Floor Statements

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, this evening, there is a vote scheduled on the Ensign amendment, which would amend an archaic regulation, called the DCA perimeter rule, that has limited competition and travel options for those who fly in and out of Ronald Reagan Washington National Airport or DCA, as it is called.

More specifically, the DCA perimeter rule restricts the departure or arrival of nonstop flights to or from airports that are beyond 1,250 miles from DCA. This restriction effectively forces passengers who are coming from the Western States or going to the Western

States to use Dulles International Airport or to connect in some other city and then come on in. Obviously, this is inconvenient and discriminatory.

The rule was first codified as a Federal statute in 1985. But actually it goes back to 1962. It first had existed as a Federal rule in its various iterations since the 1960s when Dulles was first built. The original purpose of the DCA perimeter rule was to establish Dulles as the long-haul airport serving the Washington area, and that has worked.

In 1962, Dulles only served about 52,000 passengers. But today Dulles is thriving. In 2009, the airport served approximately 23 million passengers. According to the Metropolitan Washington Airports Authority:

Dulles has emerged as one of the fastest growing airports

in the world and a major East Coat gateway for domestic and

international travelers as well as cargo activities.

Given the success of Dulles and the improvement in technology, including quieter jet engines, over the years, Congress has granted a limited number of exemptions to the DCA perimeter rule because the traveling public is eager for air travel options. Yet, today, there are only a dozen nonstop flights between Ronald Reagan National Airport and the entire Western United States. There are four to Denver, three to Phoenix, two to Seattle, one to Las Vegas, one to Los Angeles, and one to Salt Lake City. That is it.

To put that number in perspective, that is 12 flights beyond the perimeter at DCA out of approximately 400 flights daily. The beyond- the-perimeter flights represent 3 percent of all daily domestic operations at DCA. Just 3 percent of all flights out of DCA serve our Nation's largest cities such as Phoenix, Los Angeles, Las Vegas, and San Antonio.

A 1999 study by the Transportation Research Board found that perimeter rules ``no longer serve their original purpose and have produced too many adverse side effects, including barriers to competition.'' The study found, further, that such rules ``arbitrarily prevent some airlines from extending their networks to these airports'' and that ``they discourage competition among the airports in the region and among the airlines that use these airports.''

There is also recent legislative precedent that supports the argument that the DCA perimeter rule should be repealed. The Wright Amendment of 1979 was a Federal law restricting flights at Dallas's Love Field Airport. It originally limited most nonstop flights from Love Field to destinations within Texas and neighboring States. In 2006, Congress passed the Wright Amendment Reform Act, which issued a full repeal of the Love Field perimeter rule with certain conditions. Lifting the restrictions at Love Field gave the traveling public more flight options. It also cut prices and made traveling more efficient.

The Ensign amendment would amend the DCA perimeter rule by allowing any carrier which currently holds slots at DCA to convert those flights--flights now serving large hub airports inside the perimeter-- to flights serving any airport outside the perimeter. This is referred to as ``the slot conversion provision;'' in other words, no more flights simply converting a flight that exists to go to a different city. The Ensign amendment would cap the number of flights that could be converted to 15 roundtrip flights per carrier.

The slot conversion provision ensures that service to small and medium hub airports within the perimeter would not be affected. There is no restriction, however, on converting a flight that currently serves a large hub airport within the perimeter to a small or medium hub airport beyond the perimeter. So presumably the Ensign amendment could expand service to small and medium hub airports beyond the perimeter. Indeed, I know some of the airlines do intend to use some of these conversion slots to go to their hubs outside the perimeter.

It is also important to note that the amendment would not alter the slot regulations at DCA or increase the number of allowable flight operations at the airport. The number of flights currently serving DCA would remain the same. Residents around the airport would not hear an increase in noise from takeoffs or landings and would not see larger planes operating at DCA. The only change is that a few of the planes would have a different destination.

Let me speak to how this amendment would or would not affect Dulles. As I mentioned, the conversion provision is capped at 15 roundtrip flights per carrier. It is expected that only 5 carriers could take advantage of this provision, making the total maximum number of new flights that could go beyond the perimeter to 75. But not all of the 5 airlines will make full use of all 15 slots. It is estimated that the 5 eligible airlines would only convert to perhaps 30 flights.

So how could flights, say, 30, at DCA that go beyond the perimeter affect Dulles? Well, according to the latest figures from the Metropolitan Washington Airports Authority, Dulles has 401 daily flights. So 30 additional beyond the perimeter would have a negligible effect on the operations at or demand for service at Dulles.

According to a recent GAO study:

GAO did not find evidence in passengers or fare data that

would indicate that the new service between Reagan National

and the six beyond perimeter cities----

The current 12 exemptions that exist----

had substantially affected service from Dulles or Baltimore-

Washington International airports to these cities.

There is no reason to believe that 30 additional beyond the perimeter flights would be any more consequential to Dulles Airport.

The bottom line is, the Ensign amendment is not about changing the character of Dulles International Airport as to the long-haul airport for the region or increasing the amount of flights at DCA. It simply would allow a limited number of direct flights out of DCA to reach the Western States so that passengers have more choice. It would also allow more tourists and business travelers from around the country another option for visiting the Nation's capital and its surrounding States, such as the State of Virginia.

My colleagues realize a lot has changed in 50 years, and they realize the need that has previously existed to protect Dulles Airport has lessened due to its own success. Thanks to a recognition of this fact, and some assurances that have been made by Senators Dorgan and the Acting President pro tempore, the Senator from Virginia, a vote on the Ensign amendment may not be needed tonight. Instead, it is my understanding that Senator Dorgan and other conferees will make a good- faith effort to modify the DCA perimeter rule when the FAA reauthorization bill is conferenced with the House. I know my friend from North Dakota intends to pursue this matter in conference, and I appreciate what he has said on this matter.

I also very much appreciate the spirit by which the Acting President pro tempore has approached this issue. As his predecessors have done, he has very much acted out of concern both for the traveling public and also the airports in his State of Virginia, and I would expect him to do nothing less. But I appreciate the open mind he has in trying to deal with an issue that we out West have that, hopefully, could be worked out in such a way that it would be a win-win and recognize the fact that times have changed since the early 1960s.

Mr. President, unless the Senator from West Virginia has anything, I will suggest the absence of a quorum, and I do.

Mr. President, may I ask the Senator what does the amendment do?

Does the amendment add any flights to DCA?

How many flights at DCA are currently exempted from the perimeter rule?

Does Dulles need to be protected by the perimeter rule?

Is there any legislative language to support amending the DCA perimeter rule?

How does the Ensign amendment affect service to small and medium hub airports inside the perimeter?

Does the Ensign amendment increase slot allocations at DCA?

Do you intend to withdraw your amendment?

Mr. President, reserving the right to object, obviously we just received the papers yesterday and the indication about 30 minutes ago that this request would be made. It is Friday. Members aren't here. The leader is obviously not here, as explained by my presence.

Obviously, we will visit with our Members on Monday when everybody returns and determine what the appropriate way to proceed on this is. It doesn't expire until April 5, so there is plenty of time, and we will be happy to work with the majority leader to determine the best course of action to get this resolved before April 5.

I supported this extension last time, so this is necessarily obviously not based on a substantive objection but

the need to inquire with our Members as to how they wish to proceed, as a result of which, at this moment, I would have to object.

Mr. President, I appreciate my colleague bringing that to light.

The answer, of course, is absolutely yes. I think at last count there were some 38 States that had expressed either through their attorneys general, Governor, or State legislature the intention to file litigation, and some of those States, such as Arizona, will have either ballot propositions or some have already passed legislation, such as Idaho, that has the effect of law to exempt their citizens from having to participate in this Federal mandate.

I ask my colleague, has this letter been printed in the Record yet?

Mr. President, if I could, the Governor had sent a previous letter, which is also in the Congressional Record, in which she specified the amount of money, $4 billion of extra costs, for the State of Arizona after our State has already slashed billions from the budget. In fact, our State is in such financial doldrums that they literally had to sell some of the buildings at the State capital in order to generate revenue, and then they are leasing those back.

Our State is in terrible financial condition. As my colleague pointed out before, with the number of homes in foreclosure and underwater, it is a terrible situation. Now to impose an additional $4 billion expense on the people of the State of Arizona with this legislation, as the Governor said, is very objectionable. She has urged our colleagues in the House of Representatives, therefore, to oppose the legislation.

Mr. President, I say to my colleague, Mr. Fine, a leader of one of the very large health systems in the State of Arizona, had been, I would say, very forward leaning, maybe even supportive of the health care reforms that had been proposed by the President initially. This comes from someone who wanted reform and who notes in this letter that there are some good things there, but he has finally concluded that the imposition of the unfunded mandates and other features of the legislation simply make it--unsustainable.

I ask my colleague for the exact word. I am not sure if it was ``unsustainable.'' But he said: So this legislation should not be supported. Instead, he suggested the approach that we have taken, which is we should take the good features that address specific problems and try to deal with them one by one rather than in this comprehensive form.

This is from someone who initially was pretty supportive of trying to move forward with this and now has concluded it is just too much and the State cannot afford it.

Mr. President, I am going to be speaking on the legislation pending before us. Perhaps Senator Dorgan would like to lock in speaking time after I am done?

Mr. President, I am going to speak in more detail later, following up on comments that my colleague from Arizona, Senator McCain, has made. He has rightly pointed out that the Governor of the State of Arizona and our legislative leaders discussed in press conference in Arizona the impact of this legislation in Arizona. They are very worried. They have urged our congressional delegation to oppose the legislation. I will make some comments about that.

But I do want to address this question of the so-called perimeter rule, which is relevant to the FAA bill that is before us, and an amendment that has been filed by Senator Ensign that will be modified and refiled sometime today, either by Senator Ensign or by Senator Hutchison. It is an amendment which I support.

I am going to discuss the perimeter rule and the way that the amendment would change it, briefly, today, and then after it is filed we will have a little bit more to say about it. The Ensign amendment would have the effect of modifying an archaic regulation that has had the effect of limiting competition and travel options for those who fly in and out of Ronald Reagan Washington National Airport.

Many years ago, Congress restricted the departure or arrival of nonstop flights from airports that are more than 1,250 miles from Reagan National Airport. It is called DCA, in the terminology--1,250 miles. That established a perimeter beyond which planes could not fly into or out of Reagan National Airport. That is referred to, therefore, as the perimeter rule. Effectively, it forced passengers in the Western United States either to use Dulles Airport or to use some other hub partway through the country, change planes, and then fly into Reagan from that shorter distance.

Obviously, this is inconvenient and discriminatory against citizens in the western portions of the United States who, I submit, should have equal access to their Nation's Capital as citizens who are closer to the Capital.

The original purpose of it was a valid one, and it was to ensure the new Dulles Airport--I think now over 50 years old, but I still think of it as a new airport--would become successful. It did take a few years for Dulles to establish itself as a major national and international airport, now serving, I think--just 2 years ago, the last year for which I have statistics--over 24 million passengers, which is millions more than Reagan Airport.

So it is clearly both an international hub in the United States, as well as the long-haul airport serving the Washington, DC, area. It is thriving, as I said. It has something over 24 million passengers, and that was as of over 2 years ago.

Over the years because of not only the success of Dulles Airport but also improvements in technology and handling more airplanes and handling more planes on the ground and, importantly, in reducing the noise of jet engines, the desire of more people to be able to travel directly into Reagan Airport has obviously increased, and there has been pressure to grant at least a limited number of exceptions for the traveling public which is eager for options in getting in and out of the Washington, DC, area.

So a very few limited exceptions to this perimeter rule were created. Yet today there are only a dozen nonstop flights--12--between Washington National and the entire Western United States; specifically, 4 flights to Denver, 3 to Phoenix, 2 to Seattle; 1 to Las Vegas, 1 to Los Angeles, and 1 to Salt Lake City. And that is out of approximately 400 flights from Washington Reagan Airport. That is the only number-- 12--out of more than 400 flights traveling to those important cities in the United States--Los Angeles and Phoenix, 2 of the top 5 populated cities in the entire country.

In 1999, now more than a decade ago, the Transportation Research Board found that the perimeter rules ``no longer serve their original purpose and have produced too many adverse side effects, including barriers to competition.'' Of course, barriers to competition not only make it more costly for flyers but also reduce the ability of airlines to compete and create stress on them even to remain in business. With all of the other stresses that have impacted airlines recently, this is just one more.

The same Transportation Research Board found that these perimeter rules ``arbitrarily prevent some airlines from extending their networks to these airports; they discourage competition among the airports in the region and among the airlines that use these airports; and they are subject to chronic attempts by special interest groups to obtain exemptions.'' We all are aware of that latter point because we hear about it. Every month, it seems, there are people who are putting pressure on to try to get more exemptions.

There is also legislative precedent that supports this argument that this DC perimeter rule should be repealed. This was done just 4 years ago in 2006 in the Wright amendment reform of 2006.

In 1979, there was a Federal law passed, headed by Speaker Jim Wright, of the House, that restricted flights at Dallas's Love Field Airport. Love Field was the first airport in the Dallas region, and this legislation originally limited most nonstop flights from Love Field to destinations within Texas and neighboring States of Texas. But, as I said, in 2006 we passed the Wright Amendment Reform Act, which issued a full repeal of this Love Field perimeter rule. There were certain conditions to it, but the bottom line was that lifting the restrictions at Love Field gave the public a lot more flight options, it cut prices, and it made traveling for the traveling public much more efficient.

The Ensign amendment would have much the same effect with respect to the Washington, DC, area. Here is the key thing it does: It would amend the DC perimeter rule by allowing any carrier that currently has slots at Reagan Airport--not saying new air carriers would come in; only those that currently have slots--they could simply convert slots they currently have that serve large hub airports inside the perimeter to an airport outside the perimeter.

The first concern is, well, what about the cities that are served inside the perimeter? The amendment is limited to large hub cities, so there isn't an argument that some smaller city is going to be cut out. The only flights that could be transferred would be flights that already go into large hub cities, cities that are already served with plenty of flights and can be. So an airline, in order to take advantage of this amendment, would have to remove a

flight from one of its large hubs and transfer it to a city outside the perimeter, a city such as Phoenix or Las Vegas or Los Angeles or Salt Lake City, for example. This is referred to as the ``slot conversion provision,'' and this is the guts of the amendment. It does not add flights; it does not take flights away from small communities; it simply allows the airlines to move up to 15 flights per carrier from a hub that they already have to some city outside of the perimeter, the 1,250-mile perimeter.

It ensures that service to small and medium hub airports is not affected, and it would not alter the slot regulations at DCA--no new flights in or out of DCA. The only difference is that when a plane takes off from Reagan National Airport, its destination may be Los Angeles rather than--pick a city--Omaha--well, Omaha may be a smaller city--perhaps Dallas or Chicago. So there are no new allowable flight operations. The airplanes are the same, no additional concentration at the airport, and obviously very little impact on Dulles because of the fact that there would be so few flights and they would be going to cities that presumably are already being served.

As I mentioned, it is capped at 15 round trips per carrier. It is expected that only five carriers could take advantage of the provision and that not all of them would be able to take full advantage of it. So the maximum number of flights would be 75, and it is likely that it would be far fewer than that. But even if you take the maximum of 75 flights, you are talking about well over 100 flights in and out of Dulles as it is right now. According to the Metropolitan Washington Airports Authority, Dulles has 333 daily flights to 83 U.S. cities and 59 daily flights to 43 international cities. Obviously, 75 beyond the perimeter would have a negligible impact on the operations or demand for Dulles Airport.

The key, as I said, is we will be able to create greater options for passengers, thus reducing their cost of travel, providing greater flexibility, access to the Nation's Capital at a somewhat more convenient location, and help for airlines that need to do everything they can to stay in business to serve the traveling public. Airlines are under a great deal of economic pressure these days, and what these airlines have said is this will help them continue to serve the traveling public if they are able to change this perimeter rule.

So we are going to be able to debate further the Ensign amendment, which is scheduled to be considered by the Senate at 5:30 on Monday. Because of the fact that it would simply increase the ability of--the airlines' flexibility to move from large hub cities today to similar cities outside the perimeter, it is our hope that our colleagues in Virginia, who naturally have been very concerned over the years about ensuring the continued success of Dulles Airport, concerned about the environment for their citizens both in the Dulles area and in the area of Reagan National Airport, that their concerns would be assuaged by the fact that this is very limited and it, as far as I can see, has no adverse impacts of any kind for the citizens of Virginia.

So we would hope eventually to be able to work something out here where we could modify the perimeter rule. It is anachronistic; it is decades old. As I said, a lot has changed since it was put into effect, and we are hoping this is the time to do it. There will be no better opportunity than on this FAA reauthorization bill. In fact, it is probably the only opportunity. Given that fact and given the fact that we have been trying to accomplish this for many years, I think it is safe to say that those of us who support this are going to insist this legislation be the vehicle for finally making a change.

I very much appreciate the ability of probably the key person on the Democratic side, Chairman Rockefeller, but also the chairman of the subcommittee, Chairman Dorgan, to discuss this matter seriously, and the Senator from Virginia, Mr. Warner, to discuss this, recognizing that the conference committee is presumably where all of these issues are going to be hashed out given the fact that the House of Representatives adopted an amendment relating generally to the subject matter but not the Ensign amendment at all.

So it would be my hope, with the kind of constructive conversation we have had in discussing this, that that kind of constructive conversation can continue and we can get this matter resolved as part of the FAA reauthorization legislation.

I yield the floor.

Mr. President, I wish to go back to the subject my colleague, Senator McCain, was discussing earlier today. He had printed in the Congressional Record a letter sent by the Governor of the State of Arizona to the Speaker and to the majority leader of the Senate relating to the health care legislation, imploring them not to impose the new mandates that would cost the State of Arizona additional funds for covering Medicaid patients and urging the Members of the Congressional delegation to reject the legislation that does that.

It is not clear yet, because it has been hard to go through the entire legislation, what all the changes are in the last bill, but I do wish to discuss those that have at least been identified by the staff who have had an opportunity to read the bill since it was put on the Web site yesterday.

To back up a little bit, let's remember there was a bill that passed the House of Representatives. Then there was a bill that came out of the Finance Committee in the Senate. It was combined with the bill that came out of the HELP Committee in the Senate. This was done behind closed doors. It was essentially done by the majority leader in the Senate. That bill was not the subject of the normal committee process, but it was presented to the Senate floor. The Senate then modified that legislation and voted on it and sent that back to the House of Representatives. So the latest bill represents a piece of legislation drafted by representatives of the White House, the Senate, and primarily the House of Representatives, behind closed doors, primarily to add elements to it that the President desired and to ``fix'' parts of the Senate bill that Members of the House of Representatives did not want.

There is an editorial in the Wall Street Journal today called ``March Madness,'' which discusses this a little bit. In the first paragraph they say:

No bribe is too costly, no deal too cynical, no last-minute

rewrite too blatant.

The first sentence says:

Has there ever been a political spectacle like the final

throes of Obama care?

I admit I have never seen anything in my roughly 24 years in the Congress such as this, either in terms of substance or in terms of process.

I note that several days ago the President said several times he wants an up-or-down vote on this legislation. ``We just ask for an up- or-down vote,'' he said. But it now turns out the President and his colleagues in the House of Representatives don't want an up-or-down vote. In fact, yesterday, on a purely party-line basis, Democrats defeated, 222 to 200--some Democrats supporting the Republican resolution--but defeated the resolution offered by Republicans that would have required them to vote up or down on the Senate bill.

So what the President requested--an up-or-down vote--is, in fact, not going to occur in the House. Instead, they are going to pretend the Senate bill has been passed. The word they use is ``deem.'' We are going to deem it passed. We are not going to vote on it, but it is going to be passed anyway. One might say: How on Earth could that happen?

Well, there is a way they have figured out in which they can include the Senate-passed bill in a rule they will then pass, and by passing the rule, they will deem the Senate bill passed and send it to the President and he would then sign it. Then, later, they will amend that bill through what they call the reconciliation process. But there is a little problem with that, too, because when the reconciliation bill comes back over here, as the chairman of the Budget Committee has acknowledged, it will be changed. There are points of order that lie against it and those points of order will be upheld and potentially the bill could be amended as well so it will have to go back to the House of Representatives. The reality is, what the House Members are hoping will correct the Senate-passed bill will not, in fact, do all they hope it will do.

The Speaker of the House, Nancy Pelosi, told reporters last week: ``Nobody wants to vote for the Senate bill.''

I guess this is the way they avoid that vote, by having the deeming. They will assume it has passed, even though they haven't taken a vote on it. The reason they don't want to vote on it is because it has a lot of bad features from their perspective--and I think from mine as well-- but their hope to fix all those bad features is going to fail as well.

This editorial I mentioned in the Journal points out one of them, and it is the House demand to delay the tax on insurance plans from 2013 to 2018. That is something labor unions have very much wanted, and they want to respond to labor unions. They note that Richard Trumka, who met one on one with President Obama Wednesday--he is the head of the AFL- CIO--has wanted to accomplish this. The effect it would be to reduce Social Security payroll tax revenues. The reconciliation bill expressly forbids any impact on Social Security. So that would be subject to a point of order, and 41 Republicans have said we will vote to uphold the points of order. So this particular change the labor unions very much want in the taxation of the so-called Cadillac plans is not going to be able to be made in reconciliation. It will be subject to a point of order. The point of order will be sustained. The bill will have to go back to the House of Representatives. One of the big things they wanted to fix will not be fixable by reconciliation. That is just one example.

There are several changes we are aware of in the bill, and let me identify those for my colleagues. I am sure there will be others we will discover. Those of us who opposed the bill complained about the roughly $\1/2\ trillion in new taxes. Well, this latest bill increases the taxes by over $70 billion. The taxes will now be increased by almost $570 billion; to be precise, $569.2 billion. The Senate bill increased taxes by $493.6 billion. So we have now about $77 billion more taxes in this legislation than in the bill the Senate passed--$77 billion in more taxes. The CBO has, of course, said these taxes will be passed on to the consumers of health care and the buyers of health insurance through higher rates.

Medicare. Medicare was cut in the Senate bill by $464.6 billion, but under this new bill, Medicare will be cut by $523.5 billion, obviously well over $\1/2\ trillion, and much of that will be in the Medicare Advantage area we have all been complaining about.

The individual mandate is the requirement that individuals will pay a tax if they don't buy a federally approved insurance policy. This is going to be raised by a couple billion dollars. The Senate bill had it at $15 billion. It is now going to be $17 billion. I don't know whether that is because they assume more people will fail to buy the policy and, therefore, will simply be collecting more revenue or the amount of the tax has been increased. Either way, it is an individual tax increase, all of which, of course, is administered by the Internal Revenue Service.

The employer mandate. This imposes $52 billion in new taxes on employers that don't offer government-approved insurance. That is almost double from the Senate bill, which was at $27 billion. I can guarantee the small business folks are up in arms about this additional new tax on employers.

I mentioned the Medicare Advantage plans. They are now cut by $131.9 billion. The Senate bill cut them by $118.1 billion.

The payroll taxes, which is probably the most destructive of all these tax increases because it goes right to job creation, are increased. These are now $210 billion. All these figures are over 10 years. The Senate bill was $86.8 billion, and that was enough. But think about this: From $86 billion in the Senate-passed bill, the higher payroll taxes

are now up to $210 billion--so from $86 billion to $210 billion. That is 2\1/2\ times higher, and that is a direct tax on employment.

We just considered a bill that gives a break to employers, a payroll tax break to employers that hire people who have been unemployed. We understand there is a direct relationship between how much an employer pays in payroll taxes and how many people he can afford to hire or to retain--and I say ``he''--about half of small businesses are women owned, so I should obviously say he or she. We understand the relationship between the amount of payroll tax you have to pay and the amount of people you can afford to hire. Yet, in this legislation, we now impose $210 billion worth of new payroll taxes on employers. This will be a job killer. Whatever minuscule efforts we have been making in these other stimulus plans to try to increase jobs, with not much effect, I might say, and at huge cost per job, all that gets wiped out when you impose this kind of tax directly on hiring or retaining employees.

Then there is the 40-percent excise tax on the high-premium plans. This raises $32 billion. As I say, this is a problem because reconciliation, by its terms--this isn't a matter of interpretation. Reconciliation precludes an effect on Social Security. That is the way it is written. You cannot affect Social Security in reconciliation. Because of the effect that this provision has, this is not going to be able to remain in the bill.

All these estimates, according to CBO, are preliminary. In fact, I think their phrase was that there is substantial uncertainty in their estimates. So these are not final estimates. Never before, I think, have we passed a bill without having final estimates from the CBO.

It is interesting to me that as much as folks don't like the IRS, we are now going to have to add about 16,500 additional IRS employees, at a cost of up to $10 billion, just to administer the IRS-enforced provisions of this health care legislation. For example, every citizen is required to buy an insurance policy. There are certain exceptions, depending upon your wealth, but you have to buy an insurance policy the government identifies for you. If you do not, then you have to pay a tax, and that is administered through the Internal Revenue Service. That is why they are going to need 16,500 more employees. How do you like that for increasing the size and the power of the Federal Government?

Let me mention some of the other effects of the legislation. One of the payroll tax increases is a brand new tax. It is destructive, especially to senior citizens or others who have investment income because, for the first time in our history, we would be applying the Medicare payroll tax to all investment income of people with incomes over $200,000. That includes, as I said, investment income--dividends, capital gains, income of that sort. We have never taxed that in the past.

Moreover, this is going to hit people with far less income very quickly because it is not indexed for inflation. Just as the alternative minimum tax, which originally applied to about 218 millionaires, was never intended to apply to the vast majority of middle-income Americans, now it applies to over 23 million American taxpayers because we did not index it for inflation. Likewise, this tax, too, will be applied to more and more Americans as the years go on.

I mentioned the higher premiums. The Congressional Budget Office has specifically said these taxes will be passed on to all Americans. The taxes are imposed in a variety of ways: If you have insurance, you get taxed. If you do not have insurance, you get taxed. If you are an employer, you get taxed. If you do not have insurance for your employees, you get taxed. If you do and one of your employees goes to an exchange and is subsidized, you get taxed. You get taxed if you need a new device, such as a heart stent or a diabetes pump, even a wheelchair, if you need new drugs to take care of you. Why would we impose taxes? We are trying to help people with their health care. You need medical devices and you need pharmaceutical products to help you stay well or get better. Why tax those items? It is just beyond imagination.

I can imagine why we would tax alcohol or tobacco or some other sin, but the very things we need to make us healthy we are going to tax. Amazing.

We are going to tax insurance. Of course, that immediately gets passed on to you in the form of higher insurance premiums, which is one of the reasons that CBO says, yes, insurance premiums will go up under this bill. Why do that? Because insurance companies are bad. This is brilliant. This is like shooting yourself in the foot. We do not like insurance companies, so we are going to tax them and then turn right around and add that tax to your insurance premiums. The politicians then say: We punished the insurance companies. We are on your side. Right, they are on your side so they make sure you pay higher insurance premiums.

What does the Congressional Budget Office say? We are not even talking about where your employer provides the insurance. Take the individual insurance market where you have to buy it; the premiums as a result of the legislation will go up between 10 and 13 percent, and in some States it is a lot more than that.

Oliver Wyman Group, which is a very respected third party, has estimated that it is in the neighborhood of 50 percent for most folks, and in my State of Arizona it is 72 percent in insurance premiums. That is wrong. When Congress passes legislation that we are warned in advance is going to increase insurance premiums, whether it is 10 percent or 70 percent because of the legislation, it is wrong to pass that kind of legislation. Even in the nonprivate markets, CBO says the cost will go up because of medical inflation. We are not bringing insurance premiums down.

There will be more lost jobs. This bill nearly triples the penalty on businesses that cannot afford to provide their workers with health care coverage. It was $750. Now it is $2,000 for every worker. This applies to part-time workers as well as full-time workers. This does not make sense. Businesses are trying to stay in business, keep people on their payroll or, hopefully, one of these days hire new people. Yet we impose these kinds of burdens on them. This is wrong.

What about the idea that we are going to affect the deficit? First of all, as I said, the Congressional Budget Office has said their estimates are subject to revision. They are offered with substantial uncertainty and are preliminary estimates only. They make these estimates based on what Congress gives them. If Congress includes in the legislation a provision that says we will cut $500 billion from Medicare, then the Congressional Budget Office has to score that as a $500 billion cut to Medicare, even though about half of that cut is the same kind of thing we have tried to do over the years to eliminate waste, fraud, and abuse. Of course, if it could be done, it would have been done.

The President, when he talked about this over a year ago in his State of the Union speech, could have spent this last year cutting out a lot of waste, fraud, and abuse. If it is there to be cut out, he could have done it. It is hard to do. But in the law, the way this has been written, it will be done; therefore, the Congressional Budget Office must score it as having been accomplished. It is not going to happen. As a result, this bill will be in deficit. It will not create the budget surpluses.

Think about it. One of my friends said: This is a pretty neat deal. We are going to add 30 million people to the insurance rolls and reduce the size of the deficit. He said: I have a great idea. Let's get rid of the deficit by insuring everybody in China. Of course, the absurdity of the argument makes the point. You do not save money by spending money to insure more Americans. Every American understands that, which is why when we look at the surveys, they all laugh.

When they are asked the question: Do you think adding more people to the insurance rolls and paying for that is going to reduce the deficit? They say: Of course not, and it is ludicrous to suggest that it is.

I feel sorry for CBO that has to, with a straight face, say this will reduce the deficit. The only reason they have to say that, or can say it, is Congress gives a bill that says: You must assume it will reduce the deficit because we

are going to make all of these savings in waste, fraud, and abuse. It will not happen.

There are so many different gimmicks in it. Let me mention two: the physician payment cliff for Medicaid whereby payments for primary care physicians are increased for 2013 and 2014, and then it goes away. Do you really think we are going to pay physicians at the same rate we are paying them today, or slightly increase the payments in 2013 and 2014, and then they are going to suffer a 22-percent or 23-percent cut every year thereafter? Of course not. Yet that is how they balance this out. They assume a 23-percent cut in physician payments. It is not going to happen. It would be an abomination.

How do you with a straight face ask physicians to take a 23-percent cut in what they receive in reimbursements from the government? It is already difficult for them. In fact, the Mayo Clinic in Phoenix says it has to cut out many of the services and not take any additional Medicare patients because the reimbursement from the government is not enough to keep them in business.

By the thousands physicians are leaving the Medicare and Medicaid Programs. They cannot stay in it right now. Yet we are to assume we are going to cut them another 23 percent? It will not happen. Yet that is what the CBO must assume in making the budget projections.

The bill also hides the cost of filling in the so-called doughnut hole by not phasing it in. There are a whole variety of these gimmicks. I will mention one more.

This is the so-called CLASS Act, a long-term entitlement. They generate a bunch of revenue up front to make payments later on. However, the bill steals that money, reduces the cost of this new entitlement program, and never tells us how it is going to make it up later when it has to pay for the CLASS Act. It is a Ponzi scheme. The first dollar in they use to take care of the last investor, and eventually there isn't enough money to take care of the last investor, so that investor loses all the money, just like what happened with Bernie Madoff. No idea how they are going to pay for the CLASS Act once they use all the money they collected for it, spend it all on the new entitlement, and then have nothing in the till when they have to pay off benefits under the CLASS Act.

Social Security, same thing. They count the money twice. They say: We are going to extend the Social Security Program for 17 more years; it will be viable. However, we are going to take the same money we are applying to that, and we are going to pay for this new entitlement out of it, $500 billion.

You cannot count the money twice, as the CMS Actuary pointed out.

The bill is rife with these gimmicks that say it is going to be balanced. It is not going to be balanced. Everybody knows it is going to cost trillions of dollars. Mr. President, $2.3 trillion is a low estimate for the first 10 years of operation.

Let me close with a couple other points.

One of the things that has caused people so much angst about this is the sweetheart deals. The Senate bill was stuffed with them. Our House colleagues and, I might say, some of our Senate colleagues, too, said: That is wrong; we are going to fix some of them. I applaud those who realized, perhaps after the fact, but at least realized this was totally inappropriate. Things such as the ``Cornhusker kickback'' to Nebraska, that is being fixed in the bill. My guess is, even though some of these may be subject to budgetary points of order, some of them can be fixed through the reconciliation process. But there are still a bunch of them in the bill.

For those who said we have to take all of these sweetheart deals out of the Senate bill and fix that with reconciliation, no. Some are still there, and there are new ones added.

We talked before about the ``Louisiana purchase.'' It is still in the bill. Medicare coverage for folks in Libby, MT, still in here. Mr. President, $100 million for a Connecticut hospital, still in here. There is a new one. Tennessee, it turns out, is an important State in terms of votes in the House of Representatives. So Tennessee hospitals get more money for the so-called DSH payments, the disproportionate share. Tennessee hospitals--is that going to stay in here?

Another one was put in to help North Dakota relating--this is a whole other story. We have now taken over student loans for college education in the health care bill. In case you did not realize, it is not just health care. After taking over GM, Chrysler, and insurance companies, AIG, and a bunch of other sectors, now we are going to take over student loans. That is going to be put in the health care bill.

It turns out that hurts banks. Obviously, banks have a lot of employees who provide students with these loans. North Dakota has some banks that were going to get hurt. At least one bank in North Dakota was going to be able to continue to offer the student loans. To his credit, I am informed the chairman of the Budget Committee, the Senator from North Dakota, said: Wait a minute, we cannot do that, so I will try to get that out somehow or another. That is an appropriate thing to do.

You see how this happens when bills are written behind closed doors and there is an effort to make sure there are enough votes to pass it? They need to sweeten the pot, and this is the kind of thing that happens. These are some of the provisions. I am sure we will discover others that are in the bill.

One of my colleagues pointed out there are going to be some deals that have been made that do not show up in this bill. He is going to be looking for those deals wherever they do show up.

I note the last two items. We did not want to put more people in Medicaid, but there are another 2 million people in Medicaid. Still 23 million are uninsured after all is said and done. The whole idea was to get 30 million people more insured and try to reduce costs.

We know it does not reduce costs. It does not get all the people insured, and those who are covered, the majority are put into the Medicaid Program that we know is broken.

Finally, the bill does not prohibit Federal funds flowing to insurance plans that cover elective abortions. This is a matter of concern to a great many people in both the House of Representatives and the Senate. They did not try to fix it in the reconciliation bill. But even if they had, that would be subject to a point of order as well.

The bottom line is that this legislation, crafted behind closed doors yet again, is replete with special deals, is worse in virtually every respect that I can see from the Senate bill. It increases the top line spending, increases taxes by maybe close to $70 billion or a little more, cuts Medicare now by $523 billion, adds to the individual mandate, adds to the employer mandate, hurts Medicare Advantage plans even more, a much higher payroll tax--$210 billion increased payroll tax, a job killer--increases insurance premiums even more. It is hard to see how you can say that this is going to help the American people.

As the editorial in the Wall Street Journal that I cited before concludes:

This is what happens when a willful President and his party

try to govern America from the ideological left, imposing a

reckless expansion of the entitlement state that most

Americans, and even dozens of Democrats in Congress, clearly

despise.

I hope, Mr. President, that colleagues in the House of Representatives will have the courage to stand up and represent their constituents rather than the President and the Speaker of the House. They owe their obligation to respond to the message their constituents are sending: They want to stop this bill, to start over, and get it right.

Unless my colleague from Arkansas wants to respond, I will proceed.

Let me comment on the suggestion by the Senator from North Dakota that we need to move on with this legislation. I agree. It could be concluded this week. On the other hand, the matter that relates to the perimeter rule and slots at the airport, while every bit as complicated as my colleague suggested, is also very much in need of resolution. One way or another, we will have to get that resolved on this bill. I am hoping that after a meeting we will convene in a little less than an hour, a compromise can be achieved such that we can move forward and get something adopted. But we will not finish that bill until that important issue is dealt with.

I will refrain from talking further about that in the hopes that there is a compromise we can support.

Surely.

I certainly appreciate the sentiment of my colleague. The underlying bill is important to get done. These perimeter rule revisions are important too. Our fear is, unless there is some action, it will not be resolved, as it hasn't been in the past. I don't think it has to be a lot of amendments or a huge amount of debate. I do think we need the opportunity to have a vote or two on a couple of these amendments. If they don't prevail, then so be it. But that is an issue we will have to deal with one way or the other.

What I would like to do is change the subject a little bit and talk about the proposals made by Senators Sessions and Pryor in a different context. We just got the word from the Congressional Budget Office that the new cost of the legislation on health care is going to be over $940 billion. Each iteration of this bill has seen an increase in the cost. This is striking because, as we know, even though the Congressional Budget Office has had to take the legislative language as it has been given to them in providing the pricetag and, therefore, alleges that it will not put us in deficit, the truth is, it will. If you double count savings, if you assume savings that will not exist and so on, then you can project a budget-neutral bill. I think most objective observers have acknowledged that the bill will be far out of balance and that the $940 billion price tag will not be paid for by the various taxes and spending reductions ostensibly a part of the bill.

There is nearly $\1/2\ trillion dollars in Medicare cuts. Most people think that is unrealistic. We have never been able to find that much waste, fraud, and abuse in the past. It is going to be hard to find it in the future. You can't assume we will save all that money.

It is true this new bill will also raise taxes. There are 12 or 13 new taxes in the bill. It supposedly raises about $\1/2\ trillion in taxes. That includes on seniors, the chronically ill, and on the very drugs and devices that help us when we are sick. I wonder how long those taxes are going to last.

The bottom line is, we will be adding to the deficit under this legislation or paying a lot more in taxes than we do today. The irony is, we are not even solving the core problem we started out to try to solve, which was to reduce the cost of health care premiums. CBO confirms over and over again that premiums will continue to rise. They say, in the individual market, this bill will cause premiums to soar by 10 to 13 percent in the year 2016 because the government is going to force patients to buy benefits packages with coverage they may not need or want.

According to Lewin Associates, an objective observer, the premiums will go up even more. A third study, Oliver Wyman & Associates, has projected that prices will exceed a 50-percent increase--in my State of Arizona, a 72-percent increase in premiums--as a result of this legislation. That is almost incomprehensible and it is wrong. The irony is, the increases will be paid by small businesses that we are asking to hire more people. It is going to paid for by young families and individuals forced to buy insurance they don't believe they need right now. Right now they have relatively low premiums because they have relatively low health care needs. The bill will raise the cost of insurance for many Americans and then, through new mandates, force everyone to buy a policy and not just any policy but one that has actually been written in Washington.

It adds a new entitlement we can't afford. There are so many other things wrong with it. My point was not to go through all the things wrong with the health care bill but, because we now know or we believe the bill will be voted on in the House perhaps as early as Sunday and we now have the new score, the biggest score yet of almost $1 trillion, it is worth talking about in the context of the amendments on the floor to try to deal with escalating spending.

During his campaign, President Obama made almost a fetish out of saying he would fix the way Washington works. There would be no more business as usual. But from what we have seen on the health care debate, there has been arm-twisting and backroom deals and sweetheart deals that end up buying the votes they need to pass the legislation but add dramatically to the cost, as well as the unfairness, because certain provisions of the bill are made inapplicable to certain favored constituencies.

I have always thought, if the bill is such a great idea, why would Members exempt their own constituents from the application of the bill. One of the areas in which this is done is the cuts to Medicare. About half of that comes from reducing the benefits under Medicare Advantage. Medicare Advantage is enjoyed by a great many seniors who are on Medicare, about 330,000 in my State of Arizona. Their benefits will be dramatically decreased under the bill. Our colleague from Florida heard an earful from his constituents, senior citizens, who said: Don't cut my benefits under Medicare Advantage. He said OK. We will grandfather you, and we will grandfather some folks from other States. But my constituents in Arizona don't get grandfathered. Their benefits are going to be cut. How is that fair? How is that right?

Let me run through a couple of these other special deals. Unfortunately, not everybody gets the advantage of these special deals. There was the so-called ``Louisiana purchase,'' $300 million. I don't know the page of the new bill, but in the old bill it is section 2006, page 432, line 14. The ``Gator aid,'' which is the thing I was just talking about, grandfathers Medicare Advantage patients to the tune of about $25 to $30 billion from the cost of rather than from the effects of reducing their Medicare Advantage benefit. There are some other States that get specific benefits as a result of Medicaid patients who are added to the rolls: Vermont, $600 million; Massachusetts, $500 million.

There are three targeted FMAP provisions: bonuses for Vermont, Massachusetts, and Nebraska. Vermont gets a 2.2-percent FMAP increase for 6 years for their entire program. Massachusetts gets a half-a- percent increase for 3 years. Nebraska gets a 100-percent FMAP increase for newly eligibles forever. That was this new particular deal.

Under the disproportionate payment section, Hawaii is alone among the States that get an extension. Michigan and Connecticut get a special benefit under section 508 so that their hospitals have an option to benefit under that section if it means higher payments. This was also done in previous legislation.

Montana, South Dakota, North Dakota, and Wyoming get a special deal: an amendment that adds 1 percent to the hospital wage index for those States. There are other States that would qualify but would not benefit because they are already above the 1-point wage index value. It also establishes a 1.0-practice expense floor for physicians in those particular States.

One of my colleagues got a benefit for his constituents in Libby, MT: Medicare coverage for individuals. The EPA has announced there is a public health emergency at a Superfund site there, so they get a special advantage.

It is interesting that while the Nebraska ``Cornhusker kickback'' got a lot of attention, two other benefits for Nebraska entities did not. Blue Cross and Blue Shield of Nebraska and Michigan Blue Cross Blue Shield and also Mutual of Omaha get special benefits--so two in Nebraska and one in Michigan. They get a carve-out. One of them gets a carve-out from the insurance fee for Medigap policies and the other the insurance fee paid to these two particular companies.

Connecticut hospital--Senator Dodd from Connecticut took credit for getting $100 million for a hospital in his State.

I could go on and on.

The point is, the process by which the legislation has been put together, as well as its substance, is what has caused the American people to have an extraordinarily low opinion of Congress. The latest trick, this so-called

scheme to deem the legislation the Senate passed--passed without a vote; in other words, passing a law without ever voting on it--is just the latest of the chicanery that appears to be engaged in, in the House of Representatives now, in order to get around the Senate bill, which, as the Speaker said, her Members do not like and do not want to vote on.

Madam President, I ask unanimous consent to have printed in the Record an editorial from this morning from one of my hometown newspapers, the Arizona Republic, which discusses what they call the end run by Democrats as a travesty, and they discuss this so-called scheme to deem in the editorial.

Yes, I will. I was about to get to the final point, which is the matter on which my colleague from Tennessee is the expert, and that is the latest item to try to flavor the legislation to get more votes; namely, to have the Federal Government take over student loans. But, yes, I will yield.

Madam President, my colleague from Tennessee is exactly correct. Just that one item alone--of course it is part of Medicare; you have to pay doctors to take care of you in Medicare--and if you do not include the cost of that, then obviously you are not identifying the true costs of the legislation, and just that item alone would be enough to knock it out of balance.

I did not even get into all the double counting and the other ways in which they try to game the system so it makes it look like you have saved money, but you have not. One of our friends, Stephen Moore, I heard, had this analogy. He said: This is a great deal: Gee, you cover an additional 30 million people and you save money. Gee, at that rate, we should cover everybody in China. We could really reduce the deficit.

Well, I think it makes the point. The American people have broken the code here. We are not going to save money by adding more people to the rolls. That may be a good idea. It may be that we should subsidize people, but let's acknowledge the true cost, and that gets back to the amendment of our colleague from Alabama, the amendment that is pending on the floor. He says we have to stop spending so much, so let's do something very modest. Let's put a cap using last year's budget. We are not talking about cutting way back. We are not cutting into muscle or bone or anything like that; we are just saying: OK, if it was good enough for 2010, let's stop there. Let's have a little hold, let's have a little pause here before we add a whole lot more money to the deficit.

My State of Arizona has had to cut well over $1 billion out of its budget. I think it is closer to $2 billion. They are cutting significant elements that the State has paid for in the past. The city representatives were in seeing us yesterday and last week the county representatives. They are all having to dramatically cut what they provide in the way of government services.

But we in the Federal Government, we keep right on going as if there were no problem at all. That is why the amendment that is pending--I guess we are going to vote on it in about an hour--the amendment by Senators McCaskill and Sessions is one we need to support and to vote against any other amendments that appear to try to provide savings but, in fact, do not.

I will close here because I see my colleague on the floor. The last thing I want to mention is the latest gimmick to get support for this health care legislation: adding something that has nothing to do with health. It is the Federal Government takeover of the student loan program. A lot of folks in the country have gotten student loans for their kids to go to college. It is a process that has worked. It is federally guaranteed so banks are able to make those loans at a relatively low rate of interest. It is a good deal for kids who want to go to college.

Well, the Obama administration--which has taken over car companies, taken over other insurance companies, now wants to take over health care and has taken over, partially, banks--now

wants to take over student loans. It has made them part of this legislation. We do not know for sure exactly how because we have not seen the bill yet. But allegedly it is made a part of this legislation.

My colleague from Tennessee has been very good at pointing out that actually it is going to cost people more money because the government gets to borrow money at 2.8 percent interest, then it is going to loan it out at 6.8 percent interest, and then take the difference in the two and pay for additional government programs.

To me, though, one of the most pernicious things is that after July, you are not going to be able to pick the lender that best fits your needs or your kids' needs to go to college. You get to go to a Federal bureaucrat who is going to decide that for you. Instead of something like 3,000 different places where you can go to get this, I think there are going to be four call centers. Good luck. If you think it is slow down at the motor vehicle division or the Post Office, good luck trying to get a loan for your kid now to go to college.

As my colleague, Senator Alexander, wrote in the Washington Post:

[Y]ou'll work longer to pay off your student loan to help

pay for someone else's education--and to help your U.S.

representative's reelection.

This is a bad idea. To try to fold this into the health care legislation is a doubly bad idea. The bottom line is, our House Democratic colleagues who are now being very strongly pressured to vote for this health care legislation are not going to be able to fix any of this. Because when the bill comes over to the Senate, and they supposedly have put the fixes in it, the reality is that every one of those things that is subject to a point of order will be stricken from the bill on a point of order. Some things can be amended, of course. So the House is going to have to deal with the bill at least one more time if, in fact, they pass it this weekend. The Senate is not going to bail them out, as some of them apparently think may be the case.

So I throw that note of caution to my colleagues in the House who may be thinking of supporting this bill on the grounds that the Senate is going to clean it up. In fact, that is not going to happen.

Yes. Madam President, my colleague is exactly correct, and the math is correct as well. It is very disappointing to me because most of the doctors with whom I have spoken are very afraid of this legislation. They are afraid of what it will do in their practices in the way they will be able to deal with their patients. They are also afraid because they can see this continued downward pressure on reimbursements they receive. Frankly, a lot of them are saying: We are not going to be able to take Medicare patients in the future.

In my own State of Arizona, in fact, the Mayo Clinic has already announced that at two or three of its facilities, it is not going to take new Medicare patients. So that is one of the things that should be fixed in the health care bill. It is not fixed.

It disappoints me that even though the medical association has urged they take out a very pernicious amendment that deals with specialty hospitals--basically, it cuts specialty hospitals off in the future; and the AMA has fought very hard to allow specialty hospitals to exist, but that is not going to get fixed in this bill--even though they have sought to be excluded from the Medicare cuts that are in the Medicare Commission here--that is supposedly going to save $250 billion or so; that has not been fixed--and even though they need to have the basic reimbursement section, the so-called SGR, fixed--and as my colleague has just pointed out, it is not fixed in the legislation--what is disappointing to me is--and those are three of the most critical elements of this bill because of the effect it will have on the treatment of their patients--the American Medical Association is still toying with the idea of supporting the legislation, when the vast majority of physicians in the country, in my opinion, do not support the legislation. Again, it is primarily because of the effect they think it will have on their patients.

I would close by saying, all of these----

OK.

Madam President, I will conclude by saying, absolutely yes. This is one of the good ideas Republicans had. Rather than creating a new entitlement, taking money from Medicare to fund that new entitlement, the savings we believe we can achieve in Medicare should be applied to keeping Medicare solvent for another 17 years or whatever amount of time this money could provide.

Then, if we are going to expend money, let's use it to pay the hard- working physicians and all the other providers, the RNs, the folks in the hospitals, and everybody else whom we want there to take care of us when we get sick. Let's make sure that money is available there and that we have some kind of permanent resolution of this problem so we do not have to come back and try to fix it every year.

Those are just some of the things we believe should be done rather than to scrap the whole system we have, replace it with this new government-operated behemoth that takes over this big section of our economy, pushes government bureaucrats between patients and their physicians and ends up providing enormous new taxes, without cutting the premiums--in fact, allowing premiums to go up even more than they would have otherwise. Other than that, it is a nifty idea. Of course, I am being facetious. The health care bill, in my opinion, is not a good idea.

My last point is simply to urge my colleagues in the House to appreciate the fact that the Senate is not going to bail them out by cleaning up the Senate bill, which we already passed here, and they should not be voting for this legislation under the false assumption that somehow we are going to make all those changes in the Senate bill.

The following Senator is necessarily absent: the Senator from Utah (Mr. Bennett).

The following Senator is necessarily absent: the Senator from Utah (Mr. Bennett).

The following Senator is necessarily absent: the Senator from Utah (Mr. Bennett).

The following Senator is necessarily absent: the Senator from Utah (Mr. Bennett).

Mr. President, let me echo the comments of all my colleagues who have spoken to the issue. I think the comments Senator Warner just made summarize the issue very well and I

will not repeat all those things. The translation of all this for our colleagues is--although I am not making the announcement--that I presume there will be no further formal action in the Senate tonight or tomorrow but that we will be laying down a modification of the amendment that was filed that would include modifications to the perimeter rule and perhaps other matters.

We will have an opportunity to discuss that tomorrow, and there will be some opportunity to discuss that Monday, for those who perhaps have already left. In particular, I know some of my colleagues will not return until around 4:30 in the afternoon. I am not going to propound a unanimous-consent request, but I hope, in consultation with the two leaders, we could work out an arrangement whereby at least some of the time on Monday can be reserved for a debate on the amendment that will be filed by, presumably, Senator Hutchison, myself, Senator Ensign and others and that part of that time will also be in the 4:30 to 5:30 timeframe. That is the time the leader has ordinarily set for the first vote, returning on Monday, and presumably there will be a unanimous- consent agreement with the leaders that will reflect the precise understanding of what vote or votes will occur on Monday night and when, but presumably it would fall within that timeframe that is customary.

Just to conclude by saying I hope that as a result of the conversations we have had and will continue to have Monday and tomorrow, that we can lay the foundation for the establishment of a Senate position in the conference committee that would reflect a consensus and perhaps some compromise that would satisfy the interests of all. We are never going to outdo the fierceness with which both Senator Warners--Senator John Warner, who preceded, and now-Senator Mark Warner--fight for their constituents and for the interests of two national airports--in a sense representing us all. We certainly appreciate the single-mindedness with which now-Senator Mark Warner has pursued those interests but also his recognition that obviously times change, there are some needs for other parts of the country, and that through comity and conversation perhaps things can be worked out without having any detriment to anybody. That is obviously the goal we would seek to accomplish.

In any event, we will have an amendment on the floor that can discuss this. Perhaps we will vote on it. In any event, the object will be to vote on final passage of the bill on Monday evening.

The following Senators are necessarily absent: the Senator from Utah (Mr. Bennett) and the Senator from Idaho (Mr. Crapo).

The following Senators are necessarily absent: the Senator from Utah (Mr. Bennett) and the Senator from Idaho (Mr. Crapo).

The following Senator is necessarily absent: the Senator from Utah (Mr. Bennett).

I ask unanimous consent to speak for 15 minutes.

Mr. President, we are going to be taking up the so-called HIRE Act starting tomorrow. I wish to address some of the problems with it since the procedure under which we have considered this bill does not allow any amendments. As a result, we have no opportunity to fix problems that are inherent with the bill and will force me to vote against it.

The first provision that should be highlighted is the provision called the Build America Bonds. This was created first in the 2009 stimulus bill. It offers a direct subsidy from the Federal Government to States and other governmental entities to cover their cost of financing for certain kinds of projects.

The House-passed bill expands this subsidy by allowing four current tax-preferred bonds to qualify for the direct subsidy under this program and increases the generosity of that subsidy to cover all of the borrowing costs for education projects. This will mean an expansion of the already substantial support the Federal Government offers for State and local governments, support for which we taxpayers are then responsible. The Federal Government gave $44 billion in extraordinary stimulus State aid last year and regularly spends $26 billion annually in sub-Federal Government subsidies through tax-exempt bond financing. This is a significant Federal expenditure for which taxpayers will be responsible.

Here is the key problem, in addition to the additional exposure of taxpayers: Because interest rates reflect risks, States with poor credit ratings that therefore pay higher interest rates would actually be rewarded under this legislation due to the structure of these bonds. For example, a State that issues $1 billion worth of debt paying a 5- percent interest rate would receive a bigger direct payment from the Federal Government than a State issuing $1 billion worth of debt paying a 4-percent interest rate. Thus, States with lower credit ratings could receive larger subsidies, which, of course, encourages greater risk- taking and creates an incentive for States to issue even more debt than they would have without the subsidy.

The so-called jobs bill would further reward States with poor credit. The Senate version of the bill expands the Build America Bonds program by giving insurers of certain tax credit bonds for school construction and alternative energy projects the option of receiving direct payment of up to 65 percent of the interest cost. The House bill would, in certain cases, reimburse up to 100 percent of a project's interest costs.

The original Build America Bonds program encouraged States to take greater risks. The bill we will consider tomorrow would make the problem even worse. One of the lessons from the financial crisis is that people should not borrow more than they can afford. Unfortunately, it appears many of us have not taken this lesson to heart.

There is a provision relating to highway extension. Rather than being a straight extension of the current highway authorization, this bill represents a significant expansion of the Federal Government's funding for highway projects. The highway piece first cancels rescissions that were scheduled under the last highway reauthorization. It then permanently increases the authorization levels for highway spending and permanently authorizes interest payments from the general fund to the highway trust fund and authorizes a one-time transfer of $19.5 billion from the general fund to the highway trust fund.

Although not all of these costs will show up as increasing the deficit because of the unique CBO scoring conventions, all told, the highway extension under this bill will add $46.5 billion to the debt over the next 10 years and will authorize $142.5 billion in additional spending over the next 10 years.

You hear the President talking about not adding to the deficit. All of our colleagues wring their hands and say: We have to somehow control Federal spending. Yet in this legislation we take up tomorrow we add $46.5 billion to the debt over the next 10 years and then authorize an additional $142.5 billion of spending over the next 10 years. When will it stop?

There is a provision of the bill that has some merit to it. It is called the payroll tax holiday, although I think the way it has been constructed is not something we should do. This is the most expensive piece of the bill. In fact, the Congressional Budget Office has told us that it expects a provision similar to this to create five to nine jobs for each million dollars in budgetary cost in 2010. Since this provision would cost approximately $13 billion by using the CBO model, one would estimate that the provision would create between 65,000 and 117,000 jobs this year at a cost of $110,000 to $200,000 per job. This sounds a lot like the stimulus bill to me, a very inefficient way to create jobs, if, in fact, they actually get created.

The proposed payroll tax holiday comes on the heels of the Senate- passed health care bill which actually increases the Medicare payroll tax from 2.9 percent to 3.8 percent. This actually would relieve employers of an

element of the payroll tax. So which is it? Do we agree that payroll taxes that are increased are unhelpful to job creation?

According to Timothy Bartik of the Economic Policy Institute:

The employer tax credit in the Senate jobs bill is likely

to create few jobs and at an excessively high cost.

As I have said, up to $200,000 per job.

He explains it this way:

Awarding credits for hires can be very expensive. Over a

one-year period, the number of hires, as a percentage of

total private employment, is over 40 percent even during a

recession. To pay for hires that would have occurred anyway

will be expensive and won't necessarily increase total

private sector employment. The Schumer-Hatch design tries to

avoid some of these large costs in several ways. First,

credits are limited to hiring the unemployed, apply only to

the rest of 2010, and are only worth 6.2 percent of the new

hire's payroll costs. The retention bonus is of modest size

and delayed. While these limits control costs, they also

hamper the credit's benefits.

Limiting the credit to hiring someone unemployed at least

60 days makes the credit less attractive to employers.

Not only does the credit become more complicated to claim

(which reduces its effectiveness), but it restricts the

employer's hiring to a more limited pool of workers.

Bartik also explains that past experiences--for example, with the targeted jobs tax credit, the work opportunities tax credit, and the welfare-to-work tax credit--show that tax credits to encourage hiring disadvantaged workers usually generate little employer interest and have a negligible effect upon employer behavior. He says:

Employers are happy to claim such credits, if they happen

to meet the credit's rules, but they are reluctant to change

their behavior in response to such targeted tax credits.

So even the one provision of the bill that actually has some alleged relationship to job creation probably would not and, to the extent it does, would cost an extraordinary amount of money per job actually created.

Let me turn to one of the ways in which these expenses are allegedly offset: delaying the application of the so-called worldwide interest allocation. This is a very bad idea. This delays implementing a corporate tax reform we passed in 2004 in order to help American businesses properly account for their overseas income and, frankly, be more competitive with those abroad.

The worldwide interest allocation rules were originally improved as part of the American Jobs Creation Act of 2004, as I said, and were scheduled to take effect in 2009. However, the Housing and Economic Recovery Act of 2008 delayed the effectiveness of these rules by 2 years to 2011. The Worker, Homeownership, and Business Assistance Act of 2009 that extended the first-time home buyer tax credit further delayed the effectiveness of these rules to 2018.

The so-called jobs bill would delay this provision through the end of the existing budget window to 2021. Repeated delays have the same effect as repeal: an increase in the effective corporate tax rate. As I said, that does nothing to help our American businesses in their desire to compete overseas.

So these are just some of the reasons why I am not going to be able to support the HIRE Act, and I would urge my colleagues, since we are not going to have an opportunity to amend it, to oppose it as well.

Might I ask, Mr. President, how much time I have remaining?

Mr. President, I wish to address now the health care legislation we passed in the Senate and that is pending over in the House of Representatives.

There is a news report that Democrats are going to use the strangest of all procedural tactics to try to pass the Senate health care bill over in the House of Representatives, and this is against a backdrop of a lot of strange things--the use of the reconciliation process, all the backroom deals that result in the various benefits for various Senators and Representatives--we have heard so much about.

It almost seems Democratic leaders view the views of their constituents as an obstacle to be overcome, and every time the polls show even more opposition to the legislation, they decide to try even more clever ways of getting around their constituents' views--wheeling and dealing, backdoor legislation--but nothing quite as brazen, I guess I would say, as the process we now see developing. This is a process I became familiar with as a Member of the Senate--not when I was in the House of Representatives because I do not believe it was ever used then, although it might have been and I was not aware of it. But it is a process by which House of Representatives Members can actually say they have passed a piece of legislation without ever voting on it.

You might say: That does not quite comport with what I learned in eighth grade civics class, and you would be right. We all know the only way a President can sign a bill is if identical versions of legislation pass both the House and the Senate.

Well, the House does not want to have to vote on the Senate health care bill because, as the Speaker of the House said: ``Nobody wants to vote for the Senate bill.'' So now what they have done is concoct a way you can actually pass the bill without ever voting for it, and it is by including the substantive Senate-passed bill into the rule that as a procedural matter the House votes on to consider each measure. So as a rule to consider the reconciliation bill is brought to the House floor, it would contain a provision that would deem the Senate-passed bill passed, even though the House Members would never vote on it.

That is wrong. It is probably unconstitutional. Any House Member who believes he or she can go home and say to their constituents: Well, I never voted for the Senate-passed bill is, frankly, not going to get away with it because, by voting for the rule, they will have voted for the Senate-passed bill.

It seems to me this is the time for principled Members of the House of Representatives to stand and say: Enough. I may even somewhat like what we are trying to do with this health care legislation, but somebody has to stand for principle, and principle means, at a minimum, voting for legislation that you send to the President for his signature--not standing behind a rule which deems legislation to have been passed, even though it was never separately voted on.

It seems to me, first of all, we should make it crystal clear we will make this famous to the American people, if in fact they decide to use this process--something that has never been used for a bill such as this before. This so-called deeming rule will become part of the lexicon of American political discourse, and people will come to know it, just like they did the House banking scandal and certain other things here in Washington, to represent a time period and a group of people who were willing to violate all rules of sensibility, of morality, as well as legality in order to try to accomplish ends that could not be accomplished in other ways.

Nobody who votes for this rule and then later claims they did not have anything to do with passing this Senate bill is going to be able to get away with that. The American people will understand it. Frankly, whether they are sympathetic to the underlying health care legislation, they are not going to be sympathetic to Members of the House of Representatives who decide to do this kind of end run, this sort of scheme to deem a bill passed that has never been separately voted on in that body.

I hope the health care legislation we have now debated for a year can stand or fall on its merits. The American people have made it clear they do not want this legislation. Twenty-five percent do, but seventy- three percent have said either stop altogether or stop and start over. That is what we should be doing. Because of this wave of opposition by our constituents, our colleagues in the House should not try to get around that by using a procedure that is totally inappropriate to the purpose.

Mr. President, might I make a parliamentary inquiry: Is there more time remaining on the Republican side?

Thank you, Mr. President.

What I would like to do, until Senator Grassley arrives--I first ask

unanimous consent to have printed in the Record a letter from Gov. Janice K. Brewer of Arizona, dated March 10, 2010, to President Barack Obama.

Let me briefly describe the reason for this request.

Arizona is suffering, as are other States, from the economic downturn. We have an unemployment rate now that has more than doubled. In fact, it has gone from 3.6 percent in June of 2007 to 9.2 percent this month. Our State faces a $1.4 billion shortfall in the current fiscal year and a $3.2 billion shortfall for the next fiscal year, despite the fact that the Governor and the State legislature have imposed significant spending reductions.

State revenues are down by 34 percent. Notwithstanding this, over 200,000 Arizonans have enrolled in the State's Medicaid Program, known as AHCCCS--which is our Arizona health Care Cost Containment System-- just since the beginning of 2009. That is nearly 20,000 new enrollees every month. The last thing, given these kinds of numbers, Washington should be doing is making the States' economic or fiscal problems even worse. Yet that is exactly what Governor Brewer says the Senate health care bill would do because it would require every State to expand its Medicaid Program.

The Federal Government would foot the bill for 3 years. Then the States would have to help finance the expansion in 2017 and in subsequent years. She estimates the bill would increase the cost in Arizona by nearly $4 billion over the next 10 years. Making matters worse, the early expansion States--States such as Arizona that have already expanded Medicaid to cover the uninsured, as I noted--will actually get fewer Federal dollars than the States that have not yet expanded their Medicaid Programs, in effect punishing those who have tried to do the right things--the exact things Democrats have wanted in the health care bill.

As she observed in her letter:

Arizona taxpayers will have the misfortune to pay twice:

once for [Arizona's] program and then once more for the

higher match for other states.

Additionally, States currently retain important flexibility in administering their Medicaid Programs so they are not caught off-guard as the economy changes. But as Governor Brewer notes, that flexibility would be eliminated under the Senate bill. She says:

Under your proposal, more power is centralized in

Washington, DC, and the states just become another financing

mechanism. Not only will states be forced to pay for this

massive new entitlement program, but our ability to control

the costs of our existing program will be limited. These

policies are simply not sustainable, and will result in a

greater burden on state budgets and state taxpayers.

Mr. President, since I put the letter in the Record, I will not reflect further on it but note the fact that this is yet one more reason for Members to oppose the Senate-passed bill in the House.

The following Senator is necessarily absent: the Senator from Utah (Mr. Bennett).

The following Senator is necessarily absent: the Senator from Utah (Mr. Bennett).

The following Senator is necessarily absent: the Senator from Utah (Mr. Bennett).

The following Senators are necessarily absent: the Senator from Utah (Mr. Bennett) and the Senator from Alabama (Mr. Shelby).

Mr. President, I wish to pick up on the comments of my colleague, the Republican leader.

There is another distressing story in the paper today reported by the Associated Press. They report that all of the special deals that last week the President said he was going to try to remove from the legislation, now--except for the ``Cornhusker kickback''--they are going to leave them in there because they need the votes. If that is correct, this process is even sicker than we thought it was.

Part of the reason for the Democratic leadership using the reconciliation provision to fix the Senate bill was to take all of these special provisions out, but now it appears, according to the Associated Press, that they are going to be kept in there because they need the votes.

Let me detail what a couple of these are. Last week, there was a story in Politico that detailed six specific items. Of course, there was the ``Cornhusker kickback'' that got such bad publicity and everybody agreed it had to go, including the Senator who voted for the legislation after he was promised that in his State there would be no cost for the coverage of additional Medicaid patients. Now that is apparently going to be ``fixed,'' at great expense, I might add, to the taxpayers of the United States, but apparently unfixed are six other items, and there are more, by the way.

Quote:

``We have defended it and we will defend it,'' said Senator

Bernie Sanders of Vermont, whose state picked up $600 million

in extra Medicaid funding . . .

Again, I am quoting from a March 10 Politico story.

Second:

In a letter to congressional leaders last week, Obama

targeted the Nebraska and Florida deals for elimination. The

Florida provision could also shield some seniors in

California, New York, New Jersey, and Pennsylvania, according

to Senator Bill Nelson's office.

This provision deals with Medicare patients. The reason it is important to me is because there are 330,000-plus Arizona seniors who have Medicare Advantage plans. These are the plans that would suffer under the legislation proposed by the President. Because they would have benefits they currently enjoy taken away from them, the seniors in all of the States are obviously complaining to their Senators. So Democrats have said: Well, OK, if seniors are upset about having these benefits taken away, then we will shield the seniors in our States who have these Medicare Advantage policies so that they don't have to give up their benefits--the biggest set of beneficiaries, and there are over 800,000 of them in the State of Florida but apparently also some in California, New York, New Jersey, and Pennsylvania. All right. Special deal for them.

If this bill, by the way, is so great, why do we have to protect our citizens from its provisions? But that is the way it works. However, my senior citizen constituents in Arizona don't get grandfathered as do those in other States. It just shows you how bad the bill policy is in the area generally that you have to protect your constituents from suffering the effects of the bill but also the bad policy that does that to the detriment of other constituencies. Apparently, now that is going to stay in the bill.

Then there was the so-called ``Louisiana purchase,'' $300 million to Louisiana. Then there was the $1.1 billion

in extra Medicaid funding to Massachusetts and Vermont. This Politico article quotes Senator Patrick Leahy of Vermont:

What I told Harry Reid is that Vermont does the right

thing, and I don't want Vermont to be penalized for doing the

right thing.

Of course, that is the kind of argument that is made in response to provisions in the bill that are bad provisions because they hurt the people in your State. But the solution is not to exempt your State's constituents from the bad effects of the bill. Don't pass the bill. It is a bad bill.

Here is a fifth example. There is a $100 million hospital grant program requested by our colleague from Connecticut, Senator Dodd, ``who has acknowledged that the University of Connecticut would qualify for the money.''

Here is a sixth one that is being promoted by the chairman of the Finance Committee, Senator Baucus, on behalf of the residents of Libby,

Mr. President, I will briefly summarize it. The President is visiting in Ohio, I believe, today to highlight the case of a particular Ohio resident. I believe she is a breast cancer survivor. Her insurance eventually became too expensive for her to keep up. She now has a diagnosis of another disease, and the President is highlighting this type of case. I think it is important to highlight it for another reason.

I presume the President or the Senators or Representatives of Ohio are finding an alternative way to ensure she is cared for. Frequently, we have constituents come to us with situations such as this. They represent very heartrending situations, problems with which you want to deal. The real question is how to deal with it. The answer to her problem is not to pass this health care bill. There are alternatives.

For example, for those who cannot get insurance that is affordable to them because of preexisting conditions--Republicans have put ideas on the table, as have Democrats, but that is a specific kind of problem that can be solved with a specific solution rather than this entire health care bill the President is trying to sell to us.

What Robert Samuelson points out in his article is there are a lot of different situations such as this, where people who are not insured nevertheless get care. In fact, the argument is made that we need this kind of health care bill because there are too many people who are uninsured and get expensive and ineffective treatment at the emergency room. He says: ``Unfortunately it's not true.''

He quotes a study by the Robert Wood Johnson Foundation that finds that the insured population ``accounted for 83 percent of emergency- room visits, reflecting their share of the population.'' In other words, there is not a difference of who visits the emergency room and who does not depending on whether you are insured.

He goes on to say:

After Massachusetts adopted universal insurance, emergency-

room use remained higher than the national average, an Urban

Institute study found.

The point is, even after you get the so-called universal coverage, you do not find any difference in terms of emergency room visits. If anything, with universal coverage, you had even higher emergency room visits. His point is, and I quote Robert Samuelson:

If universal coverage makes appointments harder to get,

emergency-room use may increase.

So you are not making the problem better; if anything, you are making it worse. My guess is, you are not affecting it much one way or the other. It is simply not an argument that because people who are uninsured go to the emergency room, therefore, we have to pass some kind of nationwide health care bill such as has been suggested to us.

He goes on to point out:

You probably think that insuring the uninsured will

dramatically improve the nation's health.

He goes on to debunk that myth:

I've written before that expanding health insurance would

result, at best, in modest health gains.

He goes on to point out that studies have validated the fact it does not make a difference one way or another.

Claims that the uninsured suffer tens of thousands of

premature deaths are ``open to question.'' Conceivably, the

``lack of health insurance has no more impact on your health

than lack of flood insurance.

He goes on to detail the reasons why that is so.

He concludes with this point:

Though it seems compelling, covering the uninsured is not

the health-care system's major problem. The big problem is

uncontrolled spending.

That is a point Republicans have been trying to make from the very beginning, to point out we ought to first focus on dealing with what is driving up health care costs. That will, if we are successful, have a positive impact on getting people insured because it will reduce the cost of insurance they have to buy or their employer is buying on their behalf.

That is what we should be focusing on rather than this rather elusive issue of coverage of the uninsured. To be sure, nobody is arguing we should not help cover the uninsured. That is not the argument we are making. The argument we are making is, it does not justify a $2.5 trillion expenditure and that, in any event, if you focus first on dealing with costs, you are going to reduce costs, which is a good thing in and of itself, and, thereby, also enhance coverage because the cost is less expensive.

Here is the penultimate paragraph in the piece. I will quote him and close. What Samuelson said is the President is:

. . . telling people what they want to hear, not what they

need to know. Whatever their sins, insurers are mainly

intermediaries; they pass along the costs of the delivery

system. In 2009, the largest 14 insurers had profits of

roughly $9 billion; that approached 0.4 percent of total

health spending of $2.472 trillion.

Four tenths of 1 percent.

He goes on to say:

This hardly explains high health costs. What people need to

know is that Obama's plan evades health care's major problems

and would worsen the budget outlook. It's a big new spending

program when government hasn't paid for the spending programs

it already has.

His point is, instead of trying to make insurance companies the villain, the President should be honest about what their true cost is.

Somebody pointed out--my colleague, Lamar Alexander--if you take all the profits of all the insurance companies, it pays for 2 days' worth of health care expenditures in the country. What about the other 363 days? Nobody is defending the insurance companies, but you cannot say they are responsible for the high costs of health care in this country, since they are primarily just passing those costs on.

The bottom line is, we need to be honest and explain to the American people what we are trying to accomplish or what we should be trying to accomplish is reducing health care costs. That will have the salutary effect of making access easier for people

because they will be able to afford the insurance that now may be unaffordable for them. But the idea that the insurance companies are the reason we have the problem or that emergency rooms are used more because of the uninsured are two myths that are dispelled in this piece by Robert Samuelson.

I yield to my colleague from Oklahoma.

Exhibit 1

[From the Washington Post, Mar. 15, 2010]

Obama's Illusions of Cost-Control

(By Robert J. Samuelson)

``What we need from the next president is somebody who will

not just tell you what they think you want to hear but will

tell you what you need to hear.''--Barack Obama, Feb. 27,

2008

One job of presidents is to educate Americans about crucial

national problems. On health care, Barack Obama has failed.

Almost everything you think you know about health care is

probably wrong or, at least, half wrong. Great simplicities

and distortions have been peddled in the name of achieving

``universal health coverage.'' The miseducation has worsened

as the debate approaches its climax.

There's a parallel here: housing. Most Americans favor

homeownership, but uncritical pro-homeownership policies (lax

lending standards, puny down payments, hefty housing

subsidies) helped cause the financial crisis. The same thing

is happening with health care. The appeal of universal

insurance--who, by the way, wants to be uninsured?--justifies

half-truths and dubious policies. That the process is

repeating itself suggests that our political leaders don't

learn even from proximate calamities.

How often, for example, have you heard the emergency-room

argument? The uninsured, it's said, use emergency rooms for

primary care. That's expensive and ineffective. Once they're

insured, they'll have regular doctors. Care will improve;

costs will decline. Everyone wins. Great argument.

Unfortunately, it's untrue.

A study by the Robert Wood Johnson Foundation found that

the insured accounted for 83 percent of emergency-room

visits, reflecting their share of the population. After

Massachusetts adopted universal insurance, emergency-room use

remained higher than the national average, an Urban Institute

study found. More than two-fifths of visits represented non-

emergencies. Of those, a majority of adult respondents to a

survey said it was ``more convenient'' to go to the emergency

room or they couldn't ``get [a doctor's] appointment as soon

as needed.'' If universal coverage makes appointments harder

to get, emergency-room use may increase.

You probably think that insuring the uninsured will

dramatically improve the nation's health. The uninsured don't

get care or don't get it soon enough. With insurance, they

won't be shortchanged; they'll be healthier. Simple.

Think again. I've written before that expanding health

insurance would result, at best, in modest health gains.

Studies of insurance's effects on health are hard to perform.

Some find benefits; others don't. Medicare's introduction in

1966 produced no reduction in mortality; some studies of

extensions of Medicaid for children didn't find gains. In the

Atlantic recently, economics writer Megan McArdle examined

the literature and emerged skeptical. Claims that the

uninsured suffer tens of thousands of premature deaths are

``open to question.'' Conceivably, the ``lack of health

insurance has no more impact on your health than lack of

flood insurance,'' she writes.

How could this be? No one knows, but possible explanations

include: (a) many uninsured are fairly healthy--about two-

fifths are age 18 to 34; (b) some are too sick to be helped

or have problems rooted in personal behaviors--smoking, diet,

drinking or drug abuse; and (c) the uninsured already receive

50 to 70 percent of the care of the insured from hospitals,

clinics and doctors, estimates the Congressional Budget

Office.

Though it seems compelling, covering the uninsured is not

the health-care system's major problem. The big problem is

uncontrolled spending, which prices people out of the market

and burdens government budgets. Obama claims his proposal

checks spending. Just the opposite. When people get

insurance, they use more health services. Spending rises. By

the government's latest forecast, health spending goes from

17 percent of the economy in 2009 to 19 percent in 2019.

Health ``reform'' would probably increase that.

Unless we change the fee-for-service system, costs will

remain hard to control because providers are paid more for

doing more. Obama might have attempted that by proposing

health-care vouchers (limited amounts to be spent on

insurance), which would force a restructuring of delivery

systems to compete on quality and cost. Doctors, hospitals

and drug companies would have to reorganize care. Obama

refrained from that fight and instead cast insurance

companies as the villains.

He's telling people what they want to hear, not what they

need to know. Whatever their sins, insurers are mainly

intermediaries; they pass along the costs of the delivery

system. In 2009, the largest 14 insurers had profits of

roughly $9 billion; that approached 0.4 percent of total

health spending of $2.472 trillion. This hardly explains high

health costs. What people need to know is that Obama's plan

evades health care's major problems and would worsen the

budget outlook. It's a big new spending program when

government hasn't paid for the spending programs it already

has.

``If not now, when? If not us, who?'' Obama asks. The

answer is: It's not now, and it's not ``us.'' Pass or not,

Obama's proposal is the illusion of ``reform,'' not the real

thing.

The ACTING PRESIDENT PRO TEMPORE. The Senator from Oklahoma.

The following Senators are necessarily absent: the Senator from Utah (Mr. Bennett), the Senator from Kentucky (Mr. Bunning), the Senator from South Carolina (Mr. DeMint), the Senator from New Hampshire (Mr. Gregg), the Senator from Utah (Mr. Hatch), and the Senator from Ohio (Mr. Voinovich).

Further, if present and voting, the Senator from Kentucky (Mr. Bunning) would have voted ``nay.'' The Senator from South Carolina (Mr. DeMint) would have voted ``nay.''

Mr. President, the economic downturn has continued for a year-and-a-half now and has affected most Americans in some way.

Congress has approved a number of measures, which I supported, aimed at helping those Americans. It recently extended unemployment benefits for those who do not have a job. It also expanded the eligibility requirements and duration for COBRA health benefits for those between jobs, and provided a subsidy for those premiums.

I could not, however, support the so-called jobs bill put forward by the majority leader and recently passed by the Senate.

A jobs bill should create jobs. Beyond some of the tax extenders, there is little in this bill that provides a foundation for jobs creation.

The bill is essentially a large spending package that extends, through 2010, aspects of current law. The provisions it contains, such as long-term extensions of unemployment insurance, COBRA, and FMAP State aid, do not promote jobs growth, and, in fact, anticipate that unemployment will still be a serious problem for the remainder of the year.

A negative correlation exists between unemployment benefits and work incentives. As President Obama's chief economist Larry Summers has written:

Government-assistance programs contribute to long-term

unemployment by providing an incentive, and the means, not to

work. Each unemployed person has a 'reservation wage'--the

minimum wage he or she insists on getting before accepting a

job. Unemployment insurance and other social-assistance

programs increase that reservation wage, causing an

unemployed person to remain unemployed longer.

He further concludes:

Unemployment insurance also extends the time a person stays

off the job.

That analysis underscores my point. While I do not disavow the need for unemployment benefits and have supported every short-term extension, I do believe that long-term extensions of those benefits do not lead to job creation and should not be touted as part of a jobs bill.

The cost of this bill is also a problem. When President Obama signed the pay-go Act 4 weeks ago, he said:

Now, Congress will have to pay for what it spends, just

like everybody else.

This bill waives those brand new pay-go requirements and adds more than $100 billion to the already-exploding deficit.

Good jobs legislation would address the underlying problem of unemployment, rather than treating the symptoms of a weak economy. Good jobs provide far more security to American families than temporary government benefits do.

There are a number of steps Congress can take that will actually put Americans back to work.

One is ending the constant cycle of spending billions of dollars the Treasury does not have. When the government borrows money--it borrowed $1.4

trillion last year--it's more difficult for the private sector to borrow and invest. When businesses can't grow their operations, they can't afford to hire new employees.

Congress can also ameliorate the uncertainty that is preventing new hiring by not raising taxes and costs on employers. Unless they are extended, the lower tax rates that have been in place since 2001 are set to expire at the end of this year, triggering a $2 trillion tax increase over the next decade. Businesses will remain timid about hiring if they think new taxes will add to the cost of their business and consume the capital that could be used to pay new employees.

There are other steps Congress can take--promoting our Nation's exports by passing free-trade agreements with Colombia, Panama, and South Korea, and increasing production of domestic energy resources, for example.

Passing bills that increase our Nation's debt and create disincentives to work will not encourage investment in the economy. If we want business owners and entrepreneurs to start creating jobs, Congress should act so that it does not become harder and more expensive to do business.

Mr. President, I appreciate my colleague asking. There are 330,000 seniors in the State of Arizona who rely on Medicare Advantage. It is exactly as Dr. Barrasso said: Medicare Advantage is a program that helps people with preventive care, with coordinated care, and with some of the things that aren't available under regular care, including vision care, audio care, and the like. These benefits would be drastically cut under the proposal in this legislation, so they are naturally very much opposed to it. I think Arizona represents the second largest State in terms of the number of seniors participating in Medicare Advantage.

The other part of this that concerns them is the fact that if it is such a good idea to eliminate this program--or to drastically curtail it, to be perfectly accurate--then why is it that in one State the Senator was able to get his senior citizens who have Medicare Advantage programs exempted from the bill? If it is such a wonderful idea, why shouldn't it apply to everybody? But the seniors in Florida would be grandfathered in their Medicare Advantage plans because, of course, they don't like these cuts any more than seniors in Arizona or Wyoming or any other State.

So this brings up the question: How can these provisions that are objected to by the American people be fixed in the process that has now been settled upon, this so-called reconciliation process?

If I could address that for a moment. The author of this so-called reconciliation process is our esteemed colleague, the senior Senator from West Virginia, Robert Byrd. Here is what he had to say about using the process he created, this reconciliation process, for the purposes of consideration of health care legislation. I quote him from the Washington Post, March 22, 2009:

I am certain that putting health care reform and climate

change legislation on a freight train through Congress is an

outrage that must be resisted.

Using the reconciliation process to enact major legislation

prevents an open debate about the critical issues in full

view of the public. Health reform and climate change are

issues that in one way or another touch every American

family. The resolution carries serious economic and emotional

consequences.

The misuse of the arcane process of reconciliation--a

process intended for deficit reduction--to enact substantive

policy changes is an undemocratic disservice to our people

and to the Senate's institutional role.

That is what Senator Byrd had to say. Yet that is the process that has been selected by the Democratic leaders to force this legislation through the Congress.

The final point I wish to make with respect to this is I think, to some extent, it may be a cruel hoax on some of our Democratic colleagues in the House of Representatives who are counting on the Senate to back up the reconciliation bill that might be passed in the House of Representatives. What they are assuming is, when they attempt to fix the Senate bill they don't like very much by amending it through this reconciliation process and then sending that bill over to the Senate, the Senate is simply going to pass the bill. Voila: The bad Senate bill has been fixed, the President can sign the reconciliation bill, and we will now have national health care reform.

Well, not so fast. As a matter of fact, the author of this reconciliation process also created what is known around here as the Byrd rule, which means that if you go outside the narrow lanes of the reconciliation process and try to include things in the bill that don't belong in the reconciliation process, then it is, of course, subject to a point of order, as it should be, and it would take 60 Senators to override that point of order.

Well, there are a lot of things that are going to be attempted to be fixed in the reconciliation bill that are subject to a point of order-- the Byrd rule. Those points of order will be upheld because I am going to predict to my colleagues that 41 Republican Senators are not going to allow that misuse of the reconciliation process--going outside what is clearly a reconciliation process--which means the bill that is passed in the House of Representatives, if it is, would not be passed by the Senate. Key provisions of it would have been stricken on points of order. Then, our friends in the House of Representatives would be faced with the prospect that they had already passed this bad Senate bill they don't like very much--and that I don't like very much--but the President can sign that into law. Yet the process by which they would attempt to fix it has failed because of the points of order that can be raised and that will be raised and that will be sustained, as should be the case, under the application of the so-called Byrd rule.

So when my colleague from Wyoming talks about his constituents in Wyoming objecting not only to the substance of the bill but also the process by which it has been handled, I can answer the question: Yes, I met with a whole group of people from different States this weekend-- from Pennsylvania, California, New Jersey, New York--I visited with folks from literally all over the country, and they had the same objections, both as to the substance of the legislation, but they were also very curious about this reconciliation process because they had heard it could be used to ram the bill through by a process that it was never intended for, and they wanted to talk about that. When we explained the fact that the legislation adopted by the House--if it is--would not necessarily be adopted in the Senate but would be subject to these points of order--and, by the way, amendments, an unlimited number of amendments--then at least they understood why House Democrats who will insist on amending the Senate bill should not rely on the Senate to do their bidding. That isn't going to happen.

Let me say one other thing before I turn it back over to my colleague from Wyoming. It has been such a learning experience for us and an inspiration to have a couple real physicians in the Senate. Our only two physicians here are Dr. Barrasso, an orthopedic surgeon from Wyoming, and Dr. Tom Coburn, a physician from the State of Oklahoma, to talk about the real world of treating patients and how there are ways that care can be given in a less expensive way but retaining both the essential quality of care and that intangible but incredibly important--almost sacred--relationship between the doctor and the patient.

I see Dr. Coburn has joined us on the floor. It is key for the rest of us to understand how this process works when physicians sit down with patients and determine the best course of action to preventive care, that can both be the least expensive and yet still deliver the quality care that their patients deserve.

I think we ought to pay more attention to the advice they have provided to us, and I commend both Senator Barrasso as well as Dr. Coburn for the advice they have given to us, and I hope we will continue to listen to that advice as this debate unfolds.

If my colleague would yield for a quick comment on that point.

The Mayo Clinic in Arizona, unfortunately, has had to announce that in several of its key facilities there, it will no longer accept new Medicare patients. Why is that so? Because the government program of Medicare, which our seniors rely on, is getting to the point where it does not

pay physicians what they require just to stay in business, just to have their office practice continue.

The Medicaid Program, which is the other government program, is already so low in its reimbursements to physicians that--the numbers differ, but 50 to 60 percent of physicians are no longer taking Medicaid patients. As a result, these government programs end up getting very close to rationing care because there aren't enough physicians and facilities to take care of the people who are enrolled in the programs. Imposing yet another entitlement for even more people to have this care with fees regulated by the Federal Government and reimbursements at levels too low for physicians to take advantage of will simply continue to drive physicians away from the treatment of the patients they have treated over the years and want to continue to treat.

It would be our hope we could bring the incentive for physicians to continue to treat these patients, rather than the disincentives the Mayo Clinic is pointing to in backing out of the treatment of folks in Arizona.

Mr. President, I remember sitting back in the cloakroom and listening to Dr. Coburn when he was talking about how he treats patients who come into his office. A child, he said, comes in who has had a fall on the playground and the parents, understandably, are very concerned. Dr. Coburn said to me: If I just sit down and talk to that young man, that child, talk to his parents for a while, I can usually figure out what kind of treatment is going to be necessary without necessarily ordering a bunch of tests. But under the medical malpractice situation we have to work under today, I am almost required to order those tests or, if something should go wrong, be accused of malpractice. I wonder if my colleague could relay that story.

Mr. President, might I just inquire how much time remains on the Republican side?

Mr. President, I opened the newspaper, the New York Times, on

Sunday morning and was surprised--shocked--at a full-page advertisement I saw. It had a big headline that said: ``What will it be, Mr. President? Change or more of the same?'' Then it had four photographs or artist's renderings. The first one was of President Barack Obama. It gradually morphed from Barack Obama into George W. Bush, so the last in the frame of four was clearly a likeness of President George W. Bush.

This was an advertisement paid for by the American Civil Liberties Union, the ACLU. I do not know what surprised me more, whether it was the audacity and the blatant partisanship of the ad or its ignorance and misrepresentation of the law. Either way, it deserves some comment today.

The essence of the ad was to obviously try to put some pressure on President Obama not to change his initial decision to transfer the trial of Khalid Shaikh Mohammed to the Manhattan Federal district court, the so-called article III court, back to a military commission where it had originally been. The ad makes the point that ``Barack Obama vowed to change Bush-Cheney policies''--I am quoting now--``and restore America's values of justice and due process.''

Of course, those values didn't exist under the Bush administration, according to the ACLU. They then say they are ``shocked and concerned'' the President is considering changing the 9/11 defendants' trials from criminal court back to military commissions. They say that: ``Our criminal justice system will resolve the cases more quickly and more credibly than the military commissions.'' That is a matter of dispute, which I will get back to in a moment, but then there is this sentence: ``Obama can vigorously prosecute terrorists and keep us safe without violating our Constitution.'' The implication, of course, being if you go to a military commission, you are violating the Constitution.

If that is what they mean to convey, and it is clear they do, the writers of this ad are obviously intentionally misrepresenting the law. The U.S. Supreme Court has upheld military commissions. You can go back to the 1950s case of Johnson v. Eisentrager, involving German war prisoners.

The current U.S. Supreme Court in the Hamdan decision made it clear the President, with authority from Congress, could establish military commissions to try the very people we are talking about, these Islamic terrorists. Indeed, the President came to Congress and, with changes from the administration recommended by the Justice Department, Congress passed the Military Commissions Act of 2006. That act is available to try many of these same terrorists. Indeed, the Attorney General has made it clear there are four categories of these terrorists held at Gitmo. They want to try to release some of them back to their country of origin; they believe some of them should be tried in article III courts--that is like the Federal district court in Manhattan; others of them should be tried before the military commissions that the ACLU seems to think would violate due process; and, finally, that they intend to hold some of them for the duration of the conflict, which is also authorized.

Here you have one of the, at least I thought, preeminent legal authorities in the country--granted they always seem to take the side of the little guy without representation or the person who is not looked upon with great favor who needs legal representation, frequently to represent cases that represent different points of view--certainly, performing a service to our legal community over the years, most people I think would acknowledge. But now they have turned into a blatant partisan political entity that I think can have no more credibility in court for both reasons: First, because of the nature of this, morphing President Obama's face into President George W. Bush's face and talking about changing the Bush-Cheney policies, which obviously they believe do not represent America's values of justice and due process, contending that you have to go to article III courts to try these people or else you are violating our Constitution.

The final conclusion: ``The President must decide whether he will keep his solemn promise to restore our Constitution and due process or ignore his vow and continue the Bush-Cheney policies,'' which in their view, I gather, means not having constitutional rights and due process.

Again, this administration helped the Congress write the military commissions law. That law is in effect today. The administration intends to try many of these same terrorists before those military commissions. The constitutionality of military commissions has been upheld in the past. The constitutionality of the President and the Congress doing so in the future was acknowledged by the Supreme Court in the Hamdan case. No court has ruled that the military commissions that were thus created in the 2006 act would, as the ACLU suggests, violate our Constitution or due process. So what exactly is the ACLU talking about?

Moreover, I said I would get back to it, the ad suggests that the ``criminal justice system,'' meaning the article III courts, ``will resolve these cases more quickly and more credibly than the military commissions.''

Absolutely false, demonstrably false. Khalid Shaikh Mohammed, the kind of poster child here, the mastermind of 9/11, was before the military commission at Guantanamo, and he said he wanted to plead guilty in the military commission. That case could have been over with had his guilty plea been accepted.

I cannot think of a quicker and more successful outcome than accepting the guilty plea of Khalid Shaikh Mohammed.

When the Attorney General came before the Judiciary Committee and hemmed and hawed about what his reason was for moving this trial to the Manhattan Federal district court, he basically settled on the proposition that it would represent a more sure way to gain a conviction. I asked him: ``Mr. Attorney General, this defendant has agreed to plead guilty before the military commission. How much surer of a conviction do you get than that?''

Well, the Attorney General said he wasn't sure he still wanted to plead. But he also assured us, pursuant to a question one of my colleagues asked--what would happen if, for some reason, the court decided to let him go--the Attorney General said: ``Failure of conviction is not an option.''

In other words, he will be convicted, and both he and the President have talked about execution. If the ACLU and the administration are so intent on showing off the great American judicial system which presumes innocence over guilt--and it is literally unethical for prosecutors to go out before the public and guarantee the conviction and execution of a defendant--then it seems to me to be rather odd that this Attorney General would say: Oh, failure is not an option. He will be convicted and, by inference, he will be executed by our wonderful article III courts which, of course, presume innocence.

How the ACLU can say he would be more quickly and more credibly treated than through military commissions is beyond me, after these particular statements.

I go back to my original perplexity: As I say, I don't know whether to be more surprised by the audacity of this organization with a blatantly partisan political ad, obviously highly critical of the Bush- Cheney administration, implying it did not believe in America's values of justice and due process or by the ignorance and misrepresentation of the law by the ACLU. They have smart lawyers, so I assume it is not ignorance, but they are clearly misleading anyone who reads this ad in suggesting both that military commissions would not be pursuant to the Constitution or due process but would rather be a continuation of Bush- Cheney policies. Bear in mind, the new Military Commissions Act of 2006 is not a Bush-Cheney military commission, this is a current U.S. Congress Obama administration military commission law, signed into law by President Bush.

When the ACLU says prosecuting them in the article III courts would keep us safe without violating our Constitution, one has to assume they believe the Military Commissions Act would be violative of the U.S. Constitution, and that is incorrect.

It is unclear to me what is gained by politicizing this issue. My colleague, Lindsey Graham, has talked about the idea of some kind of bipartisan arrangement, whereby the President will acknowledge the will of the American

people, which is very strongly against trying these terrorists in the article III courts and in favor of trying them in military commissions. It seems to me there is sufficient understanding. The administration certainly agrees with the Military Commissions Act. It has said it would use that act to try some of these terrorists. It doesn't believe that act represents an unconstitutional approach to deal with these people. According to public opinion surveys, the American public opinion is very strongly of the view that these cases should be tried before military commissions.

That being the case, it seems to me there is an opportunity for us not to try to make this a partisan issue but to try to follow what the American people believe should be the case; that these cases can and should be tried before military commissions when appropriate; that there is also a place for them to be tried before article III courts; that some of them potentially can be returned to their country of origin, although that represents a significant danger, considering the fact that about 20 percent of them return to the battlefield to fight our forces or that there is a category that cannot be tried in either article III courts or before military commissions.

It seems to me we can have a legitimate discussion of this; that the law that the previous President signed into law that represents the point of view of both Democrats and Republicans, that allows for military commissions, can be used; that the President would be well within his rights to use military commissions; that it would comport with the law as acknowledged by the U.S. Attorney General and would reflect the views of the American people that it is important these terrorists be treated, first and foremost, as enemies of the United States and only if appropriate in article III courts as common criminals.

Finally, the last point I would make is, to some extent, the location of the trial is a lot less important than the primary objective when an enemy terrorist is captured; that is, to get intelligence.

I think this is what upset the American people: when, the first thing that happened, after 50 minutes of questioning of the so-called Christmas Day bomber, that he was read his Miranda rights and he stopped providing intelligence to those who were interrogating him.

Subsequently, that intelligence interrogation has resumed. But we will never know what kind of real-time intelligence was lost as a result of the reading of Miranda rights. When we try people in article III courts, we are going to have to quickly provide these Miranda rights. That ordinarily will mean we give up important--potentially give up important intelligence that we could gain by interrogating the individual.

Now, it is not the case that necessarily we would be foreclosed from trying the individual in an article III court because we can rely on something other than the confession of the individual to gain his conviction. In the case of the would-be bomber on Christmas Day, there was plenty of physical evidence: he was burned badly, there were eyewitnesses, and we did not need a confession of the individual.

So the Mirandizing in that case was largely irrelevant; the point being that what we ought to be doing is getting the intelligence first and then deciding which is the appropriate court in which to try the individual. In many cases, that will be military commissions. An organization which has studied the history of the ACLU should appreciate the fact that military commissions are constitutional. They do not violate due process rights. A defendant such as Khalid Sheikh Mohammed could be tried before a military commission in a perfectly appropriate and constitutional way, and it takes nothing away from our article III court system or from President Obama's leadership as President of the United States to hold those trials of this kind of individual in the military commissions.

To describe this advertisement, I ask unanimous consent that a Fox News article dated March 7 be printed in the Record at the conclusion of my remarks.

I yield the floor.