quo--or worse yet, if you are in the individual marketplace, it will be going up 10 to 13 percent.

So all of this talk about lowering the cost of health care and not settling for the status quo may sound good, it is great rhetoric, but it is absolutely factually inaccurate.

So our colleagues who come down here day after day talking about how this health care reform bill is going to drive down the cost of health care are not listening. They are not listening to the American people. They are not listening to the experts. They are not listening to the small business community. They are not listening to the provider community.

I have to say that even the academic community has weighed in on this particular issue as well.

I wish to read for my colleagues something that was said recently by the dean of the Harvard Medical School:

Speeches and news reports could lead you to believe the

proposed congressional legislation would tackle the problems

of cost, access, and quality, but that's not true. The

overall effort will fail to qualify as reform. I find near

unanimity of opinion that whatever its shape, the final

legislation that will emerge from Congress will markedly

accelerate national health care spending rather than restrain

it. This will make an eventual solution even more difficult.

That from the dean of the Harvard Medical School.

So I hope that before this debate concludes--the push is to get it done by the end of the year. I am not sure why. It seems to me, at least, that this is not something we want to hurry. We are talking about reordering or restructuring one-sixth of the American economy. As I said, today it represents 17 percent of our GDP. We spend about $2.5 trillion a year on health care. We ought to get this right. There is an intent on the other side to jam this through sometime next week. Well, I hope we can put the brakes on this. I hope there are a couple of courageous Democrats--at least one but two would be better, maybe even more--who will step forward and say: We are going to listen to the American people. We are going to listen to the providers out there, the hospitals and physicians. We are going to listen to the experts. We are going to listen to the small business community that creates the jobs. And we are not going to blindly follow the leader and take this country over the cliff when it comes to health care delivery and when it comes to our economy.

There is one final point I will make about that because I thought this was a remarkable finding by the CMS in their study. They essentially said that the savings that are proposed in Medicare--the new Federal spending that relies on Medicare cuts which are unlikely to be sustainable on a permanent basis--we all, over here, agree with that. The appetite for the Congress, the willingness for the Congress to cut reimbursements to hospitals and to nursing homes and to home health agencies and to hospices, I find very suspect.

So at the end of the day, if you cannot sustain those--and let's say, for example, for a minute that you can. Let's say these Medicare cuts take effect. If they take effect, and if the Democrats have their way and they expand Medicare, we are going to put more and

more people onto a sinking ship because we have a program that is going to be bankrupt in 2017, we are told by the actuaries. We are going to cut $1 trillion out of it over the next 10 years when it is fully implemented, and we are going to put more people onto it. So if those cuts occur, we are going to have more and more hospitals going out of business because they flat aren't going to be able to make ends meet. That is the other thing, by the way, the CMS Actuary found in their study.

But they said they don't believe we can sustain these Medicare cuts on a permanent basis. Meaning what? Meaning that the cost of this program, $2.5 trillion over 10 years, is going to fall on the backs of future generations because it will be borrowed. It will be added to the debt, which is growing at $1 trillion a year, as I said earlier.

We are going to have a vote, if you can believe that, here in the very near future to actually raise the debt ceiling by $2 trillion over and above what it is today, which is $12 trillion. This debt situation is probably the most serious crisis and challenge facing this country going forward. It just seems as though there is an endless, limitless appetite for spending and borrowing around here, and at some point the chicken is going to come home to roost and the bills will have to be paid. You can't continue to sustain this level of borrowing.

These Medicare cuts are unsus-tainable, which is what the CMS Actuary says. That means a lot of the cost of this new program is going to be financed partly by tax increases, which, as I said, are harmful to small businesses, but secondly by more and more borrowing and more and more debt. More and more future generations, younger Americans, will be faced with a massive inheritance of Federal debt because we weren't willing to make the hard choices to be able to live within our means.

So I hope when it is all said and done, there will be some people who will step forward, have the courage not to blindly follow the leader but to say with the American people, with the experts, with the small business community, with the provider community, with even some of the academic community, that this does nothing to constrain or lower health care costs. The emperor has no clothes. If they do that, we can sit down together.

We are not here for a minute to suggest we shouldn't have health care reform. All we are here to suggest is that it ought to be done the right way, it ought to be done on a bipartisan basis, and it ought to be done in a way that actually bends the cost curve down rather than raises it and that does not cost us $2.5 trillion of cuts to Medicare, which is going to impact a lot of seniors, increase taxes, which is going to crush small businesses, or debt, which is going to punish future generations.

That is what this debate is about. It is a consequential debate for America's future. The stakes are very high. I hope the American people will be engaged in it, and I hope we will be able to find some bipartisan support for defeating this really bad idea and moving to something that actually will make a difference, that will restrain costs, and that will provide health insurance reform that is meaningful reform and that doesn't bankrupt us, doesn't bankrupt hospitals, doesn't bankrupt future generations, doesn't cost us jobs by putting new taxes on small businesses, and actually bends the cost curve down.

I yield the floor.

Mr. President, the Republican leader has just arrived. I reserve any statement for him.

I would say to my friend from Texas, Senator Hutchison, that as we have examined this legislation and have looked at its cost and its benefits and how that is distributed over time, it has become clear that what the other side has tried to do--the Democrats have tried to do--with this bill is understate its true cost by front- loading the tax increases and back-loading the spending. In other words, the tax increases kick in right away, when much of the benefit of the bill does not kick in for several years.

So I want to point something out, just to illustrate what the Senator from Texas has said; that is, the tax increases in the bill begin on January 1 of this year. So 21 days from now, Americans, individuals, families, and small businesses are going to see their taxes go up. Unfortunately, they are not going to see any benefit come until 1,482 days later.

What that, in effect, does is it understates the total cost of this legislation. They have said: We want to get this under $1 trillion. The President said: I need a bill under $1 trillion. So they have tried to come up with a bill that is about $1 trillion. But what they do not tell you is that by delaying the benefits and front-loading the tax increases, you are actually going to have a 4- or 5-year period where people are having to experience tax increases. That is going to impact the small businesses because you have a Medicare payroll tax increase, which, by the way, for the first time, will not be used for Medicare but will be used to create a whole new entitlement health care program.

You have an employer mandate which is going to hit small businesses. You have the tax on medical device manufacturers, on prescription drugs, on health plans. You have all these taxes that kick in right away.

So what happens? These taxes get passed on to the consumers in this country in the form of higher premiums, so people are going to see their premiums go up. Small businesses are going to see their taxes go up immediately--well, 21 days from now. But Americans are not going to see any benefit from this for 1,482 days. So what we have is a gimmick that has been used to disguise the total cost of this bill, which we all know when fully implemented is not $1 trillion but $2.5 trillion.

So the Senator from Texas and I have a motion, which I believe is supported by the Senator from Wyoming, who is in the Chamber, that would delay the tax increases until such time as the benefits begin so we synchronize or align the tax increases and the fees to begin at the same time the benefits do so we will reflect the true cost of this legislation to the American people and not unfairly begin punishing small businesses by raising their taxes before a single dollar of benefit is going to be distributed to the American people.

I would say to my friend from Texas, it is kind of the same old Washington game, the same old Washington gimmick, the same old backroom deal that has been cut basically that, of course, we have had no input into. Incidentally, there is another now, the latest permutation of this discussion, going on right now behind closed doors, which is the Medicare expansion, which is a subject for a whole other day.

But I think the American people are looking at this and saying: How does this impact me? More than anything else, they are watching this big debate in Washington, DC, and saying: How does this impact me? I think what they are concluding is that 90 percent of the American public, according to the Congressional Budget Office, would see their premiums stay the same at best or at worst go up, and when I say ``stay the same,'' that means double the rate of inflation annual increases in their health insurance premiums.

So the best you can hope for, if you are an American today, is the status quo when it comes to your health insurance premiums.

If you buy in the individual marketplace, your premiums are going to go up 10 to 13 percent above the annual, double the rate of inflation increases that we are currently seeing.

So that is what happens to the American public, the average person out there, in terms of their health insurance premiums. If you are a small business, you are looking at tax increases. You are looking at a whole new raft of tax increases that you are going to end up having to pay, which is why all of the small business organizations--the Senator from Texas pointed out the letter from the National Federation of Independent Business, which says this is going to drive the cost of doing business up. This is going to increase the cost of health care, not lower it. What they want to see in reform--small businesses that are the economic engine that creates jobs in this economy--is they want to see health care reforms put in place that drive health care costs down.

We know from every estimate that has been done, such as from the Congressional Budget Office--we have some data now from the CMS actuary that just came out yesterday that says overall health care expenditures are

going to go up, health insurance premiums are going to go up. So small businesses are looking at higher taxes.

If you are a senior citizen in America, and one of the 11 million people who get Medicare Advantage, your benefits are going to be cut. So you have higher premiums, increased taxes on small businesses, Medicare benefit cuts to senior citizens across this country, and cuts to providers, and if you are a young American, you are faced with a $2.5 trillion new entitlement program that you are going to have to pay for.

That is what the American people, as they are observing this debate, can expect to come out of this, if the bill that has been proposed by the majority is enacted. That is why we are working so hard to defeat that and put in place some commonsense reforms that actually make sense to the American people.

I know the Senator from Wyoming, who is a physician, knows full well the impact of many of these policies from being on the front line. He is someone who has had to deliver health care services in a rural State. So I would ask him to give us his thoughts about what these tax increases and Medicare cuts are going to mean to health care delivery in places such as Wyoming.

Let me, if I might, enter into a discussion with the Senator from Wyoming because, as he said, his State and my State are not unlike in terms of the composition of population. We have big geographies in Wyoming and in South Dakota and in the West and a lot of rural health care delivery. The primary job creator in places such as Wyoming and South Dakota is small business. Small businesses are the economic engine that creates jobs.

As the Senator from Wyoming mentioned, according to many of the analyses that have been done of this legislation, it would be a job killer. It has been suggested by the National Federation of Independent Business that 1.6 million jobs would be lost.

What is ironic about that is I have heard our colleagues on the other side repeatedly say this is going to be great for jobs. This is going to be good for the economy. If that is true, then why are all of these business organizations coming out and saying it would increase the cost of doing business and it would increase health care costs? We

have that now validated by the Congressional Budget Office, by the CMS Chief Actuary at Health and Human Services saying overall health care costs under this legislation are going to go up, not down, both as a percentage of the gross domestic product as well as for individuals who are going to see it in the form of higher health insurance premiums.

I say to my friend from Wyoming, because he and I represent similar constituencies and the economies are similar, although he has--we wish we had more oil and gas in South Dakota along the lines of what they have in Wyoming--but the small business sector is what creates jobs.

He mentioned the National Federation of Independent Business. I wish to mention one other letter we received from an organization called the Small Business Coalition for Affordable Health Care. In it they state that these reforms fall short of long-term, meaningful relief for small business. Any potential savings from these reforms are more than outweighed by the new taxes, new mandates, and expensive new government programs included in the bill. This is signed by 50 small business organizations, one of which, by the way, is the American Farm Bureau Association, which is a big presence in my State, represents a lot of farmers and ranchers, small business people, and I am sure represents a lot of members in the State of Wyoming as well as in the State of Texas.

I think what they are saying is, what all of these business groups are saying, and that is we don't find anything in this--there may be some good things in it, but we find the overall core elements of this bill to be a detriment to job creation, will kill jobs, and will drive up the cost of doing business in this country.

It is hard for me to believe that some of the statements made by the other side--and I assume they are making them with the greatest sincerity, but they are factually wrong. If they weren't, we wouldn't have every business organization in this country coming out and saying we are opposed to this because it is going to increase the cost of doing business, it is going to kill jobs, and it is going to increase the cost of health care.

So to our colleague from Texas I would say I suspect she has a lot of small businesses in her State, not unlike Wyoming and South Dakota, that share that view.

That is exactly what our concern is. I would also add this recent study that came out yesterday by the CMS chief actuary sheds a lot of additional light on what is a very bad proposal, a big government proposal that does create 70 new programs here in Washington, DC, but does nothing to affect in a positive way the health care costs that most Americans are dealing with right now. The actuary goes on to say that access to care problems is plausible and even probable under the Reid bill.

So the issue we have talked about in States such as Wyoming and South Dakota, where people travel long distances to get access to health care, would be aggravated by this legislation because there would be a need for more and more providers--hospitals, physicians--who currently don't take Medicaid patients. You expand Medicare, which is the latest proposal the Democrats have put forward, and as a consequence of that you get fewer and fewer hospitals, fewer and fewer physicians who are accepting Medicare patients, because Medicare and Medicaid are both underreimbursed, therefore creating a cost shift where the cost is shifted over to private payers whose premiums continue to go up and up.

So that is why we see all of these studies coming out saying premiums are going to go up, taxes are going to go up, and Medicare benefits are going to be cut, particularly for seniors who have Medicare Advantage. At the end of the day, this ends up being a $2.5 billion expansion of the government here in Washington, DC.

But to the point the Senator from Texas made--and I think--I know we are running out of time. We want to vote. We want to vote on this motion. We don't think you ought to start taxing people in 21 days and not start delivering benefits for almost 1,500 days.

That is what our motion would do: Synchronize the tax increases with the benefits.

I yield the floor.

We do want to get a vote--a vote on our amendment and on other amendments. Right now, that is being prevented or blocked. We haven't had a vote since Tuesday. We have amendments that are ready to go.

The other side said they are open to amendments and they want to get the bill moving forward, but we are being prevented from getting votes on amendments. In the meantime, this backroom deal that is being cut, which we haven't seen--supposedly it has been sent to the CBO to find out what it will cost. We are waiting for that deal to emerge. In the meantime, we are looking at a piece of legislation that costs $2.5 trillion when fully implemented.

As the Senator said, it relies on Medicare cuts and tax increases to finance it. Just yesterday, the chief actuary at the Center for Medicare and Medicaid Services basically said the savings that are relied upon, in terms of Medicare cuts, are unlikely to be sustainable on a permanent basis. They raise the question about whether those cuts are actually going to occur and, if they do, whether they will be sustained. If they are not, then you have the question of whether a lot of these providers out there--if the cuts do occur, and they continue to lose more and more every time they see a Medicare patient, then they are going to quit participating in the Medicare Program. You will have fewer providers offering services, making it more difficult for people--especially in places such as Wyoming and South Dakota--to get access to health care.

You are assuming all these cuts in Medicare are going to occur, and you are assuming all these tax increases. Even with all that, you have a $2.5 trillion expansion of the Federal Government, which inevitably is going to rely more and more on borrowing. You are going to see more and more of this going on the debt, and we will pass it on to future generations.

As CMS pointed out, it is unlikely these Medicare payment cuts are going to be sustainable without driving hospitals and doctors and other health care providers out of business. When they start reacting to this and those Medicare cuts are no longer sustainable, then you have built in all this new spending, and there is no way to pay for it without raising taxes dramatically, which would be, I guess, something the other side--since they have already demonstrated a significant willingness to raise taxes in this bill or borrowing, neither of which is good for the future of the country or our economy.

Right now, our economy is trying to come out of a recession. Small businesses, which create the jobs in our economy, are faced with higher taxes under this bill. They have come forward and said--every conceivable business is saying this will drive up the cost of doing business, and it will raise the cost of health care in this country.

So you have all these small businesses saying we are not going to be able to create jobs. You have that specter out there. You also have the idea of the Medicare cuts, which are, according to the CMS actuary, unlikely to be sustainable, leading to borrowing and debt, which means we are already running a $1 trillion deficit every year and piling more on the Federal debt and there will be a movement here to raise the debt limit by almost $2 trillion. So we will pass this on to future generations, future young Americans, who are going to bear the cost of this massive expansion of the Federal Government.

There isn't anything in this that is good for the American public, which is why they are reacting the way they are, and why you are seeing these 61 percent of Americans coming out in the polls against it.

I say to my friend from Wyoming, his thoughts with regard to this issue, these Medicare cuts being sustainable, how it is going to impact the delivery of health care around this country, and what it will do to future generations in terms of the additional debt and borrowing.

I ask my colleague from Arizona if this is what happens when you end up with one-party rule, one party trying to go this on their own. This seems to be a model of dysfunction in how to come up with a solution to one of the major problems facing the American people, dysfunctional by Washington's twisted standards. They seem to be desperately throwing things at the wall, hoping something will stick. Surely, there has to be a better suggestion coming from the other side than to expand a program that is destined to be bankrupt in the year 2017. It is the equivalent of a ship that is sinking. It is similar to the Titanic. You will put more people on the deck of a sinking ship. Clearly, the overall objective, at least among some, and I think some have been very transparent about it--someone quoted earlier today the Congressman from New York in the other body who said this is the mother of all public options. He went on to say:

Never mind the camel's nose. We have his head and neck in

the tent on the way to a single-payer system.

Obviously, there are people here who want to see a single-payer system, who want to see government-run health care. We don't happen to believe that is the best solution for America's health care system, but the amazing thing about this proposal is, it takes a program that is destined to be bankrupt in a few short years, cuts $1 trillion out of it over 10 years, when fully implemented, and then adds millions of new people into that program. It is hard to come up with any rational explanation for what is going on here, other than that they are left with, in desperation, trying to throw something at the wall, hoping it will stick. Is this typically what happens around here when one party tries to go on its own on something that is this consequential to America? One-sixth of our economy is represented by health care.

Essentially, what they are saying is, we want to expand that part of the economy that isn't working today, that is headed for bankruptcy, that underreimburses doctors and hospitals, put more money into that failed system, exacerbate the cost-shift problem by forcing people in the private-payer market to pay higher premiums. It seems like this creates all sorts of problems that make matters even worse.

I appreciate my colleague's leadership on this issue of pointing out what inevitably is going to happen. When you have the Washington Post editorial this morning even acknowledging the terrible problems this creates for health care and the way this is being conducted, sausage being made here in Washington, DC. Even by Washington's twisted standards, this process has become so dysfunctional, I don't know how they can recover.

One thing they could do is decide to sit down with Republicans and actually figure out some things we could do that would drive health care costs down, rather than making them go up.

I say to my colleague from Idaho that I support his motion. I hope we get a chance to vote on it. I know right now they are scrambling to find an alternative to put up so they can have something on which to give their side political cover because they know the reason they are trying so hard is because they know this raises taxes. To say with a straight face this does not raise taxes--the American people get this. I think the gig is up. They figured out there are huge Medicare cuts in this bill, huge tax increases in this bill. And as the Senator from Idaho pointed out, when they say these refundable tax credits are going to go back in the form of premium subsidies and there are not that many people who are going to pay, as he pointed out, 73 percent of the people who will get those premium subsidies are people who do not have an income tax liability already. Therefore, it is hard to say you are going to reduce taxes on somebody who does not have an income tax liability.

More important than that, there are still 42 million Americans with incomes under $200,000 a year, according to the Joint Tax Committee, who are going to see their taxes go up under this bill. So you literally have millions and millions of Americans under $200,000 a year. And as the Senator from Idaho mentioned, the President's promise was he would not raise taxes on anybody earning under $250,000 a year. This flatly contradicts that, flatly violates that pledge. I cannot fathom anybody coming here with a straight face and saying: Oh, yes, this doesn't raise taxes. Of course it raises taxes.

What the Senator from Texas and I intend to do on our motion--and I hope we have a chance to vote on it and the Senator's motion--we will go back to the committee and figure this out. We want to offer a motion that we think makes sense because it aligns and synchronizes the dates of all this.

What has happened here, I would say, in a very deceptive way, is they understated the costs of the bill. My colleagues on the floor already alluded to this. They tried to get it under $1 trillion, and in attempt to get it under $1 trillion, they had to come up with budget gimmicks.

To illustrate that with a bar chart, we can see in the first 10 years of this bill--starting today and going to 2019--the spending in the early years does not show up much. That is because most of the spending gets put off until January 1, 2014.

So if we look at that first 10-year period, the spending under the bill is less than it will be when the bill is fully implemented. When the bill is fully implemented, looking at the years 2014 to 2023, it explodes the spending in the bill from about $1 trillion over the first 10 years to $2.5 trillion over the 10 years when it is fully implemented.

The reason they were able to do that is because of this sort of smoke-and-mirrors way of enacting the tax increases immediately and delaying the spending. The American people are going to end up spending $71 billion in tax increases out of their pockets, out of the American taxpayers' pockets, about $600 per taxpayer, before they ever see a benefit under this bill.

What the Senator from Texas, Mrs. Hutchison, and I are offering is a motion that would delay the tax increases until such time as the benefits begin. That, to me, seems to be a fair way to go about making public policy.

What they have done, in an effort to obscure the overall cost of this bill, is to say that 22 days from now, we are going to raise your taxes. On January 1 of this year is when most of these taxes--the taxes on prescription drugs, taxes on medical devices, taxes on health plans--all the taxes in the bill begin to take effect January 1 of next year. For 4 years, people will be paying taxes out of their pockets. I might add, because of the taxes that are going to go on all the device manufacturers, prescription drugs, and health plans, they will get passed on in the form of higher premiums. They are going to see tax increases and premium increases before they ever see a dollar of benefits.

It is 1,483 days until the benefits under this bill kick in. That is unfair. It is unfair to the American taxpayer, it is unfair to the American people, and it is unfair to try to obscure and mask the total cost of this bill and say we are only spending $1 trillion on this bill when we know full well when it is fully implemented, the total cost of that is $2.5 trillion.

I appreciate the discussion that is being held here in pointing out the smoke and mirrors, the sort of underhanded way to try to shield the cost of this bill but also to support the Senator from Idaho with his motion that would commit this bill and get these tax increases out of here because the one thing small businesses are saying right now is we want to invest, we want to create jobs. But you cannot raise taxes on small businesses when you want them to create jobs. That is what this bill does.

The National Federation of Independent Business, the Chamber of Commerce, the National Association of Wholesalers and Distributors--all the major business organizations--have come out opposed to this bill.

The National Federation of Independent Business in a letter yesterday said: We do not support policies that increase the cost of doing business and that raise taxes. Clearly, that is what this bill does.

Our motion is very simple; that is, it simply delays tax increases until such time as the benefits begin.

I yield back my 5 seconds. I don't have enough time to distribute equally. It would not be fair.

Will the Senator yield for a question?

The Senator mentioned that for these seven bills, the year-over-year increase in spending is 12 percent. Does the Senator from Arizona know what the CPI this last year was?

If the Senator will yield for another question, do any of these numbers the Senator is talking about--this 12-percent increase in spending in these seven appropriations bills over

the previous year, at a time when families across this country are being asked to tighten their belts, small businesses are tightening their belts; as the Senator said, we have record unemployment--do these numbers include the almost $1 trillion that was spent earlier this year in the stimulus bill?

I say to my colleague and friend from Arizona, that is a 12-percent year-over-year increase and the five bills that have already passed had increases that were in the teens in terms of the year-over- year increases too. I do not know how, when you pass a $1 trillion stimulus bill, much of which was distributed to Federal agencies that are also going to get these year-over-year 12-percent, 14-percent, 15- percent increases in spending, we can justify that to the American taxpayer or to hard-working Americans who are struggling right now to make ends meet and have to balance their family budgets. States are struggling to balance their budgets. But here in Washington, it seems as though it is spend, spend, spend.

I say to the Senator, one final point I would make is, of all that spending the Senator mentioned--and again the $1 trillion in stimulus money was all borrowed money; that was all added to the debt, will be added to the debt, and is going to be paid for by our children and grandchildren, but the $1.4 trillion the Senator mentioned that last year constituted the Federal deficit means that out of every dollar the Federal Government spent last year, 43 cents was borrowed.

There is no question. The one thing that I guess is bothersome is most generations of Americans--your generation, obviously--worked hard, sacrificed so the next generation could have a better life. What we are basically doing is borrowing from the next generation because we have not been able to live within our means. That turns on its head one of the great ethics of America that has served this country so well for generations. Washington, DC, has not learned the lesson that when you borrow money, it has to be paid back, and that you cannot spend more than you take in. Forty-three cents out of every dollar last year was borrowed--all to be put on the bills of our children and grandchildren.

Madam President, I wish to speak to a couple issues this evening. The first one has to do with what we understand to be the evolving so-called deal that is being worked out by the other side on the public option/government plan and the attempt to try and reach 60 votes on the other side, in what appears to be a process that continues to unravel and break down because every single day there is a new story about some new gimmick thrown out there to attract the requisite number of Senators to get to that threshold of 60.

The most recent one--and, of course, as I said, I cannot verify all of this because we have not been privy or included in any of the discussions that have occurred behind closed doors. In fact, one of those meetings just occurred earlier this evening.

We read from press reports that one of the proposals contemplated by the majority to get that requisite number of votes is the expansion of the Medicare Program. What is interesting about that is that has engaged organizations that prior to this time had essentially been at the table and negotiated their own kind of agreement. But that has gotten the interest level up of the American Hospital Association, the Federation of American Hospitals, the AMA, the physician group, and I even have something here from the Mayo Clinic.

It is interesting that would be considered now as an alternative to what previously had been discussed in terms of a public option. Here is why. Medicare, as we all know, is destined to be bankrupt in the year 2017. It is a very large program that benefits a lot of seniors across the country. We all support reforming it, making it more sustainable, putting it on a pathway to where it will be solvent well beyond that date and extending its lifespan.

What this would appear to do is allow people younger than 65 or 62, down to 55, to buy into Medicare. Essentially, you would allow more people to participate in a program that, as I said before, is destined to be bankrupt in the year 2017. So what you are doing with this proposal--because we all know the underlying bill cuts Medicare reimbursements to hospitals, nursing homes, hospices, home health agencies, and to Medicare Advantage beneficiaries by about $1 trillion over 10 years, when it is fully implemented--you are going to take $1 trillion of revenue out of Medicare--remember, this is a program that is already destined to be bankrupt in 2017--you are going to take $1 trillion of revenue out of it over the 10-year period, when it is fully implemented, and expand and add the number of people who are going to be on it. It is equivalent to putting more people on a sinking ship. In fact, that is what has gotten the attention of provider groups around the country.

Hospitals, as we know, cannot recover their costs with the reimbursements they are currently receiving under Medicare. In most States, it varies a little bit--80 to 90 cents on the

dollar. So hospitals, every time they serve a Medicare patient, shift that cost over to the private payers and increase costs for everybody who is receiving insurance in the private market.

Essentially, what you will be doing is expanding the government-run Medicare Program which underreimburses hospitals, physicians and other health care providers and forcing even more of a cost shift. You are exacerbating the cost shift already occurring, making it worse and getting all the provider hospital groups--the American Hospital Association, the American Medical Association--engaged in this debate because they see what a train wreck it would be for them.

Frankly, what that means is you would have a lot of providers that would not be able to make ends meet. They would have to shut their doors and go out of business because many of them are very dependent on Medicare patients.

In my State of South Dakota, most of our hospitals, especially in rural areas, are heavily dependent--70 percent or thereabouts--between Medicare and Medicaid. If they are not a critical access hospital and still getting reimbursed under the traditional Medicare Program, they are going to have a very hard time making ends meet because right now what they do is what all hospitals do. They shift costs over to the private payers.

Here is what AMA said about the proposal:

AMA has a longstanding policy of opposing expansion of

Medicare given the projections for the future.

That is what the doctors group said.

The American Hospital Association urged all Senators to reject expansion of Medicare and Medicaid as part of the public option, saying Medicare pays hospitals just 91 cents of each dollar of care provided. This again would expand the number of people they would have to cover and shrink the private-payer market and lump more and more of the costs on those so everybody else's premiums would go up.

The Federation of American Hospitals, which is the private hospitals across the country, said any Medicare buy-in would invariably lead to crowdout of the private health insurance market, placing more people into Medicare. Such a policy will further negatively impact hospitals after we have already agreed to contribute a maximum level to sustainable reductions in the deal they struck earlier. It seems to me these deals have fallen off the table.

This latest proposal--if, in fact, what we are reading is true--I think they recognize would be a disaster. Here is what the Mayo Clinic in their letter said:

Any plan to expand Medicare, which is the government's

largest public plan, beyond its current scope does not solve

the nation's health care crisis, but compounds it.

They go on to say:

Expanding the system to persons 55 to 64 years old would

ultimately hurt patients by accelerating the financial ruin

of hospitals and doctors across the country. A majority of

Medicare providers currently suffer great financial loss

under the program. Mayo Clinic alone lost $840 million last

year under Medicare. As a result of these types of losses, a

growing number of providers have begun to limit the number of

Medicare patients in their practices.

That is what we are talking about. If you expand this program and you have a reimbursement system that currently does not cover the cost of hospitals, they are going to cease covering Medicare patients in the same way they currently are not covering Medicaid patients.

They say about 50 percent of physicians today have chosen not to accept Medicaid patients. So you compound the access problem that many people in rural areas already experience.

There are big problems with this proposal. I have to come back to what Congressman Anthony Weiner said about this issue:

Extending this successful program to those between 55 and

64, a plan I proposed in July, would be the largest expansion

of Medicare in 44 years and would perhaps get us on the path

to a single payer model.

Therein, I think, lies the ultimate goal, and that is to expand Medicare to where we have a whole government-run health care system in this country on the way to single-payer status. That is precisely what many of our colleagues on the other side want to see happen.

Ironically, there are some who have expressed concern about this. Our colleague from North Dakota, the chairman of the Senate Budget Committee, Senator Conrad, said when asked about this proposal:

It's got many of the same problems I have with previous

versions of the public option. That then ties you to Medicare

levels of reimbursements for a whole new population.

He contended that the hospitals in his State would go bankrupt. His State of North Dakota is not unlike my State of South Dakota. Hospitals are not going to be able to make it if these reimbursement levels that are currently afforded them under Medicare are extended to a whole new population.

I hope this is a bad idea that is just being thrown out as one of these things that is being thrown at a wall and hoping it sticks in a desperate effort to get to 60 on the other side because this is a bad idea and the provider groups are weighing in heavily against it.

It is pretty clear it would be a disaster for health care delivery in rural areas of the country and, for that matter, Mayo Clinic and many of the providers that weighed in on this. It would literally make it more difficult for people to have access to health care and exacerbating the cost-shifting issue that already exists with regard to the private-payer market and make their costs and everybody else's costs go up more.

I want to shift gears for a moment because tomorrow Senator Hutchison and I will be offering a motion to commit. Basically, what it deals with is the whole tax component of this health care reform bill. In very simple terms--and I will demonstrate exactly why this is a relevant issue--if you look at the cost of this health care proposal, the Reid proposal before us, you can see what the costs are in the early years and then you can see how the costs explode in the outyears. There is a reason for that. The revenues kick in right away. The tax increases start coming in right away, but the spending proposals and many of the benefits that will go out under this bill don't occur until much later.

So what we have is a 10-year budgetary picture and cost for this program that completely understates what the true cost of the program is. If you look at this particular chart, look at the years 2010 to 2019, you can see how, particularly in the early years, it doesn't look like there is that much spending. In fact, the number in the first 10 years is $1.2 trillion in spending. However, if you look at the cost of this when it is fully implemented--take the year 2014 and extend it through the year 2023--you can see how the costs explode, and the total fully implemented cost over a 10-year period is $2.5 trillion.

There is a reason for that, as I said. A lot of budgetary gimmicks were used to understate the cost, particularly in the first 10 years, so people could say it costs only $1 trillion. In fact, as you can see, when it is fully implemented, it is $2.5 trillion. One of the major reasons for that is because the tax increases in the bill take effect 23 days from now--January 1 of the year 2010. That is when many of the tax increases in this legislation go into effect. But the spending and the benefits that are going to be distributed--the exchanges and the premiums, the premium subsidies, and that sort of thing, the tax credits--don't begin to kick in until the year 2014 or 1,484 days later. So for those 1,484 days--well, back out the 23 days from that-- so for those 1,461 days, taxes are going to be assessed and levied against people in this country--on small businesses, families, and individuals--but you will not see any benefits for over 1,000 days, almost 1,500 days.

What the Hutchison-Thune motion to commit does is it aligns the tax increases, the fees--the taxes included in this proposal--with the benefits in terms of timeline so that the tax increases and the benefits occur at the same time. In other words, we would delay the tax increases in this bill until such time as the benefits package and structure would kick in so that they are in sync.

Right now, there is essentially 4 years--at least 4 years--of tax revenues coming in, tax increases being borne by people all across this country, including businesses. Incidentally, there is a lot of discussion now about job creation and the need to grow the economy. The worst thing you can do to small businesses, when you are trying

to create jobs, is to levy new taxes on them. But that is what this bill does. And, by the way, in that first 4 years, almost $72 billion of taxes will be collected. I say the first 4 years, I think that is through the year 2014. But you have all these taxes that kick in on January 1 of 2010--less than 23 days from now--and then actually you have this amount of time--as I said, almost 1,500 days--before the benefits begin to pay out.

So all we are saying in our motion to commit is let's align the tax increases and the benefits structure so you don't have this period of 4 years where people are paying taxes and receiving literally no benefits under this health care reform bill.

The advantage that has is that it accurately reflects the cost of this program in the first 10 years, rather than understating it because of the revenues that kick in immediately and the benefits that don't kick in until much later. It is very straightforward, very simple, very understandable. Tax increases that are designed to kick in on January 1 of this next year would not kick in until such time as the benefits kick in. So the fees, the taxes, and the tax increases in this bill are all aligned and sync'd up, so to speak, with when the spending under the bill begins.

Of course, what that does is give us a more accurate reflection of the overall cost of the bill. And many of these tax increases which will kick in 3 weeks from now, or a little over 3 weeks from now, on January 1 of next year, are going to be distributed across a wide range of businesses, but most will be passed on to consumers across this country. In fact, the CBO, in a letter to Senator Evan Bayh on November 30 of this year, said essentially that all these fees and taxes in the bill--and there are fees on medical devices, there are fees on prescription drugs, there are fees on health care plans--all these fees would tend to raise insurance premiums. In testimony in front of the Finance Committee, the CBO, when this question was posed during the deliberations at the Finance Committee level as to what all these fees would do to insurance premiums, they said, roughly, it would increase premiums dollar for dollar.

So we have the taxes and fees that will kick in immediately, and that will have an upward impact on premiums so that people across the country will begin to see those premium increases take effect. The tax increases, of course, are taking effect on medical device manufacturers and on prescription drugs, and there is a whole other range of taxes in here--there is the tax on high-cost insurance plans, there is a health insurer fee, there is a Botox tax, which starts January 1 of 2010, and you can kind of go down the list. There are limits on FSAs, flexible spending accounts, which is something people use to put aside money so they can buy a high-deductible plan and have dollars available to deal with the incidental health care costs they have. So the taxes are going to go up on those. You can go through this whole list of taxes, all of which, as I said, are going to go into effect in the near term, but none of the benefits kick in until many years later.

Unfortunately for the American public, they are going to see the premium increases that will come as these taxes are imposed on all these various sectors of the health care economy and which will all be passed on to consumers in the form of higher premiums. So the American consumer--the American public, the taxpayers of this country--are going to see the costs immediately and won't see the benefits for 5 years. That is not fair. It is not the right way to set policy here in Washington, DC. It is much more transparent if we have these dates of the tax increases and the fees and the taxes in this bill sync'd up-- synchronized, aligned--with the benefits when they begin so that everything starts at the same time.

So the motion to commit is, again, simply a motion to commit this back to the Finance Committee, and to create a level playing field where the revenues that are raised under the bill don't begin to kick in until the benefits start to kick in and the spending starts to kick in. That will give us the true picture, the actual picture of the cost which, as I said before, is $2.5 trillion over 10 years when it is fully implemented, and not the $1 trillion, or under $1 trillion that is being used by the other side. You have to look at the full picture over a 10-year period, when it is fully implemented. Obviously, that gives you a very different perspective about the overall true cost of this particular proposal.

The basic contours of this bill we have in front of us have not changed, nor do we expect them to change. They will tweak around with this government plan. There was already a vote on the issue of abortion, which I happen to believe taxpayer funds should not be used to finance. We have had that vote. There will be some other votes on individual aspects. But some of those things are not going to affect the fundamental core elements of this plan, which have stayed the same throughout the entire process. And those core elements are a massive expansion of Federal spending--$2.5 trillion over 10 years when it is fully implemented--massive cuts to Medicare--about $1 trillion over 10 years, when fully implemented, affecting hospitals, nursing homes, home health agencies, hospices, and beneficiaries of Medicare Advantage, of which there are about 11 million across the country--and it is also financed with increases in taxes, which I have mentioned. Those are the basic components of this bill. Seventy new government programs are called for. All the new spending, all the new bureaucracy, all the new taxes, and all the Medicare cuts, those things have not changed since this bill first started being debated several months ago.

That is where we are today. That is why I believe this is such a bad proposal for the future of this country. Because even after all that, if you look at the impact it has on premiums, according to the Congressional Budget Office, 90 percent of Americans end up the same or worse off. When I say the same, I mean year over year increases in their insurance premiums that are double the rate of inflation. So if you are buying in the small-group market today, or the large-group market, according to the Congressional Budget Office, you are going to see your insurance premiums continue to go up over time. If you buy in the individual market, you are going to see them continue to go up, but way more--a 10- to 13-percent increase in premiums for people who buy in the individual marketplace, above and beyond the rate of inflation that will impact people in the large- and small-group markets.

So the bottom line is, if you are looking for reform, if you are the average American citizen out there, the person I represent in South Dakota, who is hearing about health care reform, to them it means a couple of things. It means affordable access to health insurance for people across this country; and something that most of us--at least here on our side--think ought to be a part of this, and that is measures or proposals that actually bend the cost curve down rather than up. But what we have seen consistently throughout the course of this debate, with all the spending and all the tax increases and all the Medicare cuts, is no positive impact on premiums. The best that 90 percent of Americans can hope for is to maintain the status quo--stay where you are--which is double your increases year over year, double the rate of inflation in your health insurance premiums or, worse yet, increases of 10 to 13 percent above and beyond that. That is what 90 percent of Americans are looking at as a result of the health care reform proposal that is currently before the Senate.

There is a better way, and we believe the way to get this right is to start over and to actually focus on solutions that will drive down the cost of health insurance, that will bend that cost curve down, such as interstate competition, allowing pooling for small businesses, medical malpractice reform. We have a whole series of things that we think represent the consensus view of the people in this country. There is common ground we can all stand on. But regrettably, we have not been included in any of the discussions, nor have any of our ideas been a part of those discussions. Rather, they have chosen to pursue this course of a big spending program, with the higher taxes, and the Medicare cuts and the higher premiums.

I truly hope there will be support, as this process moves forward and we get onto the critical votes ahead of us, for a more rational step- by-step approach, doing this right, getting away from

this huge massive expansion of the Federal Government here in Washington, DC, and seriously focusing on solutions that actually do bend the cost curve down, that don't rely on these huge cuts to Medicare, that don't rely on these huge tax increases, but that actually find savings. And they can be achieved in the market by putting policies in place that will constrain costs and put downward pressure on the prices most people pay for health insurance in this country. It can be done. But it is going to require some boldness on the part of some of our colleagues on the other side.

I think our side is pretty well united. This is a bad policy, a bad prescription, if you will, for America's future. But we are going to need some help from a courageous Democrat or two to make sure this massive expansion of the Federal Government is defeated and that we can go back, start over, do this in a step-by-step way--the right way--and in a way that actually does lower costs for people in this country. I certainly think that is what my constituents in South Dakota expect, and I think that is what most Americans expect. They deserve to have health care reform that gives them that outcome--lower cost and access to affordable health care.

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

Mr. President, today I recognize Kenneth Christopher Satterlee, an intern in my Washington DC, office, for all of the hard work he has done for me, my staff, and the State of South Dakota over the past several months.

Kenny is a graduate of La Jolla High School in San Diego, CA. Currently he is attending the American University, where he is majoring in history. He is a hard worker who has been dedicated to getting the most out of his internship experience.

I would like to extend my sincere thanks and appreciation to Kenny for all of the fine work he has done and wish him continued success in the years to come.