Floor Statements

The following Senator is necessarily absent: the Senator from Idaho (Mr. Risch).

Further, if present and voting, the Senator from Idaho (Mr. Risch) would have voted: ``nay.''

The following Senator is necessarily absent: the Senator from Idaho (Mr. Risch).

Further, if present and voting, the Senator from Idaho (Mr. Risch) would have voted ``yea.''

Mr. President, I want to compliment my colleague from Oklahoma for the leadership he has exercised with respect to the rogue Environmental Protection Agency attempting to regulate, in effect, what we breathe and the job-killing program that would result from the regulations that would be prohibited from being adopted were the Inhofe-McConnell amendment to be adopted by this body. I share his desire that we be able to vote on that and stop these onerous regulations from being put into effect.

I ask unanimous consent to speak not to exceed 15 minutes in morning business.

Mr. President, I want to address two things but start with health care. I recall that during the debate over health care--and we celebrated the 1-year anniversary of the signing of the health care legislation a little over a week ago. But I recall then-Speaker of the House Nancy Pelosi saying: We will have to pass the bill in order to find out what is in it. I do not think she realized how true her statement really was.

I just read something over the weekend from a March 31 edition of the Washington Examiner. I ask unanimous consent to have this article by Byron York printed in the Record at the conclusion of my remarks.

I will read the first sentence and then a couple of other items from it. The headline is ``Uncovered: New $2 billion bailout in Obamacare.''

Here is the first sentence in the story:

Investigators for the House Energy and Commerce Committee

have discovered that a little-known provision in the national

health

care law has allowed the Federal Government to pay nearly $2

billion to unions, state public employee systems, and big

corporations to subsidize health coverage costs for early

retirees.

Then the article goes on to point out that they discovered this in oversight hearings of an obscure agency known as the CCIO, or the Center for Consumer Information and Insurance Oversight. The idea under the law apparently was to subsidize unions and States and companies that had made commitments to provide health insurance for workers who retired early.

They point out that there was a $5 billion appropriation in the bill, and at the rate of spending by this agency they will burn through the entire $5 billion as early as 2012. And where is the money being sent to? Well, by far and away, the biggest single recipient is the United Auto Workers Labor Union, which so far had received well over $200 million.

Other recipients include AT&T, Verizon, General Electric, General Motors Corporation, and a few State public employees retirement systems. But, by far and away, the contribution to the United Auto Workers and the Teamsters and United Food and Commercial Workers was more than the amount of money sent to the State pension funds--the point being that we learn something new almost every week about Obamacare.

As I said, it was just a little over a week ago that it celebrated its first anniversary, and we are only now discovering some of the things that were hidden away in it, which I think had we been able to debate the bill in a more appropriate fashion--remember, it passed on Christmas Eve day of the year before last--we probably would have been able to discover these things. Had the bill been read, had we had time to read all of the fine print, these are the kinds of things that we would have discovered; and I suspect the proponents of the bill, those who voted for it, might not have been so quick to vote for it.

Maybe we will have a chance to repeal this particular provision of the bill if there is any money left that has not been spent by the time we get around to doing that. I will propose to my colleagues that we try to accomplish that.

The second point with respect to Obamacare that continues to trouble me is something called the Independent Payment Advisory Board. This is troublesome for three reasons, two of which have to do with process and the third the substance. The Independent Payment Advisory Board goes by the acronym of IPAP, and it was created in order to try to find savings in the Medicare Program.

Now, obviously, we have read a lot about the billions, tens of billions of dollars of waste, fraud, and abuse in Medicare. The problem is, this board is not likely to get at that waste, fraud, and abuse because its primary mission--and, in fact, it is restricted to finding cost savings only as a result of reducing the payments to providers. In fact, James Capretta of the Ethics and Public Policy Center has done some very good writing on this subject, and he notes that the board is strictly limited to what it can recommend and implement and that the board can only ``cut Medicare payment rates for those providing services to beneficiaries.''

Well, that is a problem because it does not get to the real heart of a lot of the waste, fraud, and abuse in Medicare. Secondly--and I will conclude my remarks with this main point--when we cut the payment rates for the doctors, for example, who are taking care of Medicare patients, what happens? We get fewer doctors willing to take care of Medicare patients.

We are all familiar with the stories in our own States of more and more physicians either not taking any Medicare patients or at least not taking any new Medicare patients. As a result, there are far fewer doctors available to treat folks, which means there is a much longer waiting time for people to get the care they need. The end result of that is, of course, care delayed is frequently care denied. That is the problem that exists in other countries such as Great Britain, our neighbor to the north, Canada, and it is coming to your own community pretty soon as a result of the fact that we are not paying the physicians and other providers enough as it is. That is the only thing that IPAP can do to further reduce the costs.

But I mentioned two procedural problems. The first is that this board is comprised of 15 unelected bureaucrats. The President makes the appointments. He does not have to balance them politically, so they can all be members of one political party. He can make recess appointments so the Senate may not even have an opportunity to pass on these individuals.

The second procedural problem is, when they make their recommendations it comes to the Congress in a take-it-or-leave-it procedural posture; that is to say, either Congress adopts the recommendations of the board or at a number equal to that, with what we decide ourselves is the appropriate way to achieve that amount, or the Department of Health and Human Services must implement the board's original recommendations, period. That is it.

So we are ceding authority to an unelected board of people whose political views could reflect, for example, only those of the President of the United States, and whose recommendations almost automatically become law. Only if the Congress, within a specified period of time, is able to recommend an alternative that can get the votes, and it would have to be a 60-vote majority, would the recommendations of the board be overridden.

So for procedural reasons this was not the right way to tackle the problem of costs of the Medicare Program that we do need to get a handle on. It is a very undemocratic approach. But as I said, the procedure is part of the problem. The real question is, how are we going to address costs in Medicare?

Now, we are going to see some very innovative ideas from the House of Representatives, from the Budget chairman, Paul Ryan, this week when the House budget is released. He will tackle the tough problem of helping to constrain the costs of Medicare. One of the ways I find very unappealing to control Medicare costs is putting a cap on how much we can spend and reimbursing the providers, in particular physicians, with that particular cap in mind.

As I said, the reason is because it is going to cost physicians a certain amount of money to take care of each patient. If they cannot be reimbursed in an amount sufficient to cover their expenses and a little bit more, they are simply going to turn to other kinds of patients.

They have already turned away from Medicaid patients because Medicaid does not reimburse at a level that meets their requirements. As a result, it is a dirty little secret in the medical profession that Medicaid is rationed health care. That is not right. These are the poorest in our society. They need support. They need help. But they have to wait a long time. A lot of times, there just aren't the people to take care of them. Now we are going to convert the system that takes care of senior citizens into the same kind of whatever-we-have- available kind of service because when we begin reducing payments to providers, we will get fewer providers, with the result that we will get less care. It is a simple matter of economics.

This is being recommended not by physicians, not by the patients groups, and so on, but by people who are unelected bureaucrats appointed to this board. According to Mr. Capretta, under the law this is all the board can do. This is what it is restricted to doing. By cutting Medicare patients, the board will only delay and deny care. That is the critical point.

I am painting this picture of physicians not being paid enough. The reality is that today Medicare already pays physicians 20 percent less than private insurance companies do. Part of that is because private insurance companies are cost shifters. When a physician can't make enough money serving government-paid-for patients--Medicare--then they charge more to private sector-paid patients. We therefore are paying more in the private sector for our insurance than it really would cost, but that is in order to subsidize the payment of physicians who don't make enough under Medicare today. What the IPAB would do is reduce those payments even more. This, in turn, will lead to reduced access to care for seniors, and reduced access to care means rationed care.

I quoted James Capretta before. He says:

In a very real sense, seniors will be the ones holding the

bag from these cuts when they can't access care due to a lack

of willing suppliers.

I will close this point by noting that there is another government health care program I am very familiar with because of the large number of Native Americans in Arizona who have access to health care from the Federal Government under the Indian Health Service. In Indian Country, they have a saying that is not really facetious. They say it with a bit of a wry smile on their face, but they are not at all happy. They say: Just get sick before July. The reason is, there is a definite limit on how much the program will pay out. They set a cap at the beginning of the year, and when enough people have gotten sick enough to a certain point in the year, that is the end of the coverage. So they wait until money is available the next year.

That is an oversimplification, but it is what a total single-payer government system does. When we need to cut costs, we reduce the amount of money available. And who suffers? The people to whom we promised care. We see it in the Indian Health Service. We are seeing it now in Medicaid. We are going to see it in Medicare if we are not careful.

That is why we need to repeal the IPAB, the Independent Payment Advisory Board established under ObamaCare. There is legislation introduced to do this. Senator Cornyn and I cosponsored the Health Care Bureaucrats Elimination Act, S. 668, which would eliminate the IPAB. I hope we will have an opportunity to bring that legislation to the floor so that my colleagues can join us in excising this piece of ObamaCare so that our seniors don't suffer from rationed health care. There is a long group of organizations which joins us in our opposition to IPAB, groups such as the American Health Care Association, the American College of Radiology, National Senior Citizens Law Center, National Association of Social Workers, Volunteers of America, and others.

I hope that when the time comes, we will have an opportunity to have a debate about this aspect of ObamaCare. I know the supporters of the health care reform act did not intend this negative result. I am not suggesting that colleagues who supported ObamaCare love seniors any less than I love my mother, and they love their parents and others. That is not the point. Laws have unintended consequences. When we create a mechanism to save money such as this one and constrain it the way we have, I know what we will get, and we will not like it. We will hear from seniors. And before I hear from my mother, I would just as soon get this problem fixed.

Exhibit 1

[From the Examiner, Mar. 31, 2011]

Uncovered: New $2 Billion Bailout in Obamacare

(By Byron York)

Investigators for the House Energy and Commerce Committee

have discovered that a little-known provision in the national

health care law has allowed the federal government to pay

nearly $2 billion to unions, state public employee systems,

and big corporations to subsidize health coverage costs for

early retirees. At the current rate of payment, the $5

billion appropriated for the program could be exhausted well

before it is set to expire.

The discovery came on the eve of an oversight hearing

focused on the workings of an obscure agency known as CCIO--

the Center for Consumer Information and Insurance Oversight.

CCIO, which is part of the Department of Health and Human

Services, oversees the implementation of Section 1102 of the

Affordable Care Act, which created something called the Early

Retiree Reinsurance Program. The legislation called for the

program to spend a total of $5 billion, beginning in June

2010--shortly after Obamacare was passed--and ending on

January 1, 2014, as the system of national health care

exchanges was scheduled to go into effect.

The idea was to subsidize unions, states, and companies

that had made commitments to provide health insurance for

workers who retired early--between the ages of 55 and 64,

before they were eligible for Medicare. According to a new

report prepared by the Department of Health and Human

Services, ``People in the early retiree age group . . . often

face difficulties obtaining insurance in the individual

market because of age or chronic conditions that make

coverage unaffordable or inaccessible.'' As a result, fewer

and fewer organizations have been offering coverage to early

retirees; the Early Retiree Reinsurance Program was designed

to subsidize such coverage until the creation of Obamacare's

health-care exchanges.

The program began making payouts on June 1, 2010. Between

that date and the end of 2010, it paid out about $535 million

dollars. But according to the new report, the rate of

spending has since increased dramatically, to about $1.3

billion just for the first two and a half months of this

year. At that rate, it could burn through the entire $5

billion appropriation as early as 2012.

Where is the money going? According to the new report, the

biggest single recipient of an early-retiree bailout is the

United Auto Workers, which has so far received $206,798,086.

Other big recipients include AT&T, which received

$140,022,949, and Verizon, which received $91,702,538.

General Electric, in the news recently for not paying any

U.S. taxes last year, received $36,607,818. General Motors,

recipient of a massive government bailout, received

$19,002,669.

The program also paid large sums of money to state

governments. The Public Employees Retirement System of Ohio

received $70,557,764; the Teacher Retirement System of Texas

received $68,074,118; the California Public Employees

Retirement System, or CalPERS, received $57,834,267; the

Georgia Department of Community Health received $57,936,127;

and the state of New York received $47,869,044. Other states

received lesser but still substantial sums.

But payments to individual states were dwarfed by the

payout to the auto workers union, which received more than

the states of New York, California, and Texas combined. Other

unions also received government funds, including the United

Food and Commercial Workers, the United Mine Workers, and the

Teamsters.

Republican investigators count the early-retiree program

among those that would never have become law had Democrats

allowed more scrutiny of Obamacare at the time it was pushed

through the House and Senate. Since then, Republicans have

kept an eye on the program but were not able to pry any

information out of the administration until after the GOP won

control of the House last November. Now, finally, they are

learning what's going on.

Mr. President, finally, I wish to have printed in the Record and discuss briefly an op-ed in the Wall Street Journal of today titled ``Time for a Budget Game-Changer.'' This was written by Gary Becker, George P. Shultz, and John Taylor. John Taylor and Gary Becker are both economist professors, Becker at the University of Chicago, Taylor at Stanford. Of course, George Shultz is a former Secretary of Labor, Secretary of the Treasury, and Secretary of State. All three are affiliated with the Hoover Institution. In this article, they present a real answer to the two key problems that face us today.

I ask unanimous consent that this piece be printed in the Record at the conclusion of my remarks.

The two key problems are that we don't have enough jobs and we have a very high unemployment rate. We need to get the economy growing, and we are having to borrow far too much money because of government spending. What this piece points out is that there is a direct relationship between the two. That is not too surprising. The bottom line is that government borrowing and spending distorts the market by making less money available for the private sector to invest. If the private sector can invest, jobs can be created and we can grow the economy.

What they do in this piece is create a credible strategy to reduce the growth of Federal government spending, bring the deficit down, and increase economic growth. Those goals are not only not inimical to each other, they actually fit together nicely.

As they point out, the essential first step is to reduce discretionary spending in the current fiscal year, 2011. That is the work the Senate and House are engaged in right now. We will have to pass a continuing resolution to fund the government through the end of September. We can substantially reduce the spending, and they point out how in this op-ed.

The second part is a longer term plan to get total spending as a share of GDP down. They have a plan to do that in a relatively gradual way but that nevertheless provides real, substantial savings over the next 10 years and longer to a point that is consistent with the historical relationship between the revenues the government has collected and the spending the government makes.

Let me quote the first three sentences of their op-ed:

Wanted: A strategy for economic growth, full employment,

and deficit reduction--all without inflation. Experience

shows how to get there. Credible actions that reduce the

rapid growth of federal spending and debt will raise economic

growth and lower the unemployment rate. Higher private

investment, not more government purchases, is the surest way

to increase prosperity.

They go on to point out:

When private investment is high, unemployment is low. In

contrast, higher government spending is not associated with

lower unemployment.

It is a piece I recommend to all of my colleagues because it establishes--and these are first-rate economists who have done the research and can demonstrate beyond peradventure the direct relationship between reduced government spending and more employment and growth. The bottom line is, if we leave more money in the private sector to be invested by businesses in the private sector, the more they will invest and hire people, and the more the economy will grow. Ironically, the more the economy grows, the more revenues the Federal Government gets because we have more taxes and a higher tax basis.

Private economic growth is good for families and businesses and people seeking jobs as well as for the Federal Government if we are looking for more revenue. The wrong answer is to spend more money in the government, 40-plus cents of which has to be borrowed. Every dollar we spend we have to borrow 40 cents of, half of which is borrowed from countries abroad. That borrowing and spending crowds out opportunities in the private market to do the same.

So there is a direct relationship in terms of how much we can reduce Federal spending on the one hand and how much we can grow the economy on the other. That is what these economists point out--the way for us both in the short term and the longer term to get a handle on both the Federal budget deficit and induce the private sector to invest more, thus reducing unemployment and increasing our economic growth.

I thank the Chair.

Exhibit 1

[From the Wall Street Journal, Apr. 4, 2011]

Time For a Budget Game-Changer

(By Gary S. Becker, George P. Shultz and John B. Taylor)

Wanted: A strategy for economic growth, full employment,

and deficit reduction--all without inflation. Experience

shows how to get there. Credible actions that reduce the

rapid growth of federal spending and debt will raise economic

growth and lower the unemployment rate. Higher private

investment, not more government purchases, is the surest way

to increase prosperity.

When private investment is high, unemployment is low. In

2006, investment--business fixed investment plus residential

investment--as a share of GDP was high, at 17%, and

unemployment was low, at 5%. By 2010 private investment as a

share of GDP was down to 12%, and unemployment was up to more

than 9%. In the year 2000, investment as a share of GDP was

17% while unemployment averaged around 4%. This is a regular

pattern.

In contrast, higher government spending is not associated

with lower unemployment. For example, when government

purchases of goods and services came down as a share of GDP

in the 1990s, unemployment didn't rise. In fact it fell, and

the higher level of government purchases as a share of GDP

since 2000 has clearly not been associated with lower

unemployment.

To the extent that government spending crowds out job-

creating private investment, it can actually worsen

unemployment. Indeed, extensive government efforts to

stimulate the economy and reduce joblessness by spending more

have failed to reduce joblessness.

Above all, the federal government needs a credible and

transparent budget strategy. It's time for a game-changer--a

budget action that will stop the recent discretionary

spending binge before it gets entrenched in government

agencies.

Second, we need to lay out a path for total federal

government spending growth for next year and later years that

will gradually bring spending into balance with the amount of

tax revenues generated in later years by the current tax

system. Assurance that the current tax system will remain in

place --pending genuine reform in corporate and personal

income taxes--will be an immediate stimulus.

All this must be accompanied by an accurate and simple

explanation of how the strategy will increase economic

growth, an explanation that will counteract scare stories and

also allow people outside of government to start making

plans, including business plans, to invest and hire. In this

respect the budget strategy should be seen in the context of

a larger pro-growth, pro-employment government reform

strategy.

We can see such a sensible budget strategy starting to

emerge. The first step of the strategy is largely being

addressed by the House budget plan for 2011, or HR1. Though

voted down in its entirety by the Senate, it is now being

split up into ``continuing'' resolutions that add up to the

same spending levels.

To see how HR1 works, note that discretionary

appropriations other than for defense and homeland security

were $460.1 billion in 2010, a sharp 22% increase over the

$378.4 billion a mere three years ago. HR1 reverses this

bulge by bringing these appropriations to $394.5 billion,

which is 4% higher than in 2008. Spending growth is greatly

reduced under HR1, but it is still enough to cover inflation

over those three years.

There is no reason why government agencies--from Treasury

and Commerce to the Executive Office of the President--cannot

get by with the same amount of funding they had in 2008 plus

increases for inflation. Anything less than HR1 would not

represent a credible first step. Changes in budget authority

convert to government outlays slowly. According to the

Congressional Budget Office, outlays will only be $19 billion

less in 2011 with HR1, meaning it would take spending to 24%

of GDP in 2011 from 24.1% today.

If HR1 is the first step of the strategy, then the second

step could come in the form of the budget resolution for 2012

also coming out of the House. We do not know what this will

look like, but it is likely to entail a gradual reduction in

spending as a share of GDP that would, in a reasonable number

of years, lead to a balanced budget without tax rate

increases.

To make the path credible, the budget resolution should

include instructions to the appropriations subcommittees

elaborating changes in government programs that will make the

spending goals a reality. These instructions must include a

requirement for reforms of the Social Security and health-

care systems.

Health-care reform is particularly difficult politically,

although absolutely necessary to get long-term government

spending under control. This is not the place to go into

various ways to make the health-care delivery system cheaper

and at the same time much more effective in promoting health.

However, it is absolutely essential to make wholesale changes

in ObamaCare, and many of its approaches to health reform.

The nearby chart shows an example of a path that brings

total federal outlays relative to GDP back to the level of

2007--19.5%. One line shows outlays as a share of GDP under

the CEO baseline released on March 18. The other shows the

spending path starting with HR1 in 2011. With HR1 federal

outlays grow at 2.7% per year from 2010 to 2021 in nominal

terms, while nominal GDP is expected to grow by 4.6% per

year.

Faster GDP growth will bring a balanced budget more quickly

by increasing the growth of tax revenues. Critics will argue

that such a budget plan will decrease economic growth and job

creation. Some, such as economists at Goldman Sachs and

Moody's, have already said that HR1 will lower economic

growth by as much as 2% this quarter and the next and cost

hundreds of thousands of jobs. But this is highly implausible

given the small size of the change in outlays in 2011 under

HR1, as shown in the chart. The change in spending is not

abrupt, as they claim, but quite gradual.

Those who predict that a gradual and credible plan to lower

spending growth will reduce job creation disregard the

private investment benefits that come from reducing the

threats of higher taxes, higher interest rates and a fiscal

crisis. This is the same thinking used to claim that the

stimulus package worked. These economic models failed in the

1970s, failed in 2008, and they are still failing.

Control of federal spending and a strategy for ending the

deficit will provide assurance that tax rates will not rise--

pending tax reform--and that uncontrolled deficits will not

recur. This assurance must be the foundation of strategy for

a healthy economy.

I suggest the absence of a quorum.

The following Senators are necessarily absent: the Senator from South Carolina (Mr. DeMint), the Senator from South Carolina (Mr. Graham), the Senator from Texas (Mrs. Hutchison), the Senator from Idaho (Mr. Risch), the Senator from Pennsylvania (Mr. Toomey), the Senator from Louisiana (Mr. Vitter), the Senator from Mississippi (Mr. Wicker), and the Senator from Illinois (Mr. Kirk).

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

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

Mr. President, last Wednesday marked the 1-year anniversary of the deeply flawed health care bill. The worst aspect of that bill is that it will lead to health care rationing by the Federal Government. That is the delay and denial of care in order to control costs. The words ``ration,'' ``withhold coverage'' and ``delay access to care'' of course are not found anywhere in the bill. But new Federal rules that aim to reduce health care costs will inevitably result in delayed or denied tests, treatments, and procedures deemed too expensive and in less innovation in the development of drugs, devices, and treatments. Many of the decisions will be based on information provided by a new entity called the Patient-Centered Outcomes Research Institute, sometimes referred to as the PCORI. That will conduct comparative effectiveness research.

Comparative effectiveness research weighs the effectiveness of two or more health care services or treatments. The goal is to provide patients and doctors with better information regarding the risks and benefits of, for example, a drug versus a surgery for a particular situation. The problem is not with the merits of the research but whether the research should be used by the government to determine treatments and services covered by one's insurance. The health care law actually empowers the Secretary of Health and Human Services to do just that, to use this comparative effectiveness research when making coverage determinations.

Section 6301 of ObamaCare states:

The Secretary may [. . .] use evidence and findings from

research conducted [. . .] by the Patient-Centered Outcomes

Research Institute.

That means the government, not patients and doctors, has the power to make health care decisions that affect you. A bureaucrat decides if your health care is an effective use of government resources without regard to the patient's individual needs and medical history. The end result is the government inevitably interferes with access to care. That is rationing, and it is wrong.

While ObamaCare includes limited safeguards for how this research may be used--appreciating the dangers involved--there is nothing that prohibits the government from taking it into account when, for example, making Medicare coverage decisions.

In fact, when asked whether the Federal CER agency should be involved in cost determinations, Donald Berwick, the President's recess- appointed head of the Centers for Medicare and Medicaid, responded:

The social budget is limited.

Ask citizens in Britain how well the system is working in their country. Britain's National Institute for Health and Clinical Excellence--called NICE--routinely uses comparative effectiveness research to make cost-benefit calculations.

Last year, NICE rejected a cutting-edge drug, Avastin, used to treat bowel cancer because it said the drug's limited effectiveness for extending life--they said 6 weeks; but up to 5 months according to the chief executive of the organization, Beating Bowel Cancer--they said it did not justify the cost. As Mike Hobday, head of policy at the charity, Macmillan Cancer Support, told Britain's Daily Telegraph:

We think this is devastating news for cancer patients with

metastic colorectal cancer, especially as this drug could

have a significant impact on peoples' quality of life.

Although a few extra weeks or months might not sound much to

some people it can mean an awful lot to a family affected by

cancer.

Likewise, in August 2008, NICE recommended against coverage of four expensive drugs for advanced kidney cancer. NICE considered the drugs clinically beneficial in specific situations but concluded they ``were not cost-effective within their licensed indications.''

Health care in Britain is also routinely delayed. Several years ago, the country's National Health Service launched an ``End Waiting, Change Lives'' campaign--``End Waiting, Change Lives.'' The campaign's goal was to reduce a patient's wait time to 18 weeks from referral to treatment. That is 4\1/2\ months, and that is an improvement.

Government-run health care systems that ration care are the reason many Europeans and Canadians come to the United States each year to get treatments denied to them in their own countries.

Access to the highest quality care and the sacred doctor-patient relationship are the cornerstones of U.S. health care--the very things Americans value most and that the health care law jeopardizes.

So I will join Senators Coburn, Barrasso, Roberts, and Crapo in introducing the Preserving Access to Targeted, Individualized, and Effective New Treatments and Services Act of 2011. That is also known as the PATIENTS Act.

The PATIENTS Act does not prohibit comparative effectiveness research; rather, it is a propatient firewall that protects patients' access to high-quality care by prohibiting the Federal Government from using comparative effectiveness research to delay or deny care.

Additionally, the bill would require comparative effectiveness research to account for differences in the treatment response and preferences of patients, genomics and personalized medicine and the unique needs of health disparity populations and it would clarify that nothing shall be construed as affecting the FDA Commissioner's authority to respond to drug safety concerns.

All Americans deserve personalized treatment and should be able to get the care they and their doctors decide is best for them. No Washington bureaucrat should interfere with that right by substituting the government's judgment for that of a physician.

The administration has repeatedly promised that the health care law will not result in rationing. Well, if that promise is true, they should have no problem supporting the PATIENTS Act.

I urge my colleagues to join us in cosponsoring this important legislation.

I suggest the absence of a quorum.

The following Senators are necessarily absent: the Senator from Utah (Mr. Hatch), the Senator from Missouri (Mr. Blunt), the Senator from Mississippi (Mr. Cochran), the Senator from North Dakota (Mr. Hoeven), the Senator from Illinois (Mr. Kirk), the Senator from Idaho (Mr. Risch), the Senator from Louisiana (Mr. Vitter), and the Senator from Mississippi (Mr. Wicker).

Further, if present and voting, the Senator from Utah (Mr. Hatch) would have voted ``yea.''

Mr. President, I ask unanimous consent that morning business be for 1 hour and that the time be equally divided.

Mr. President, would the Chair acknowledge that the 51 minutes now is the time of 1 hour, equally divided, minus the time of Senator Alexander; is that correct?

Mr. President, as three of my colleagues have already noted this morning, President Obama's health care law turns 1 next week, and in my view it hasn't been aging very well.

On the eve of its 1-year anniversary, I too would like to review a few key developments related to the law and its implementation and note that, at least to me, it is very clear this bill has not become more popular with Americans but decreasingly popular.

Let us go back to March 23, 2010, just about 1 year ago. That is when the President signed this health care bill into law. Later, that very day, 13 States filed a lawsuit against it in a Florida Federal court. Another 13 States have joined the suit since. In addition, Virginia filed its own separate lawsuit on the day of enactment.

May 11, 2010. The nonpartisan Congressional Budget Office revised upward its cost estimate of ObamaCare. According to the CBO, ObamaCare will cost $115 million more than originally estimated, pushing the cost of the program to over $1 trillion.

June 2010. With public opinion still decidedly against the law, a poll at that time found that 58 percent of Americans supported repeal. The Department of Health and Human Services launched a public relations campaign to try to change people's minds. Many seniors received a pamphlet from HHS Secretary Kathleen Sebelius that made claims such as:

Your guaranteed Medicare benefits won't change--whether you

get them through original Medicare or a Medicare Advantage

plan.

But, of course, the pamphlet failed to mention the fact that the law cuts Medicare Advantage plans by $202 billion over 10 years, meaning higher premiums, less benefits, and fewer plan choices for seniors. The CBO estimates that the extra benefits currently provided by Medicare Advantage plans will be cut in half.

July 11, 2010. President Obama used a recess appointment to name Donald Berwick as Administrator of the Centers for Medicare and Medicaid Services, an agency that will play a critical role in the implementation of ObamaCare. The President used this procedure in an attempt to bypass the regular confirmation process before the Senate had held a hearing or voted on the nominee. The recess appointment allows Dr. Berwick to run the Centers for Medicare and Medicaid Services through the end of this year.

A hearing would have given Senators the opportunity to question Dr. Berwick about his very controversial views, including his espousal of health care rationing. He has, for example, praised the British national health care system, which routinely denies and rations care, as ``extremely effective'' and ``conscientious.''

On September 24, 2010, the Department of Health and Human Services issued its first waiver of ObamaCare provisions dealing with the limited benefit or mini-med plans. Since then, a total of 1,040 waivers have been granted, many to the administration's favored political constituencies. It seems as though they like the law as long as it doesn't apply to them.

December 13, 2010. A Federal district court judge in Virginia ruled that the law's mandate that individuals purchase government-approved health insurance is unconstitutional.

January 19 of this year. The House of Representatives voted 245 to 189 to repeal ObamaCare.

January 25, 2011. My Governor, Jan Brewer of Arizona, asked Secretary Sebelius to waive the maintenance-of-effort provision in the health care law. That is the provision that forces an unfunded Medicaid mandate on States by denying them the flexibility, the full ability to manage their own Medicaid Programs to fit their own budgets and their own unique Medicaid populations. This is a huge problem because Arizona, along with most other States, is experiencing a dire budget crisis.

January 26, 2011. Medicare Chief Actuary Richard Foster testified before the House Budget Committee. He acknowledged to the committee that President Obama's promise that Americans will get to keep their coverage if they like it is ``not true in all cases.''

January 31, 2011. Judge Roger Vinson, a Federal district court judge in Florida, ruled that the individual mandate in the law is unconstitutional and he invalidated the entire law. He concluded the law's requirement to buy insurance or pay a fee:

. . . is outside Congress' Commerce Clause power, and it

cannot be otherwise authorized by an assertion of power under

the Necessary and Proper Clause. It is not constitutional.

He also writes:

It is difficult to imagine that a nation which began, at

least in part, as the result of opposition to a British

mandate giving the East India Company a monopoly and imposing

a nominal tax on all tea sold in America, would have set out

to create a government with the power to force people to

buy the tea in the first place. Surely this is not what

the Founding Fathers could have intended.

On February 2 of this year, on the Senate vote to repeal the law, it failed on a party-line vote, 47 to 51. So the Senate did not follow the path of the House of Representatives to repeal ObamaCare.

On February 14, Valentines Day, the IRS submitted to Congress its fiscal year 2012 budget request. The health care bill is mentioned by the IRS more than 250 times. The IRS will have to hire thousands of new workers to implement the many new tax provisions. As the request noted, the health care law:

. . . presents a major challenge for the IRS. It represents

the largest set of tax law changes in 20 years, with more

than 40 provisions to amend the tax laws.

Just to remind my colleagues and our constituents throughout this country, the health care law has more than 40 provisions, the largest set of tax law changes in 20 years.

February 22 of this year. A Clinton-appointed Federal judge ruled that ObamaCare is constitutional because the Constitution somehow permits the Federal Government to regulate what the court called ``mental activity.''

So much for keeping your thoughts to yourself.

On March 3, 2011, at the request of the Obama administration, a Federal judge in Florida, the Federal judge who had previously ruled that ObamaCare is unconstitutional, clarified his ruling and noted his continuing concern with the fact that if the law is upheld, he says, ``Congress could, indeed, mandate that everyone buy broccoli.''

I think the first President Bush would have a real problem with that mandate.

March 14, 2011, just 3 days ago. The latest Rasmussen poll shows that support for repeal of the health care law has reached its highest level since May of 2010, with 62 percent of likely voters now favoring repeal.

That is what we should do. These developments highlight just some of the reasons why the bill is so unpopular and so deeply flawed that the American people agree it should be repealed and it should be replaced with more sensible ideas.

The debate on the health care law will no doubt continue throughout this year, especially now that two Federal courts have already ruled it is unconstitutional. It would be best if we could stay the law until the Supreme Court rules on its constitutionality. States and businesses could save a great deal of money, and insurance companies wouldn't have to raise their rates. We will have a chance, I hope, to vote on such a proposal.

Some things age well with time--not ObamaCare.

I yield the floor.

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

The PRESIDING OFFICER (Mr. Cardin.) Without objection, it is so ordered.

Mr. President, I wanted to say a few words in support of the continuing resolution that the House of Representatives passed that we are going to be voting on here in another hour or so. It is H.J. Res. 48.

This is the second short-term funding extension to prevent a government shutdown while our congressional leaders are negotiating to try to reach an agreement on a long-term plan to keep our government working through the end of this fiscal year ending in September. The short- and long-term continuing resolutions under discussion are leftover work from 2010 to finish the job of funding the government, as I said, through the end of this fiscal year.

Notably, the spending cuts that have been achieved so far are really the first meaningful spending cuts the Congress has passed since the Deficit Reduction Act which was enacted in February 2006.

The House-passed 3-week CR or continuing resolution, which runs until April 8, includes $6 billion in spending cuts, which will keep the Congress on track to implement the overall $61 billion in spending reductions which are included in the long-term CR. Enactment of this short-term measure would mean that in just 5 weeks we will have cut $10 billion from this year's spending, and because of the adjustment in the baseline, that means that over a 10-year period of time, we will have saved the taxpayers $140 billion. Even in Washington, DC, that is real money.

The cuts in H.J. Res. 48 include funding rescissions, reductions, and program terminations. It also eliminates earmarked accounts within the Agriculture, Commerce-Justice-Science, Financial Services, General Government, and Interior Subcommittee jurisdictions. It reduces or terminates 25 programs, for a savings of $3.5 billion, and

eliminates $2.6 billion in earmarked account funding--all in all, a pretty good day's work. While we could argue the spending cuts are not large relative to the overall budget, as I said before, they will amount to $140 billion in savings over 10 years.

I urge my colleagues to support this ability to cut funding-- something we do not often have the opportunity to do. Why do we need to do this? Well, we all know that, first of all, we have a gross Federal debt exceeding $14 trillion. In fact, we are piling up debt at such a fast rate, that soon, the administration says--and the administration has--the President has asked us to increase the debt ceiling of the United States because of the amount of debt we keep adding to that that exists.

Obviously, we are living beyond our means. We have to borrow $4 billion a day. Another way to look as it is that for every dollar we spend here, we have to borrow 42 cents of that from somebody else. About half of that borrowing occurs from foreign nations. If you want to look at how the debt relates to the American citizens, it is equal to $45,500 per American or, if you want to relate it just to those who pay taxes, it is $127,000 for every taxpayer in the United States. That is how big our debt is.

That money has to be paid back. This is not something that just is out there in the ether somewhere; our creditors will want to be paid back when the bonds we have issued become due. It is either going to be us here in Congress and the President deciding how to reorder our priorities so we get our fiscal house in order or eventually the bondholders are going to do it for us by demanding far higher interest rates in order to buy our debt.

It is not just a fiscal problem, it is a national security problem. The Chairman of the Joint Chiefs of Staff, Mike Mullen, has made the point: ``I believe that our debt is the greatest threat to our national security.''

Now, why does he say that? Well, there are two basic reasons why. If we do not have the economic capability of funding all of the national security requirements we have, we no longer are the world's leading power, able to project our authority throughout the world, our ability to help others as well as defend ourselves.

Second, when we get into hock with other countries, become their debtors, our ability to influence their decisions in the world is diminished. It is very hard for us to go to the Chinese, who hold a couple trillion dollars of our debt--I think it is a figure roughly in that neighborhood--and say: We demand that you support us in the United Nations Security Council to impose sanctions on Iran. It is pretty easy for them to say: Oh, really? How about that debt you owe us? How about if you pay a little higher interest rate on that money?

Well, of course, paying a higher interest rate would devastate both our Federal budget and our economy. So it impacts our ability to influence others around the world, thereby also influencing our national security.

Finally, there is the impact of the cuts we are making today, when we pass this legislation, on job creation in our country. There is a direct relationship between government spending on the one hand--going into debt--and job creation on the other. It is one of the reasons we have the high unemployment we have today. In fact, if you look at a chart, there is an absolute direct correlation between the unemployment in our country and the deficit spending and debt in our country. That is why we have to get that lower. When we reduce the amount of debt and we spend less, which is what this legislation will do, we can leave the money in the private sector, enabling private businesses to invest that money, including in jobs, thereby not only hiring more people but helping our economy to grow.

In his work, Stanford economist John Taylor has shown this direct correlation between these spending cuts and increased employment. He recently released an analysis, and it is titled ``Why a Credible Budget Strategy Will Reduce Unemployment and Increase Economic Growth.'' That is the title. It concluded that the spending cuts in H.R. 1, which is the underlying continuing resolution in the House, ``will increase economic growth and employment as the federal government begins to put its fiscal house in order and encourage job-producing private sector investment.'' He is, by the way, among 150 top economists in the United States who signed a statement arguing for a change in direction and immediate action ``to begin to slow government spending, reduce uncertainty, and support the creation of new private sector jobs.''

We can begin that process by adopting the legislation that is before us here in another hour or so. It will, as I said, cut an additional $6 billion, so that the total in this last month and 1 week will be $10 billion in spending cuts that will, over a 10-year period of time, save the taxpayers $140 billion--all in all, a good day's work.

I urge my colleagues to support the legislation.

I suggest the absence of a quorum.

The following Senators are necessarily absent: the Senator from Oklahoma (Mr. Inhofe) and the Senator from Nevada (Mr. Ensign).