Floor Statements

Mr. President, I ask unanimous consent that the following letter, which consists of my May 19, 2008, comments on proposed Federal regulations governing the collection of DNA samples from Federal arrestees and illegal-immigrant deportees, be printed in the Record.

Mr. President, I believe if I am to speak for more than 10 minutes I need to ask unanimous consent. If that is correct, I ask unanimous consent to speak for 15 minutes.

Mr. President, I wish to speak to the Crapo motion--an amendment that, hopefully, we will be voting on a little later today-- and I urge my colleagues to support the motion of the Senator from Idaho.

This is about jobs and it is about taxes. I think one thing Americans don't expect out of this legislation is that they are going to have a pay a lot of taxes and that jobs are going to be killed rather than created. The President is talking about creating more jobs. Everyone in America is focused on putting people back to work, ending this recession, and bringing unemployment down so we can get jobs and go back to work. One of the problems with this bill is it kills jobs. It kills job creation. One of the ways it does that is through the many new taxes and mandates it imposes.

Naturally, we want to be sure that whatever we do, we don't harm our economy or job creation, but this $2.5 trillion legislation is filled with new taxes and mandates that will ultimately be borne by small businesses and the American workers. I will talk about just three.

First, a new employer mandate that says that employers have to provide insurance to their employees or face a penalty. This would hurt low-income workers especially, according to a Harvard economist, and I will be talking about that.

Second, there is a new Medicare payroll tax. Incidentally, the revenue raised doesn't go back to Medicare. It would be nice if we could help with the Medicare solvency, but this too threatens the creation of jobs, particularly in small businesses, because it is a direct tax on hiring more people.

Finally, new taxes on the health care industry could undermine its ongoing job creation gains. By the way, it is the only industry to have gained jobs since the start of the recession and this legislation will actually cause job losses.

I will describe all three of these. First, the employer mandate. The bill imposes a requirement--a costly new mandate--on employers that will have the perverse impact of actually hurting employees, especially low-cost employees. How so? Any employer with more than 50 employees who does not offer health care coverage would be required to pay an assessment for each employee who receives a tax credit for purchasing coverage through a newly created exchange. Those are folks in the lower income brackets who qualify for tax credits. So this becomes a direct tax on hiring people.

According to the Center on Budget and Policy Priorities,

. . . the particular employee provision in the Finance

Committee bill would pose significant problems by imposing a

tax on employers for hiring people from low- and moderate-

income families who would qualify for subsidies in the new

health insurance exchanges, it would discourage firms from

hiring such individuals, and would favor the hiring--for the

same jobs--of people who don't qualify for the subsidies

(primarily people from families at higher income levels.)

To conclude:

It would [also] provide an incentive for employers to

convert full-time workers (i.e., workers employed at least 30

hours per week) to part-time workers.

So here you have it--a mandate in the bill that would directly impact the hiring of low-income workers--precisely the opposite of what we want to be doing these days.

Harvard economist Kate Baicker examined the effect of an employer mandate similar to the one in the Reid bill. She estimated the cost of hiring a low-wage worker would rise by 33 percent--or $2 per hour on a worker earning $6 per hour. Think about that. She concluded that 224,000 workers would lose their jobs as a result of a mandate with these costs.

In addition to all the other problems we have with growing unemployment, here is another one-quarter million people who would lose their jobs because of this bill. It makes no sense.

There was a recent letter sent to the two Senate leaders from the National Federation of Independent Businesses which states:

Mandates destroy job creation opportunities for employees.

The job loss, whether through lost hiring or greater reliance

on part-time employees, harms low-wage or entry-level workers

the most.

That is exactly what the other study said. By the way, the NFIB is a nonprofit, non-partisan organization, defining itself as the voice of small business. We are all familiar with the good work it does. I think it would know

what is best for American business and workers.

The second way this bill imposes taxes and hurts workers is it actually creates a payroll tax; in other words, a tax on hiring people or keeping them on your payroll. It raises the Medicare payroll tax by 0.5 percent on small businesses with taxable receipts of $200,000 a year or $250,000 or more, if the small business employer filer is married.

Because many small businesses pay taxes at the individual level, imposing higher individual income taxes hurts these engines of job creation. The Joint Committee on Taxation recently estimated that one- third of the income that would be taxed under a similar House proposal comes from small businesses. Let us remember, as President Obama reminded us earlier this week, small businesses generated 65 percent of the job growth between 1993 and 2008 and represent about half the private sector employment of the United States.

So this huge potential engine for job creation is going to get whacked by the imposition of a new tax, which is a direct tax on the hiring or retaining of employees. The Joint Committee estimates that this increase in the Medicare tax would raise $54 billion over the next 10 years. That is $54 billion of resources that could have better been used in the private economy, in these small businesses, to expand job creation.

Each new tax dollar paid by these small businesses is one less dollar that could go toward the hiring of new employees or, for that matter, preventing layoffs or even giving raises to their existing employees.

A group of organizations recently told us in a letter--by the way, these are all organizations that represent small businesses in their communities--they oppose this bill because of what it would do to these small businesses. I wish to read the names of the groups that represent these folks: the Associated Builders and Contractors, the Associated General Contractors, the International Food Service Distributors Association, the National Association of Manufacturers, the National Association of Wholesaler-Distributors, the National Retail Federation, the Small Business and Entrepreneurship Council, and the U.S. Chamber of Commerce.

Here is a telling quotation from their letter:

In order to finance part of its $2.5 trillion price tag,

H.R. 3590 imposes new taxes, fees, and penalties totaling

nearly half a trillion dollars. This financial burden falls

disproportionately on the backs of small business. Small

firms are in desperate need of this precious capital for job

creation, investment, and business.

That is exactly what President Obama said yesterday. We have to get more capital into the hands of these small businesses so they can either continue their businesses with their employees or, potentially at least, soon begin hiring more. Yet as this letter points out, this bill imposes taxes with a burden that falls disproportionately on the very firms we are trying to help.

In a November 19 statement, the National Federation of Independent Businesses said of the bill's impact on small businesses:

We oppose [the Reid bill] due to the amount of new taxes,

the creation of new mandates, and the establishment of new

entitlement programs. There is no doubt all these burdens

will be paid for on the backs of small business. It is clear

to us that, at the end of the day, the costs to small

business more than outweigh the benefits they may have

realized.

They go on:

The impact from these new taxes, a rich benefit package

that is more costly than what they can afford today, a new

government entitlement program, and a hard employer mandate

equals disaster for small business.

They know what they are talking about. These are the folks whom we are depending upon to create jobs and we are punching them right in the stomach, right where it hurts, with respect to their ability to create these new jobs with the new taxes and mandates imposed in this bill.

Let me share a brief letter from one of my constituents. He is a small business owner in Tempe, AZ. His name is Justin Page. He would like to be able to grow his business, but the burdensome new taxes in this bill would force him to lay off workers and cut hours from his payroll. Here is what he says:

Dear Senator Kyl, As a long time Tempe and Arizona

resident, who has been operating a small business for the

past 19 years, I urge you to not vote for the healthcare bill

as it is currently proposed and as recently passed by the

House of Representatives. My business has taken a severe

financial hit in the past 18 months with several employee

layoffs, reduced hours for current employees, heavier

workloads, et cetera. My answer to increased health care

costs and additional small business taxes is to lay more

people off . . . not good for [my employees], and not good

for me! But survival is my primary goal right now! Reform is

necessary, but please do it in a bipartisan manner and within

a timetable that allows for constructive debate. This is too

important.

So small businesses have some very real concerns about this legislation and good reason to worry that they will be victims of its destructive policies. Obviously, it is not the kind of legislation small business owners or the American worker wants and, of course, not particularly in times of double-digit unemployment. We need to listen to the people out there who are actually creating jobs, who have to meet a payroll, balance a budget, and know what is necessary to run a successful small business. They are not happy with this legislation.

The third and final point is the new taxes on the health care industry, which of course get passed through to the people who ultimately have to buy insurance. Let me just discuss one--the medical device tax. This medical device tax is a tax on things that are used to treat us, to give us health care every day. The $110 billion in new taxes on industries such as this--the pharmaceutical, the insurance, and medical device industries--is a direct passthrough in terms of what we will end up having to pay in insurance premiums.

For example, this medical device tax will be assessed against thousands of products, such as contact lenses, stethoscopes, hospital beds, artificial heart valves, and advanced diagnostic equipment. Why would you impose a tax on these things that help us? I could maybe see a tax against liquor or a tax against tobacco but a tax on things such as this--these advanced technologies that help us? Why do we want to make them more expensive? These have been invented so we can have an extension of our lives; so our families can have better health care.

We all know when you tax something, you get less of it. In fact, a UBS Investment Research paper recently confirmed:

If the plan passes as proposed and our estimates are

correct, the initial years would be a financial challenge for

medical device manufacturers, as the full industry fee

becomes due before newly covered patients impact volumes.

What they are saying here is, first, before they can even begin to pass these costs on, it could kill this particular industry.

These taxes will hit smaller firms particularly hard since some of the smaller companies don't start out with a lot of profits. They rely almost entirely for domestic sales on their revenues.

I note my colleagues on the other side of the aisle, Senators Klobuchar, Bayh, Franken, and in addition Senator Lugar from this side of the aisle, recently sent a letter in which they said:

Independent estimates indicate that this tax could

translate into an annual income tax surcharge of between 10

and 30 percent on medical device manufacturers.

Think about that, a 10- to 30-percent tax on folks who are inventing these kinds of things to help us.

These Senators go on in their letter:

This provision would harm economic development and health

care innovation nationwide.

This was a letter to the chairman of the Finance Committee.

I know there some who argue that lost jobs in the private health care sector will be made up with new jobs in the government with health care bureaucrats here in Washington. Wonderful, I say.

That is not a good thing. We need jobs in the private sector. That should be our primary goal and that certainly is what President Obama was talking about yesterday when he talked about creating more jobs in the private sector.

In conclusion, I have described three ways in which this legislation through its mandates and its new taxes will

cripple our ability to come back out of this recession. It will make it very difficult for us to retain, let alone hire, new employees.

All of us here in the Senate I know want to do what we can to bring down the current very high unemployment. It is obvious that this health care bill makes things worse, not better. At every turn its new taxes and mandates put us on the wrong course. I think it is very hard to justify support for this legislation that threatens job creation, especially job creation for low-income workers.

I urge my colleagues, when we vote on the Crapo motion here pretty soon, to consider its impact. It will enable at least people in the lower income levels to avoid the kind of taxes that are imposed here, one of which, for example, is the tax that IRS will enforce if you do not buy the insurance policy that the government, under this bill, will mandate that you buy. If you cannot afford the insurance the Government has, you have to buy it anyway. If you do not, we will impose a new tax on you, enforced by the IRS. The Crapo motion would say no, not so fast, IRS, we are going to protect folks from that new tax. That is why it is important to support the Crapo motion.

I urge my colleagues, even though I know we have had a lot of votes here where very few Democrats have supported Republican amendments, this is one which I hope all of us could support.

Mr. President, America's seniors have made clear they value the Medicare Advantage Program. They like their access to private plans, plan choices, lower cost sharing, and all the extra benefits not included in traditional Medicare, such as vision, dental, hearing, and the wellness programs that help them stay fit.

Before the Medicare Modernization Act of 2003, seniors had been decrying their lack of choices. We made sure, under the Medicare Modernization Act, that seniors would be assured health care choices, just as all of us here in the Congress enjoy.

Now that they have access to private coverage and enjoy more benefits and choices, seniors want us to make sure Medicare Advantage stays viable, and they are not happy about the proposed cuts in the majority leader's bill.

I have received more than 500 phone calls since November 1 from constituents who oppose the $120 billion Medicare Advantage cuts proposed by the majority's bill. They know you cannot cut $120 billion from a program without cutting its benefits. A lot of seniors in Arizona are asking, What happened to the President's repeated promise that if you like your insurance, you get to keep what you have? They do not like the idea that under this bill their benefits would be slashed by 64 percent, from $135 of value per month to $49 of value per month, which is exactly what the Congressional Budget Office projects would happen. They do not want the money they paid into Medicare going to fund a new government entitlement program for nonseniors. They are not satisfied with the majority's promise to protect ``guaranteed'' benefits. They want Members of Congress to be straight about our intentions and not engage in semantics. They want an unequivocal promise they will be able to keep exactly what they have now, just as the President promised.

Here is the problem. There is an earmark buried on page 894 of the legislation before us that suggests that senior citizens in Florida must have insisted on this exact kind of protection for their Medicare Advantage as well.

This provision, in section 3201(g), was specifically drafted at the request of the senior Senator from Florida to protect the benefits for at least 363,000 Medicare Advantage beneficiaries in Florida but very few anywhere else. Nothing in the bill grants the same protection that is granted to these senior citizens to those in my State or in the other States in which there are a lot of seniors who have the Medicare Advantage Program.

That is why I support the motion of my colleague, Senator McCain, to commit this bill to the committee and return it without these-- actually, what his bill does is to ensure that all seniors, whatever State they are in, enjoy the same grandfathering status as the senior citizens in Florida would have under the Nelson proposal.

The McCain motion to commit is straightforward. First of all, it would help the President keep his commitment that seniors get to keep their insurance if they like it. And it applies to all of America's seniors the same protection granted to Floridians, as I said. Isn't that what all seniors deserve, the security of knowing their current benefits are safe? If our Democratic colleagues are not willing to extend this protection to every Medicare Advantage beneficiary, then I cannot imagine how they can claim to be in favor of protecting Medicare.

I have been sharing letters that I have received from Arizona constituents describing what the Medicare Advantage Program means to them. I thought today I would share some excerpts from a few more of these letters.

A constituent in Surprise, AZ--I hope the Presiding Officer likes the name of that town: Surprise, AZ--just west of Phoenix, says:

I truly hope you will consider keeping the Medicare

Advantage plans for seniors. I find the savings a must on my

fixed income.

I appreciate the [high quality] doctor care on my MediSun

Advantage plan. Prescriptions are included in the cost of my

plan, providing further savings for me. Medicare Advantage

has made a real difference in my life. Please don't let

anything happen to this important program.

A constituent from Fountain Hills, AZ, writes:

I suffer from a specific type of amyotrophic lateral

sclerosis, and rely on Medicare Advantage for all of my

medical needs. I am asking that you do all that is in your

power to protect and provide for the continued funding of

this program. In Arizona, we have over 329,000 people who

count on Medicare Advantage. Our lives would be devastated

without it.

A constituent from Wickenburg, AZ, says:

Please don't let anything happen to my Medicare Advantage.

I like my Medicare Advantage plan because I can choose my own

doctor in my own town and also choose a specialist if I need

one.

I can also get regular check-ups and don't have trouble

getting to see the doctor. So, I ask that you don't let the

government cut my Medicare Advantage.

A constituent from Mesa, AZ, says:

I am a senior citizen. I am becoming more and more

concerned about President Obama's healthcare plans, and I am

writing to tell you that I am happy with my Medicare

Advantage plan. I request that you do all you can not to cut

my benefits.

I have a fairly wide choice of doctors and specialists, who

have always treated me with respect, given me the time I feel

I need, and have given me excellent care.

I have a fitness benefit, which entitles me to the Silver

Sneakers program at our local YMCA; two choices of a dental

plan; a vision plan; plus many other options to maintain my

level of health or to try to improve it.

Please, I beg you, do whatever you can to maintain our

Medicare Advantage plan. Do NOT cut any of our benefits.

We know there are millions of seniors out there who absolutely depend on Medicare Advantage. Many have stories to tell about how this program has improved the quality of their life and their health. I urge my colleagues to support the McCain motion to commit to ensure that all of America's seniors, not just those in certain preferred counties, primarily located in the State of Florida, are grandfathered in these benefits.

Again, to make it very clear, Medicare Advantage benefits are cut by the $120 billion reduction in Medicare under the bill. The Senator from Florida found a way to grandfather the Medicare Advantage benefits for many of his constituents. What the McCain motion to commit does is to apply that same grandfathering to all seniors in all States so that none of the seniors who have Medicare Advantage today would lose any of the benefits they enjoy today.

It seems to me what is good for our senior citizens in Florida ought to be good for our senior citizens in Arizona or any other State in which they reside. I urge my colleagues to consider and to support the McCain motion to commit.

I thank my colleague from Nevada. I had the opportunity, which we don't have very much anymore, to preside for a half hour, watching over a dozen of my Republican colleagues engaging in a very informative debate for the American people.

It occurred to me, as my colleague from Nevada was talking about his amendment, which would actually reduce the cost of medicine, would reduce the defensive medicine practiced by physicians and, therefore, have a tendency to reduce health care costs, that he was doing that by actually attacking another problem we have been talking about; that is, these runaway lawsuits or these junk lawsuits that have been talked about.

As a person who used to practice law, as I was listening to the Senator, it occurred to me that maybe I should take the microphone and defend the trial lawyers. So I wish to make sure I have the math right.

Under the amendment of my colleague, there would be a cap on the amount of attorney's fees these lawyers could get, depending upon how much money they recovered for their plaintiff client; is that correct?

First of all, you would get one-third of all the money you collected up to $150,000. That is $50,000. Then you would get one- fourth of everything beyond that; is that correct?

Is my colleague aware that the average malpractice award in this country today is $4.3 million? Does that sound about right?

In fact, over half of all the awards are over $1 million. As a poor trial lawyer, for every one of these cases--we are not talking about cases per year and this is per case, you can try 20, 30, 40, 50 cases a year--so for each case, if the average award is $4.3 million, I am only going to keep $1.1 million. Is that fair; that the trial lawyer should only get $1.1 million for every one of these cases? Of course, the clients I am recovering the money for don't get that money. That money goes into my pocket.

Exactly so. Under the amendment of my colleague, at least the plaintiff, on whose behalf the lawsuit was brought, would get a fair amount of recovery, unlike today, when there are no caps, and we frequently find the person who was injured gets a very small percentage after the lawyer gets his chunk, the expert witnesses, other court costs, and so on.

Maybe I should not defend my lawyer friends. Maybe the Senator is right. This is a way to attack costs. It is certainly not unfair to the trial lawyers and actually would benefit the people who do deserve to get some recovery in these cases where, in fact, they have been injured.

The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning).

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

The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning).

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

The following Senators are necessarily absent: the Senator from Kentucky (Mr. Bunning), the Senator from Oklahoma (Mr. Inhofe), and the Senator from South Carolina (Mr. Graham).

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

The following Senators are necessarily absent: the Senator from Kentucky (Mr. Bunning), the Senator from Oklahoma (Mr. Inhofe), and the Senator from South Carolina (Mr. Graham).

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

Mr. President, I thank my colleagues for their courtesies. I am sure the Chair will cut me off at 5 minutes.

I wish to respond to some comments made earlier relative to the amendment of the Senator from Nevada on capping attorney's fees. We have an amendment we will vote on tomorrow that caps executive compensation, effectively, and the response to that from Senator Ensign was, if we are going to do that, let's cap the attorney's fees because we can accomplish something by doing that in medical malpractice cases. We can make sure the people who were injured get more of the money coming from these awards, with less going to the attorneys.

I think this would be a very salutary situation. This contingent fee system can really result in some abuses. I will cite some statistics from the Jury Verdict Research in a study done in 2005: Fifty-two percent of all awards in medical liability lawsuits exceed $1 million. Think about that. Over half of the awards in these malpractice cases exceed $1 million. The average award now weighs in at $4.7 million. That is a lot of money. Obviously, juries have felt that is what the victims in these cases needed in order to be properly compensated.

The Ensign amendment would limit the amount of contingency fees in these kinds of lawsuits to no more than a third of the first $150,000 recovered and a quarter of any recovery in excess of $150,000. For example, an attorney representing a client in this average case, with a $4.7 million verdict, would still receive $1,187,500 for his or her services under the Ensign amendment. That is not a bad deal with a $4.7 million verdict. The attorney gets $1.1 million-plus and the injured party, the plaintiff, gets the remainder. I ask my colleagues, in that situation, isn't $1.1 million-plus enough compensation?

We are limiting the compensation for an entire year for an executive of an insurance company to $400,000 as the amount that would be deductible to the company as a usual and ordinary business expense. Here, a lawyer has just one case, and you can have many cases in a year. He would be limited, in this particular situation, to $1.1 million.

A lot of folks have been asked to sacrifice under this legislation-- hospitals, doctors, and States, by accepting more Medicaid patients under their program; seniors would face sacrifices because of the $500 billion cuts in Medicare; individuals would see their premiums rise; and small businesses would get hit. The one constituency that hasn't been asked to sacrifice anything is the trial lawyers. I don't think it is much of a sacrifice to say, when you get this kind of award--a $4 million award--for your client, your fees should not exceed a little bit over $1 million.

Even Howard Dean stated:

Tort reform is not in the [health care] bill because the

people who wrote it did not want to take on the trial

lawyers. And that is the plain and simple truth.

We know that to be the case. Surely, it wouldn't be too much to ask our trial lawyer friends to limit just a little bit the contingency fees they make in these cases.

There is a study that was recently conducted by the Institute for Legal Reform that found that medical liability lawsuits are being driven by the plaintiffs' bar. It cites all the advertising costs and the increase in the amount of advertising they are doing. That is where a lot of this money is going--to advertise for these lawsuits. Additionally, it showed that spending for these ads has increased dramatically in the last few years.

The threat of these ``jackpot justice'' suits against doctors is one of the reasons health insurance premiums are rising faster than the rate of inflation. In fact, a PricewaterhouseCoopers study concluded that approximately 10 percent of the costs of health insurance premiums are attributed to the cost of litigation and defensive medicine.

An even bigger health care cost related to the threat of frivolous lawsuits is the practice of defensive medicine. A 2005 survey in the Journal of the American Medical Association found that 93 percent of physicians reported practicing defensive medicine, costing the health care system $200 billion annually.

We clearly need to reform the tort system, and not in the form of some sense of the Senate but in the way of something real. It seems to me the Ensign amendment begins that process by saying: Let's at least allow the injured plaintiffs in these cases to keep more of the award granted to them and have less of that go to the lawyers who bring the cases. Surely, it is an adequate incentive that they receive about $1 million out of a $4 million lawsuit.

I thank my colleagues from New Jersey and Michigan for allowing me to speak first.

Will my colleague yield for a quick point?

The Senator was making the point that you cannot take $120 billion out of the program without hurting folks. Those on the other side of the aisle said we can do that--we can cut it by $120 billion and it still won't hurt anybody. My colleague asked the Senator from Tennessee exactly what some of the benefits were and he repeated them. I went to get the actual statistical number of how much it will actually reduce benefits in terms of actuarial value. According to the Congressional Budget Office, in the year 2019, when fully implemented, here is the statistic: The actuarial value of the reduction in benefits under Medicare Advantage is 64 percent; in dollar terms, it goes from $135 a month down to $49 a month. In other words, the very things my colleague talks about--vision care, dental, all of those things----

The last point. I want to say that I hear my colleague loudly and clearly. I hope the American people do too because you cannot call a $120 billion cut something that doesn't hurt people, and especially when the Congressional Budget Office itself says, yes, that reduces these very benefits from a value of $135 a month down to $49 a month. That is a huge cut in the value of the services they receive under Medicare Advantage. That is what we are trying to prevent by this amendment.

I had hoped to take the next half hour, but if we could do 40 minutes, equally divided, I could take 20.

Would I be able to take the first 20 minutes then?

Mr. President, we are discussing the Hatch motion to preserve Medicare Advantage. I wish to give a little bit of background about the Medicare Advantage Program. It was established with the goal of ensuring that beneficiaries all across the country would actually have Medicare choices. Under the program, private health plans receive government payments in order to serve Medicare beneficiaries. In addition to offering comparable coverage to Part A, which is for hospitals, and Part B, physician services, Medicare Advantage plans can also offer Part D coverage, prescription drug benefits.

The central goal of the Medicare Advantage provisions was to ensure that beneficiaries across the Nation, not just those in populous areas, would have access to health plan options. Under the law, Medicare Advantage plans must provide all physician and hospital Medicare benefits.

Here is the key. I hope my colleagues will think about this for a moment because this has been a little bit perhaps distorted in the conversation we have had. If a plan's costs to provide all the Medicare benefits is less than the government payment, then by law, the plan must apply the difference to provide additional benefits to the beneficiary or to reduce premiums.

It seems to me that is what this whole reform was about in the first instance, to try to ensure quality care and reduce the cost of insurance to beneficiaries.

But what are these extra benefits? We have heard them discussed. They include, first of all, lower cost sharing, including out-of-pocket limits on beneficiary cost sharing, as well as specific health benefits such as vision, dental care, hearing services, routine physical, cancer screenings, and so on. Plans can also offer management services, which can be particularly important to beneficiaries with chronic illnesses, and that is a protection, by the way, that does not exist in regular fee-for-service Medicare.

Today, every beneficiary has health plan choices. Since 2003, the number of Medicare beneficiaries enrolled in private plans has nearly doubled from 5.3 million to 10.2 million in the year 2009, according to the Kaiser Family Foundation. So these are very popular plans and growing in popularity.

Let's go back in time just a little bit to consider the history, back to 1972, because in past years my colleagues on the other side of the aisle were all for Medicare Advantage. Over the years, Congress has tried to control spending by reducing payments to private Medicare plans. One problem was, severe payment reductions resulted in the elimination of plan options. For example, in 1997, the Balanced Budget Act reduced plan payments by $74.5 billion over 10 years. What happened? Well, about three-quarters of a million beneficiaries, from 1999 to 2003, had to change plans or else lose their health plan altogether. This included not only less populous and more rural areas of the country but also areas such as Long Island, NY.

Well, Congress heard from these seniors loudly and clearly. They were angry about losing their coverage. Many remember that the Medicare Modernization Act was a landmark achievement which provided seniors with prescription drug coverage, but it was necessary for another reason as well and that was to respond to the call of the seniors who wanted their private options back.

So, in 2003, the Medicare Modernization Act expanded plan options to include regional PPOs and restore plan payments. It was a deliberate, bipartisan decision to increase the plan's payments so they could enter rural areas of the country and even some of the urban areas--as I mentioned, Long Island. If my colleagues don't remember, let me remind them.

Former Senator Clinton from New York, for example, said that these Medicare+Choice plans--that is now what we call the Medicare Advantage plans, and I am quoting:

. . . are feeling the squeeze in a system caught between

rapidly exploding costs and rapidly imploding finances. While

we debate the future of Medicare, we need to recognize that

there are people right now in our States who depend on these

plans today.

The current senior Senator from Massachusetts said at the time, and I quote:

I urge my colleagues to support the additional funding that

is urgently needed to strengthen the Medicare+Choice program

for seniors. This should be among our highest priorities in

this year's Medicare debate.

It was, and we did. So this is not something bad that we provided this money to these plans. We provided it so the plans could provide the benefits to seniors, particularly in areas where otherwise they wouldn't have those choices.

So why has this all of a sudden become unpopular with our friends on the other side of the aisle? Well, obviously, first and foremost, they need trillions of dollars to fund their bill, so they look around for where they can get some money and decide: Well, we can get $120 billion from here; this is one way we can help pay for the new entitlements under their bill. But to them, there has to be some kind of justification to take that money, so the idea is: Well, it is not fair that the government would pay money into this program for extra benefits for seniors when that money could be spent on regular fee-for- service Medicare. Of course, that argument presupposes that government health care is always superior to the plans offered in the private market, which these seniors have made clear, by doubling the enrollment in the private plans, is not the case. As I said, they have made their preference clear.

They asked us for choices, as Members of Congress enjoy. They want access to private plans and these additional benefits, and we delivered as promised. We gave them the choices, Republicans and Democrats alike. Now they need the money, so they decide this is a way to get some money to pay for their new entitlement.

Our friends on the other side of the aisle have been talking about overpayments. There is no such thing as an overpayment in this program under the law. No money goes to the plans. It is not as if the insurance companies get the money from the government. The insurance companies, if their bid is under what the traditional Medicare bid is, have to return 25 percent of it to the U.S. Government and the other 75 percent, by law, must go to their beneficiaries, either in the form of lower premiums or additional benefits. So these aren't overpayments to the plans, as has been represented. As I said, 75 percent of the additional payments must be used to provide seniors with extra benefits, which could include lowering premiums, including chronic care management, and so on. The other 25 percent is returned to the government, so there is no overpayment.

Some on the other side argue that they are protecting guaranteed benefits. Well, this is semantics. Nobody is going after the benefits Medicare has traditionally supplied. What we are pointing out and what this amendment would prevent from happening is, the benefits under Medicare Advantage would not be cut, and there is no question--nobody can deny--that those benefits would be cut. In fact, according to the CBO, by the year 2019, they will have been cut by 64 percent, a huge-- almost $90--over $90 in actuarial value. So my point is, seniors, of course, would like to keep what they have.

What about this promise if you like what you have, you get to keep it. Sorry. Not if you are on Medicare Advantage. As I said, according to the Congressional Budget Office, the legislation would cut benefits from $135 a month actuarial value to $49 actuarial

value. That is a real cut. It may not sound like much to some people, but to our seniors, it is a huge hit. They are asking what happened to this promise to let them keep what they have.

There is an interesting memo by James Capretta and Robert Book, who write for the Heritage Foundation, on the Medicare Advantage cuts, and here is what they say:

Reform should mean more patient choice and health plan

accountability. But these current proposals would lead in the

opposite direction--toward a system of less choice, less

accountability, and eventually lower-quality health care.

That is what the Hatch motion is attempting to prevent, to preserve these benefits for seniors.

I have gotten tons of calls, about 500 calls just in the last several days, opposing cuts to Medicare Advantage. I haven't, by the way, received a single call from a senior citizen asking us to make these cuts. I have been reading from these letters. I have read about a dozen of these letters. Let me read a few from constituents who tell us the real effect these cuts would have on them. Bear in mind, in my State we have about 329,000 seniors who are enrolled in Medicare Advantage plans.

One constituent from Phoenix says:

For the past month I have heard a lot about proposed

Medicare cuts. Finally, after years of being self-employed

and being able to afford only high deductible insurance, I am

now in Medicare and have a Medicare Advantage plan. Please

tell me you are not cutting Medicare Advantage. Have a heart.

Leave Medicare and Medicare Advantage alone.

We are trying.

A constituent from Peoria, AZ, says:

I oppose cuts to Medicare Advantage. I have two family

members receiving health care under this program. The care

has consistently been outstanding due to the efforts of our

case manager in coordinating patient care between providers

and patients. We have a voice in determining type and scope

of our care. Please do not cut Medicare Advantage!

Here is a note from a constituent from Apache Junction:

I have heard reports that if passed, the new government

health care plan would do away with or cut Medicare

Advantage. If so, it would nearly double my health care costs

with my present health care provider. I do not want any

legislation passed that would take away the Medicare

Advantage option for seniors.

Another constituent from Peoria:

President Obama has said we can keep the insurance we have

if we like it, but has said he wants to cut or eliminate

Medicare Advantage. What happens to the millions of people

who have Medicare Advantage? These are all seniors, many of

whom cannot afford to pay more. Why should so many seniors

have to sacrifice in order to help pay for universal

coverage? Why do we not hear more debate on this issue?

Well, to my constituent from Peoria, that is what this debate is all about. We are trying to prevent these cuts.

Here is a constituent from Prescott Valley:

I have Medicare Advantage. My husband wants to retire from

his job where he has excellent health coverage for some

serious health concerns. So long as he has good medical

coverage, he does well. Should Medicare Advantage be cut, his

health would necessarily suffer after his retirement. We

cannot afford higher supplemental coverage. I don't want to

lose my husband. I have spent many a sleepless night

wondering how to keep my husband healthy once he retires. I

have several friends currently undergoing chemotherapy and

they are wondering if their health would be in jeopardy if

Medicare Advantage were cut. Are we not worth saving?

Clearly, there are many who want to spend our money on their

own priorities. God bless you, sir, for advocating on our

behalf!

These are real concerns from real people. They don't want us to cut Medicare Advantage.

The final point I wish to make is one of our colleagues was saying: Well, there are bad Medicare Advantage plans and good Medicare Advantage plans. How do we know which ones are good and bad? It turns out the senior Senator from Florida devised a formula which protects a lot of folks in his State, especially in Broward County, Miami Dade County, and Palm Beach but doesn't protect very many other folks.

Maybe this is the definition of good versus bad. There are a few that are protected in Colorado, Maryland, Mississippi, Oklahoma, and Texas. In my State of Arizona, with a lot of retirees, very few are exempted from the cuts. This is not going to go over well--to exempt only a few in certain key areas, and none of the others.

Again, what happened to the promise that everyone gets to keep what they have?

My bottom line in supporting the Hatch amendment is that we should not punish seniors who signed up to have the choice of Medicare Advantage. There are better ways to reform health care. We have talked about those ways. Our senior citizens have paid into the program. They have asked us for this program. Democrats and Republicans have supported it in the past. Now, simply because somehow or other we have to scrape up money for the new entitlements in this legislation, we are going to attack the very program all of us have supported in the past.

It is unfair, it is not right, and we need to defeat those cuts in Medicare, and that is why the Hatch motion to preserve Medicare Advantage should be supported by my colleagues.

Mr. President, the Community Living Assistance and Services and Supports Act, known as the CLASS act, is a new, government-run, government-funded program for longterm care, intended to compete with long-term care plans provided by private insurers.

One of the oft-repeated arguments we have heard in favor of the CLASS act is that it would reduce budget deficits between 2010-2019.

First, when has a government program ever reduced budget deficits?

Second, the Congressional Budget Office tells us that this program will actually add to future Federal budget deficits. The CBO writes: ``The program would add to future federal budget deficits in large and growing fashion.''

Why would it do this?

The program offers returns that payments made into the system cannot cover--just like a Ponzi scheme, as Senator Conrad said. Participants would have to pay into the system for five years before they start collecting benefits. Under the Senate proposal, only active workers could enroll in the program. So this would not be a program that would not benefit seniors or the currently disabled. So, if a worker began making payments in 2011, he or she could not collect benefits until 2016. So, for a time, the program would generate surplus receipts for the government while Americans are paying in and not collecting benefits. But eventually, we will reach a point when payments made into this program cannot sustain promised benefits.

As the CBO tells us, the program would ``lead to net outlays when benefits exceed premiums.'' (By the third decade of program operation-- 2030-2039--CBO assumes that CLASS begins to generate net increases in Federal outlays. The net increase in Federal outlays is estimated to be ``on the order of tens of billions of dollars for each (succeeding) ten-year period.''

CBO notes that the increase in net Federal outlays which will begin to occur after 2029 results despite the requirement that premiums be set to ensure the program's solvency over 75 years. The solvency requirement counts interest income paid to the program's trust fund as available to pay future benefits. However, CBO notes that those interest payments are an intra-governmental transfer within the Federal budget. Thus, CBO notes that from a budget scorekeeping perspective, the CLASS program would inevitably add to future deficits (on a cash basis) by more than it reduces deficits in the near term, even though the premiums would be set to ensure solvency of the program.

The administration's chief health actuary said the CLASS Act would result in ``a net federal cost in the longer term.''

Bottom line, this program is not sustainable outside the 10-year window.

That is why the Washington Post called it, ``a gimmick . . . designed to pretend that healthcare is fully paid for.''

The Post goes on:

Money that flows in during the 10-year budget window will

flow back out again. These are not `savings' that can

honestly be counted on the balance sheet of reform.

The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning).

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

The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning).

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

The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning).

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

The following Senator is necessarily absent: the Senator from Kentucky (Mr. Bunning).

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

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

Mr. President, to continue our debate on the McCain amendment to ensure Medicare benefits for our seniors are not cut, as would happen under this legislation, I wanted to talk a little bit about the commitments we have made to our seniors and what exactly would happen under the legislation that is before us.

As we all know, seniors have paid into the Medicare Program, and that is with the expectation that they will get the benefits that have been promised to them. The question is, Why would we, at this point, reduce the benefits that have been promised to them, especially if the purpose is not to enhance the financial viability of Medicare, which everyone knows is going broke but, rather, to use that money to establish a new entitlement program?

Let me break down the list of cuts seniors would face under this legislation: $137.5 billion would be cut from hospitals that treat seniors, $120 billion from the Medicare Advantage plan. By the way, that Medicare Advantage plan serves almost 40 percent of the Arizona seniors on Medicare. It cuts $14.6 billion from nursing homes, $42.1 billion from home health care, and $7.7 billion from hospice care. These are deep cuts, and you cannot avoid jeopardizing the health care seniors now have under Medicare by making these deep cuts. That is why the Chief Actuary at the Centers for Medicare and Medicaid Services--we use the initials CMS--believes these cuts would cause some providers to end their participation in Medicare, which, of course, would further threaten seniors' access to care. There would not be as many providers to whom they could go for their services.

Our friends on the other side of the aisle say part of this is an intention to eliminate waste, fraud, and abuse. Of course, we have known for many years that there is waste, fraud, and abuse in Medicare, but actually doing something about the problem and recognizing it are two different things. If it were easy to wring hundreds of billions of dollars of savings from Medicare by just pointing to waste, fraud, and abuse, we would have done it a long time ago. Certainly the President would, during his first year in office, want to do that, given the fact we are spending a lot of money and he is trying to find sources of revenue for the various spending programs he has proposed. If it were that easy to do, it would have been done before now.

Moreover, Medicare faces a $38 trillion, 75-year unfunded liability. That is almost incomprehensible. Most of us believe that whatever savings we could achieve in Medicare, to the extent you could eliminate waste, fraud, and abuse, for example, you should do that to help make Medicare solvent.

Next I want to talk about what seniors are telling us. They believe, according to public opinion surveys--and I have talked to enough of them to know this is true--that these Medicare cuts are going to jeopardize their health care. They are troubled in particular by this $120 billion proposed cut to Medicare Advantage. It has been called the crown jewel of Medicare. It is the private insurance addition to Medicare in which many are able to participate in programs they would never have been able to afford otherwise. It gives them this choice to supplement Medicare to provide all kinds

of benefits such as dental, vision, hearing, physical fitness programs, and other things, as I said, that they could not get otherwise. One in four of the beneficiaries in Arizona, as I said, signs up for this program--more than 329,000 seniors. They like the low deductibles and copayments in Medicare Advantage.

But the Congressional Budget Office has bad news for the seniors who like this program and who like the extra benefits they have under Medicare Advantage because, as the Congressional Budget Office notes, it would cut benefits on average by 64 percent over the next 10 years, from an actuarial value of $135 to $49 a month. Think about that. The actuarial value of the benefits the average Medicare Advantage participant has is worth $135 a month today. It would be cut in this bill to $49 a month. That is a 64-percent cut, according to the Congressional Budget Office. When we say we are not cutting benefits seniors currently receive, that is not true. This legislation would do that.

I have been sharing letters from constituents who have expressed concerns to me. Let me share three more letters today.

One recently arrived from Joseph and Mary-Lou Dopak of Sun City West, in Arizona, of course. They wrote as follows:

The plan to reduce our coverage and take $120 billion from

Medicare Advantage is a slap in the face to all seniors. The

Medicare Advantage plan works because Medicare funds are

given to a private insurance company to administer the plan.

We do not want our Medicare Advantage plan robbed to fund a

government-operated comprehensive health insurance plan.

Commonsense tells us that will not work.

The President should be fixing what ails the current health

care system, instead of putting everyone into a government-

operated health care plan.

For our President to pick on Medicare Advantage is totally

unfair to those of us upon whose shoulders this country has

been built.

A constituent from Tucson, AZ, wrote a rather short and direct letter, and so it is easy to quote here.

I am a senior citizen age 83. If I lose my Medicare

Advantage coverage, I'll also lose my primary care physician

of 18 years because he does not accept Medicare Direct.

Senator Kyl, do not let them take away my Medicare Advantage.

I get these letters every day. I have not yet had a constituent come up to me and say: Please, would you take away the Medicare Advantage Program, it is not right. Everybody has said, of course: Please preserve this important program.

Finally, a constituent from Phoenix, AZ, who suffers from multiple sclerosis, describes what it means to her.

I am a 57-year-old woman with multiple sclerosis, currently

on Social Security Disability. I make under $14,000 a year

and have been on the Secure Horizons Medicare Advantage plan

for a long time now. . . .

I realize it is hard for Congress to understand, but we

need to keep our Medicare Advantage plans in order to have

[quality] health care at a price we can afford.

We need you to help protect Medicare Advantage plans for

the seniors in your State. We are the ones you need to fight

for and we should not have to choose between going to a

doctor and getting our medication and having food on the

table and a place to live. Please do your part to protect our

Medicare Advantage plans and keep prices within our reach.

As I said, these are the kinds of letters we get all the time. It is hard for these folks to understand, first of all, why, having paid into the plan and having taken advantage of what is a good supplement to the basic Medicare, that would be taken away from them. I think it is even harder for them to fathom that the reason it is being done is to pay for a new program rather than to keep Medicare itself solvent.

I tell folks like this that I will continue to fight for her and I will continue to try to protect this program because we believe it is essential. It is why I support the McCain amendment to commit the bill back to committee. It only has to be there a day. We are not talking about a further delay here. But it addresses both of the key issues of cuts and savings. If the McCain amendment passes, it would send the bill back to the Finance Committee with instructions to remove the Medicare cuts from the bill. That is all it does. But, second, those savings would be applied to Medicare rather than to fund a new government program. Those savings could therefore address the waste, fraud, and abuse problem that has been identified by everyone. It can be used to strengthen the Medicare trust fund rather than to fund a new health care entitlement program.

We believe the first thing we should do to see whether we can actually fix this bill--I have been quoted as saying that I don't think we can fix this bill. By that, I mean, with all due respect to my colleagues on the other side of the aisle, I don't think they want to make the changes I think would be necessary for the American people to begin to support this kind of legislation. Seniors are overwhelmingly opposed to the Medicare cuts. That is a fact. If my colleagues on the other side of the aisle are not willing to support the McCain amendment or something like it, I don't know how we could then say we can fix this bill. So I hope my colleagues will use this process we have to actually make amendments to the bill and not simply have a political discussion.

Republicans have pointed out that there are better ways to reform the health care problems we have today than to do it on the backs of seniors. We put forth a bounty of ideas. Let me just recoup some of them.

We think we could start and we could save a great deal of money by medical malpractice reform. That would bring down costs. We could allow Americans to buy lower cost insurance policies across State lines. That alone would unleash a wave of competition for patients' business. We could allow small businesses to band together to get the same purchasing power big businesses have. These ideas have essentially been ignored by the majority. Instead, we have this big government takeover of health care at a huge cost and significant reduction in quality and benefits to the American people. We don't think this is the way to go.

Certainly, on behalf of my senior citizen constituents and others who are on Medicare Programs, I am going to continue to fight for them, as my colleague John McCain is, and therefore urge my colleagues to support his amendment to eliminate the Medicare cuts under this bill.

Mr. President, I ask unanimous consent that during the 30 minutes controlled by the Republicans, we be allowed to engage in a colloquy.

Mr. President, I will begin by making some comments about the amendment Senator McCain, my colleague from Arizona, has filed. This is an amendment that, as the minority leader just said, will protect America's seniors. It will disallow the Medicare cuts this bill includes.

The economist Milton Friedman famously said, ``There is no such thing as a free lunch,'' and that applies to health care as well. There is no such thing as free health care. Someone has to pay. Since this bill is a $2.5 trillion bill, the first question is, Who pays? The first answer to who pays is, it is America's seniors, because about half of the cost of the bill is allegedly paid for by cuts to Medicare.

Let me break down a little bit more specifically than the Republican leader did exactly what that means. This is about $500 billion in Medicare cuts as follows: $137.5 billion from hospitals who treat seniors; $120 billion from Medicare Advantage, which is the insurance program that provides benefits to seniors which will be cut more than in half as a result of this $120 billion reduction; $14.6 billion from nursing homes that treat seniors; $42.1 billion from home health care for seniors; and $7.7 billion from hospice care, one of the most cruel cuts of all.

Obviously, with cut this dramatic there is no way to avoid jeopardizing the care seniors now enjoy, and seniors know this. That is why they have been writing our offices and attending townhall meetings to let us know they disapprove. I quoted from two letters constituents of mine from Arizona sent asking to please not cut their Medicare Advantage Program. This has been called the crown jewel of the Medicare system, and many of them rely on Medicare Advantage for dental care or vision care or hearing assistance they have come to rely on. They are not buying the claims that somehow or other we can make $\1/2\ trillion cuts in Medicare without somehow hurting their care. They know better than that, and they are right. The care they have been promised will be compromised to pay for this new government entitlement under the bill.

Finally, many are wondering what happened to the promise that they get to keep the care they have. We all heard the President say that many times: If you like the care you have, you get to keep it. That is simply not true. There are 337,000 Arizonans who are Medicare Advantage patients. They like what they have. Yet we know, according to the Congressional Budget

Office, that the benefits they have under Medicare Advantage are going to be cut by more than half. They are saying: What happened to the policy I like? I am not going to be able to keep it if this bill passes.

This is why the McCain amendment must pass. If our Democratic colleagues are not willing to protect Medicare, then I cannot imagine how the bill could otherwise be made acceptable since it starts with the commitments that Congress and the President have made to our senior citizens.

Mr. President, I say to my friend from Tennessee, first of all it comes from a reading of the bill. It is very clear in the bill as to how much money is taken from Medicare. The number the Senator from Tennessee just articulated is the correct number.

In addition to that, the Congressional Budget Office and the Joint Tax Committee analyzed the specific numbers. Obviously they were given the numbers in the bill, but the numbers they are using are--I just broke it down into four or five general categories. There are other divisions within that. But as I said, for notional purposes here: $137.5 billion from hospitals; $120 billion from Medicare Advantage. That number might be $118 billion; I am not precisely certain of it, but it is very close. There is $14.6 billion from nursing homes, $42.1 billion from home health, and $7.7 billion from hospice care. If any of our colleagues would like to contest these numbers, I would be happy to be corrected, but I believe those are the correct numbers.

On a new program. That is exactly correct. What the Medicare trustees were saying is, if we can effect cost savings in Medicare, and surely there are some to be had there, they should go to strengthen the Medicare Program itself and not allow it to go bankrupt, rather than it being used to create a new government program.

Perhaps one of the reasons why there are different numbers from one side of the aisle to the other is that sometimes we are not talking apples to apples. We are talking apples to oranges, and perhaps both numbers are correct in their context. The Senator from Tennessee used the number $2.5 trillion when the program is fully implemented. That is a very important statement. The other side will argue it is only $1\1/ 2\ trillion for the first 10 years of the program. That is a correct statement. But it is $2.5 trillion for the first 10 years of total implementation of the program. What is the reason for the difference? For the first 4 years, money is being collected, but very few benefits are going out. The benefits start after year No. 4. So if we take the first 10 years of the program, we are collecting money to pay for it over the entire 10 years, but almost all of the benefits only occur during the last 6 years. Naturally, we have collected more money than we have paid out. But when we take the first 10 years of full implementation, it is as my colleague from Tennessee noted, a cost of $2.5 trillion. That is how sometimes we get somewhat different numbers.

As long as we are clear about what we are talking about, one thing is crystal clear: Whether it is $1\1/2\ trillion or $2.5 trillion, we are talking real money. Somebody has to pay for it. If America's seniors are being asked to pay for half of it, that is not fair to America's seniors, given the commitment we have made to them. That is the point of the McCain amendment. Protect Medicare, protect America's seniors. We can do that with the simple amendment Senator McCain has which is send the bill back to committee--it would only take 1 day--and send it back here without those Medicare cuts in the bill.

The following Senator is necessarily absent: the Senator from Alabama (Mr. Sessions).

I ask unanimous consent to speak up to 20 minutes in morning business.

Mr. President, I rise to talk about the health care legislation because in a few minutes the official debate in the Senate will commence. The American people will have before them the full panoply of arguments both for and against the legislation. They will make their judgment about whether we are in fact carrying out their will.

According to public opinion surveys, the will of the American people is that this bill should not pass. According to a relatively new Rasmussen poll, by an 18-point margin, Americans say this bill should not pass. By 56 to 38, they oppose it. In terms of people in the middle, the independents or other voters not identified with either political party, the percentage of people who oppose the legislation is even greater. More than 3 to 1, Independents oppose this legislation. The majority believes it will both increase their costs and decrease the quality of health care. It is for these reasons that I indicated before--and I will say it again--I don't think this bill can be fixed. In fact, I don't think the majority will allow it to be fixed. That is why, along with my Republican colleagues, I believe we should start over and attack the problems that face our country in a more realistic way, in a step-by-step approach, first to win back the confidence of the people and then to provide elements of relief to each of the problems we face, rather than trying to tackle the entire health care system, the government programs, the private programs, the insurance, the physicians, the hospitals, trying to do it all in one giant bill that results in massive government takeover, over $1 trillion--in fact, $2.5 trillion--in expenditures, massive new debt, more taxes, higher insurance premiums, all of which will result in, ultimately, the rationing of health care which is, to me, the most dangerous part of this entire exercise.

Somehow or other, we could probably pay the expense of this. Somehow or

other we will survive. But we won't survive the life-and-death decisions that are made every day by patients, doctors, and families, if the government begins intruding between the patient and the physician, begins making decisions about what kind of health care we can have, what kind of health care the government will allow payment for and the like. Those become life-and-death decisions. That is why Americans feel so strongly and personally about this debate and about the decisions we are about to be making here.

Let me address something the distinguished majority leader said a moment ago, and then I wish to talk a bit about Medicare as one of the aspects of this insurance debate.

The majority leader said that Republicans have had a seat at the table. I am on one of the two major committees, the Finance Committee. I think one amendment was adopted. It was an amendment offered by a Republican and a Democrat on the committee. There were well over 100 amendments that Republicans offered that were all shot down, defeated, largely on party-line votes. I say to my distinguished friend from Nevada that maybe we have a seat at the table but it is a little like the kids table at Thanksgiving dinner where you are told to mind your manners and keep the noise down. That is the way Republicans feel about our role at the table in fashioning this legislation.

The majority leader himself would acknowledge that after the two committees in the Senate acted, he went behind the closed doors of his office and, along with representatives from the White House and a couple of other Democratic Senators, no Republicans at all, legislation was developed in his office that he then presented here on the Senate floor just before the Thanksgiving recess. That is how the legislation got developed. It was without Republican participation.

We will have a chance to amend this bill. Maybe he will prove me wrong. Maybe he will demonstrate that we can fix this bill.

I do, with all deference, disagree with his comment that the motivation of Republicans is to do nothing. Of course, he frequently says doing nothing is not an option. Nobody is arguing about doing nothing. Republicans have presented some very good ideas to do something, to do a lot of somethings. Our ideas have been rejected. Let's don't get into false debate about doing something or nothing and the only alternative is the bill that is on the Senate floor. There are alternatives, and I will discuss one group of alternatives we have presented in a moment.

There will be a good test to see whether in fact we can amend this bill or if my prediction that there is no way to fix it will turn out to be true. That has to do, first and foremost, with what this bill does to Medicare, the program we have developed for seniors. Let me go over some of the Medicare cuts in this bill and then ask my Democratic colleagues if they are willing to join Republicans in restoring these provisions of Medicare--in other words, in striking these cuts--if they are willing to join Republicans in that effort. Then maybe the majority leader is right. Maybe we can fix this bill. If they are not willing to do that, then I resubmit that this bill can't be fixed, and it can't because our Democratic friends won't allow it to be fixed.

Here are the ways this bill cuts Medicare benefits for seniors: $137.5 billion is cut from hospitals that treat seniors; $120 billion is cut from Medicare Advantage. I will return to Medicare Advantage in a moment. That is the private insurance company that somewhere around a quarter to a third of seniors take advantage of. Well over a third of the seniors in Arizona, approaching 40 percent of Arizona seniors, participate in the Medicare Program, the benefits of which are substantially cut. Continuing, $14.6 billion is cut from nursing homes; $42.1 billion from home health care, $7.7 billion from hospice care. That is a total of $464.6 billion in Medicare cuts. Seniors know we can't make these kind of cuts without jeopardizing the care they receive. That is the concern I have. We are not talking about cuts in the abstract. We are talking about delay and denial of care for American citizens. These folks wonder how it is fair or justifiable to cut the health care that has been promised to them in order to pay for some kind of new government entitlement.

I receive letters and phone calls every day. I have quoted from many of these letters. Many of them have to do with the proposed cuts in Medicare, in particular to Medicare Advantage.

I mentioned the percentage. In numbers, it is about 329,000 Arizonans--329,000 Arizonans--a third of a million who enjoy Medicare Advantage plans. That is over 37 percent of overall Medicare beneficiaries in my State of Arizona. They know $120 billion in Medicare Advantage cuts will hit our State and, specifically, their coverage very hard. They worry that under the Reid bill, they will lose the low deductibles and the low copayments they enjoy under Medicare Advantage and many of the other benefits I mentioned a moment ago.

They worry about losing the choices they have, which is one of the nice things about the Medicare Advantage plan, and the extra benefits, including things such as eyeglasses, hearing aids, dental benefits, preventative screening, free flu shots, home care for chronic illnesses, prescription drug management tools, wellness programs, medical equipment, and access to physical fitness programs. These and many more are the kinds of benefits that are included in the Medicare Advantage Program, and they will lose many of these benefits under the legislation that is before us right now.

I think they have a right to be concerned about losing these benefits. If there is any doubt about this, incidentally, the Congressional Budget Office, which is a nonpartisan entity which serves both Democrats and Republicans here--it calls it straight; sometimes they give answers we do not like, but they provide the analysis of the costs and benefits--and the Congressional Budget Office has confirmed that under the Democrats' bill, Medicare Advantage beneficiaries will lose, and they will lose big. In fact, they will lose more than half their extra benefits under Medicare Advantage.

Well, my senior citizen constituents do not like that, and they have let me know about that. Let me share a couple letters--just excerpts from letters from two of my constituents. The first is from Surprise,

Mr. President, I wonder if I may interrupt to ask, when the Senator said this is not the approach, the approach taken by the Democratic leader, among other things, because of the cost of it--my colleague from Arizona is here, and I think no one takes second place in this body to him in carefully looking at the cost of every bill we have on this floor. He frequently proposes amendments to reduce the cost of the bills.

I wonder if my colleague from Arizona agrees with my colleague from Utah and is aware of the respected columnist David Broder who wrote in today's Washington Post--actually, it is for publication tomorrow--a column, the title of which is ``A Budget Buster in the Making.''

Mr. President, if I can interrupt my colleague and compliment him on the phrase ``arrogance.'' Maybe ``hubris'' is another word. To think we are smart enough in Washington to figure out what is best for 300 million Americans is truly arrogant.

A question posed by my colleague from Arizona a moment ago: Do they really think they can whiz this by the American people with regard to it not adding to the deficit, for example? Good question.

I want to get back to that Broder piece my colleague from Arizona quoted. There is actually a survey that answers that question. It turns out the American people are pretty smart about this. The question in this Quinnipiac poll read:

President Obama has pledged that health insurance reform

will not add to our Federal budget deficit over the next

decade. Do you think that President Obama will be able to

keep his promise? Or do you think that any health care plan

that Congress passes and President Obama signs will add to

the Federal budget deficit?

Answer: Less than one-fifth of the voters, 19 percent to be

exact, think he will keep his word. Nine out of 10

Republicans, 8 out of 10 independents said that whatever

passes will add to the torrent of red ink and by a margin of

4 to 3 even Democrats agreed that this is likely.

That is why, Broder says at the end:

By a 16 point margin the majority of this poll said that

they oppose the legislation moving through Congress.

So while it is true they are rather arrogantly trying to contend there will not be any big budget deficit from this, the reality is the American people have broken the code they will. One of two things will happen. My colleague from Arizona put his finger right on it. Either we will make cuts in Medicare, for example, that we have never had the political ability to make in the past, in which case our seniors will be hurt, or else, as David Broder said, this bill will truly be a budget buster.

Neither of those results are very sanguine outcomes to an attempt to transform or reform our health care.

Absolutely.

If my colleague will yield, Broder, in his column as to this estimate of budget deficit, he says it depends upon two big gambles.

Will future Congresses actually impose the assumed $420

billion cuts to Medicare, Medicaid and other Federal health

care programs? They never have.

Mr. President, I see our other colleague from Utah here. I know that during Finance Committee deliberations, he was directly involved in one of the conversations about the drug costs and also has been working on his own ideas for alternative approaches to some of these problems. I will ask a question and then if my colleague from Utah, Senator Hatch, may like to comment further, we would invite that.

Is it the case that the Joint Committee on Taxation, which reported to the Finance Committee, and the Congressional Budget Office both said that not only would the increased taxes on the pharmaceutical industry, the medical device industry, and the insurance industry be passed on to consumers in the form of higher premiums but that overall under the legislation that is before us, for the average family as compared to what prices are today, insurance premiums would actually go up and this was one of the two major reasons, the other being mandated benefits?

Mr. President, I went back to my office and got the exact pages our doctor colleague has just been talking about--page 1,189 and page 1,190 of the actual bill. My colleague from Arizona asked the question--this entity, this U.S. Preventive Services Task Force; the entity that made the recommendations with regard to mammograms is it possible their recommendations could be used to deny coverage or reduce payments or deny payments?

Well, here is the exact language, if my colleagues would like to hear it. The Secretary of HHS is, of course, the person who implements this. It is not the task force. The task force makes the recommendations, and then the Secretary of HHS issues the regulations. Quoting:

Notwithstanding any other provision of this title,

effective beginning on January 1, 2010,--

That is just a couple months from now--

if the Secretary determines appropriate, the Secretary

may--

(1) modify--

(A) the coverage of any preventive service described . . .

to the extent that such modification is consistent with the

recommendations of the United States Preventive Services Task

Force. . . .

So there you have modifying the coverage. Then, secondly, as my colleague was just reading:

(2) provide that no payment shall be made under this title

for a preventive service described in subparagraph (A) of

such section that has not received a grade of A, B, C, or I

by such Task Force.

In other words, they make the recommendation, and they say this does not meet our standards, so she can say, therefore, we are not going to pay for it.

That is taking the recommendations of this task force and translating it into the rationing of health care. This is how rationing begins.

The following Senator is necessarily absent: the Senator from Ohio (Mr. Voinovich).

Mr. President, I rise today in my capacity as the cochairman of the Senate's National Security Working Group. It is in that capacity I recently traveled on a CODEL with the senior Senator from California.

Pursuant to the requirements of the current Memorandum of Understanding on the Administrative Procedures for the U.S. Senate National Security Working Group, specifically paragraph 6, Senator Feinstein and I have filed in the Office of Senate Security a classified memorandum available to the members of the working group and their designated staffer.

As my colleagues are aware, the NSWG, which is the successor of the Senate's Arms Control Observer Group, was created by the Senate to aid administrations that choose to negotiate arms control treaties. In view of the 67-vote threshold to ratify a treaty, and given the complexity and importance of the subject matter at the heart of arms control treaties, as well as the Constitution's mandate that the U.S. Senate has a role of advice and consent in treaty making, the NSWG exists to provide a forum for an expert group of Senators to have up-to-date information on ongoing treaty negotiations, and to provide the Administration with consultation from the Senate.

This consultative role is important, because the Constitution entrusts the Senate with the responsibility to provide its advice along with, perhaps, its consent to a treaty. This means administrations are supposed to listen to the advice of Senators if they expect to earn the Senate's consent.

The U.S. negotiating team is lead by Assistant Secretary of State Rose Gottemoeller, a highly capable administration official and a gracious host. I thank her for her time and hospitality, as well as for her service.

I urge my colleagues in the NSWG to take the time to study the classified memorandum Senator Feinstein and I have drafted. The issues covered in our memorandum are significant, and, in some cases worrisome. I won't go into detail here--the memorandum is classified and for good reason.

That said, I will ask to have printed four recent articles on the START follow-on treaty negotiations to the Record. These articles highlight issues that every Senator should consider.

As my colleagues know, the 1991 START Agreement expires 2 weeks from today. I urge my colleagues to consider what will happen on December 6, the day after the expiration of that agreement. For the first time in 15 years, an extensive set of verification, notification, elimination and other confidence building measures will expire.

The U.S. will lose a significant source of information that has allowed it to have confidence in its ability to understand Russian strategic nuclear forces; likewise, the Russian Federation will lose information about U.S. nuclear forces, almost all of which are strategic, unlike the Russian-forces, which place tremendous emphasis on tactical nuclear forces not covered by the 1991 Agreement or its successor.

Yet, no one appears to know what will come next. According to the reports I will add to the Record, there is no plan for what provisions of the 1991 Agreement will be maintained after the 1991 Agreement expires on December 5.

The question of what happens after the 1991 Agreement expires is important. The Russian Federation is already telling us they intend to deploy a new road mobile missile, one which, for the first time, will have multiple independent reentry vehicles. Open source reports indicate this missile will constitute 80 percent of Russian ICBM forces by 2016. This is a significant deployment. Moreover, it confirms that Russia, unlike the U.S., is modernizing its nuclear forces.

How will we monitor this highly destabilizing weapon, the RS-24? According to the article I introduced from the Global Security Newswire by Elaine Grossman, we won't have the entry and exit portals at Votkinsk.

That we don't have answers to these questions is alarming, more so because our negotiators must have known for months that a ``bridge'' would be necessary. Why do I say this? Simple: the Moscow Treaty took the Senate 9 months--287 days--to ratify from the date of its signature. And that was a very limited treaty--it was about two to three pages long.

The START agreement of 1991 took 429 days to ratify on October 1, 1992, after it was submitted to the Senate on July 31, 1991. And by everything we have seen in the press and been briefed on in the National Security Working Group, this new treaty will be almost as complicated, and will include highly significant nuclear force reductions, that will take time for Senators to consider. In fact, the Senate has not had even one hearing on the START process yet.

The administration must have understood this. Yet it spent the first half of the year negotiating a joint understanding that would allow it to show progress towards the President's goal of world without nuclear weapons. According to press reports, only now have the negotiators begun looking at the question of verification.

I was shocked that there had been virtually no talk--and I know this from my conversations with members of both the Russian and U.S. delegations in Geneva--of what happens after December 5 and prior to the possible entry into force of the follow-on agreement when and if it is signed by the two executives. Mr. President, I don't say this lightly, but, this borders on malpractice.

I have said repeatedly that I hope to be able to support the treaty being negotiated now. I have kept an open mind throughout this process. Yet as I learn more about what has been negotiated thus far, and the general process this treaty negotiation has taken, I grow more concerned.

The paramount object of this treaty should have been to extend the verification measure of the 1991 Agreement. But, it appears that the administration's object was to lock in significant nuclear weapons cuts; they achieved that with the July joint understanding. Only recently has verification gotten the attention it deserved all along.

And, now, the Russians may think they have the advantage. That may be why they returned a counter offer a little over a week ago that the U.S. was ``very disappointed about'' in the words of Under Secretary of State Ellen Tauscher. We have entered an end-game where the Russians may feel that the U.S. wants the START follow-on agreement more than they do; even though Russia needs this treaty, needs to lock the U.S. into strategic delivery vehicle reductions as Dr. Keith Payne explained in his testimony before the House Foreign Affairs Committee, only the House so far has held a hearing on START.

I believe the U.S. would have been very well served with a simple 5 year extension of the 1991 Agreement, as the treaty allowed. But, now the President is preparing to head to Oslo to collect his Nobel Peace Prize, one that was apparently based on the President's endorsement of the Global Zero vision. The Russians apparently perceive that the President would be quite embarrassed if he had to pick up his Prize having failed to get a START follow-on completed. In the interest of the United States, I implore the administration not to negotiate against an artificial deadline. There are means to lock in verification and associated activities from the 1991 Agreement after it expires in 2 weeks.

Mr. President, I ask unanimous consent that the four articles to which I referred be printed in the Record.

Thank you. Mr. President, we are going to focus for the next hour on perhaps one of the most pernicious aspects of Leader Reid's bill: the fact that it cuts Medicare by almost $\1/2\ trillion--almost $500 billion in Medicare cuts.

There are a lot of seniors in my State of Arizona and in the States represented by my other Republican colleagues. Those seniors are scared of these cuts. It is not because of anything Republicans have said to try to scare them; they have simply become aware of what is in these bills. By ``these bills,'' I am talking about both the Senate bill offered by the majority leader and the House bill, which are the two bills that would presumably try to be reconciled in conference. Our seniors have been told that under both bills, their benefits are going to be cut by about $500 billion, and that is enough to scare them.

In fact, all of America is concerned about this. A recent USA TODAY Gallup Poll shows that an overwhelming number of Americans--61 percent--oppose cutting Medicare to pay for health care reform. Yet, despite that overwhelming opposition, Democratic leaders in Congress have moved ahead with this bill to slash, as I said, nearly $\1/2\ trillion from Medicare to pay for the new health insurance programs. They are simply not listening to what Americans have to say about this.

If Democratic leaders have their way, hundreds of billions of dollars will be slashed from hospitals that treat seniors, from the Medicare Advantage Program, which we will talk about in a minute, from nursing home care, home health care, and hospice care. Medicare already faces a severe challenge, including a whopping $38 trillion in unfunded liabilities and insolvency by the year 2017. That is almost incomprehensible--in just a few short years, $38 trillion in unfunded liabilities and insolvency. Obviously, seniors want us to fix that problem rather than raiding Medicare to pay for a new health care program, and they want to preserve Medicare Advantage.

I receive letters from worried seniors every day about this Democratic plan to cut Medicare Advantage, which is a very popular program in Arizona. Medicare Advantage is the opportunity we have given seniors to enroll in a private insurance company to help them receive Medicare benefits. What these private insurance companies do is make a more attractive program by adding some additional benefits to the basic set of benefits that are promised under Medicare. What our seniors are telling us is, these are very important benefits to them, things such as vision care and hearing. Now that I am getting a little bit older, I can tell you that both my vision and hearing is starting to go, and I would like to have that kind of benefit. Dental benefits, preventive screenings, free flu shots, home care for chronic illnesses, prescription drug management tools, wellness programs, personal care, and durable medical equipment, all very important for seniors. By the way, physical fitness programs, one of which has a great name--it is called the SilverSneakers Program, and the seniors are very supportive of this because it keeps them physically fit which is, of course, what we should be doing.

I get letters and phone calls from my constituents, and they are sharing their anxieties about losing these benefits, losing prescription drug coverage; about the overall decline in the quality of care that they understand will occur when their doctors' payments are cut, when all these other cuts under Medicare that my colleagues are going to discuss in a moment finally hit. They know it is going to impact their care. They don't like this interference from government bureaucrats, in effect, getting between them and their physicians when it comes to their health care.

Let me read portions of three letters from constituents and then I will yield to my colleagues.

A constituent from Surprise, AZ, writes:

Dear Senator Kyl:

Please fight the cuts to Medicare Advantage. I am on Social

Security disability and on a fixed income. The Medicare

Advantage insurance I have has literally been a lifesaver for

me. I cannot afford to lose the coverage that includes

prescription drugs. I need your help on this.

Two Medicare beneficiaries, a husband and wife from Mesa, AZ, write:

We believe that our health is our responsibility and that

we have a right to make all

the decisions regarding our health. We do not need permission

from our government to take actions that will protect and

preserve our health. We do not need a third party who has

never met us and who is not acting in our best interests in

making decisions about our medical care and we do not want to

lose our Medicare HMOs.

That is the Medicare Advantage about which I spoke.

Then, a constituent from Sun City West, AZ, who incidentally is a World War II veteran, wrote a very powerful letter about how Medicare Advantage improved his life and his wife's life. He said:

As a B-17 pilot I flew 50 combat missions out of England

and I earned five air medals after flying B-24s on coastal

submarine patrol. When we moved to Arizona to be near our

children I visited a local VA hospital to find out that I had

a $50 copay for each visit and I never saw a physician, just

an assistant. In desperation, I purchased a Medicare

supplement for my wife and myself. The cost was almost $600

per year and I only receive $833 a month on Social Security.

Fortunately, here in Arizona, my wife and I were both able to

sign up for MediSun, an Advantage plan, with no monthly

payment and simple $10 or $20 copays. That made it possible

for us to purchase a home. With the health care reform being

considered, we understand that Advantage plans will be

reduced or eliminated. What happened to ``if I like my

insurance, I can keep it''?

Well, it is a good question from my constituent. Of course, he is exactly right. When the promise was made: If you like your insurance you get to keep it, unfortunately, that is not the way this legislation works. As a result, a lot of the benefits they are currently receiving, for example, from Medicare Advantage, would be cut or eliminated.

My constituents are right to be wary of cuts to their Medicare Advantage. They depend on it. They realize you can't cut $\1/2\ trillion from Medicare without adversely affecting your health care.

I am happy to yield to my friend.

Mr. President, the Senator from Mississippi is exactly right. It is not just Members of the House and Members of the Senate, Republicans and Democrats and senior citizens in the State of Arizona. Here are some other third-party sources. I will just cite three: The Centers for Medicare and Medicaid Services; that is, CMS. That is the outfit that runs Medicare. They confirm that cuts will indeed compromise the services seniors now receive.

The Washington Post--how about that for a third-party source-- summarizes a report in a November 13 article entitled ``Bill Would Reduce Senior Care.'' That is a fairly specific headline. It says:

A plan to slash more than $500 billion from future Medicare

spending, one of the biggest sources of funding for President

Obama's proposed overhaul for the Nation's health care

system, would sharply reduce benefits for some senior

citizens and could jeopardize access to care for millions of

others.

Then Politico, which is a Capitol Hill newspaper, reported that, by 2014, enrollment in Medicare Advantage would drop from 13.2 million to 4.7 million because of less generous benefit packages. That is a 64- percent decrease.

Looking at my colleague's chart there, Medicare Advantage, which I spoke about and which my constituents wrote to me about, the concern there is that people now enrolled--13.2 million--are going to be reduced down to 4.7 million because the reductions in the benefits are simply no longer sufficient incentive for them to enroll in that program.

Of course, that is what the pro-government-run health care folks want to happen. They are all for a public company competing with private insurance companies in the market for folks, but when it comes to Medicare, they don't want the private companies that provide Medicare Advantage care competing with the government program. Under this bill, they will get their way. It is going to go from 13.2 million down to 4.7 million. That is a lot of senior citizens who will lose their Medicare Advantage coverage.

I will conclude by confirming what the Senator from Mississippi said. It is not just Representatives in the House or Senators who have sworn to help protect our constituents, but it is third-party sources as well in the government and in the media that have

confirmed that this bill will cut benefits. They will certainly do it for senior citizens.

We will talk later about the Republican ideas. Republicans have suggested a step-by-step approach to target specific solutions to specific problems, including things such as medical liability reform; allowing Americans to purchase insurance across State lines, which would expand competition for patient business; association health plans to help reduce costs. Most of our ideas are cost-free; they won't cost a dime. They wouldn't cut Medicare or diminish the quality of care for anybody. They have been rejected by our Democratic colleagues.

I hope my colleagues will agree that a place to start in this legislation is not to cut Medicare. Why would you want to cut Medicare if the whole idea here is to provide greater opportunity for affordable and quality health care for American citizens? It makes no sense to me.

I yield the floor to my colleague from Idaho.

Mr. President, the answer to that is yes. The idea was that seniors were complaining about the existing program. One thing was that a lot of folks in rural areas were not receiving good, efficient, and quick care because they had to drive long distances and couldn't find a doctor to serve them and hospitals couldn't take care of them.

Republicans tried to figure out, how could we incent the insurance companies to put together pools of physicians and hospitals to go into rural areas and take care of citizens who live there. The Medicare Advantage Program was one of the ways in which that was done. It has proved to be very successful.

Mr. President, I ask if my colleague will yield for a quick question.

We talked a lot about the rationing of health care that is the inevitable result of these cuts in this bill; that when you reduce the amount of money you compensate hospitals, doctors, nurses, and others, they cannot provide as many services. Some leave the business altogether. As the Senator from Idaho pointed out, some businesses go out of business. So there are fewer entities providing the care. That means it takes longer for patients to obtain the care where it is available, and frequently they do not get as good of care because folks cannot take that much time to take care of them in that sense.

Will my colleague please talk about his concerns about the overall problem of rationing that comes from the reductions in the benefits to providers? By the way, the Senator's chart says ``other Medicare cuts to providers.'' We use that term ``providers'' as a short-cut term. Will my colleague explain what it means to a 70-year-old woman in Idaho who is a provider and how important is that, what happens when you don't pay that provider so that provider is no longer available to take care of her?

Mr. President, I want to interrupt my colleague from Mississippi for a moment and ask him--or I think the Senator from Idaho has some experience with this as well--we have been talking about $\1/ 2\ trillion in cuts to Medicare. But we have not even talked about the biggest one yet. We have talked about cuts to Medicare Advantage, we have talked about the cuts that will be ordered by this new Medicare Commission. But I guess I would ask my colleague from Idaho, isn't it true that the biggest dollar cuts to Medicare are going to come because we are going to pay the doctors and the hospitals and the nurses a lot less money?

Of course, every one of my constituents who has talked to me about it said wait a minute, if you are going to pay them a lot less money--I am having a hard time finding a doctor who will take Medicare patients. Isn't that going to result in delay of care for me and denial of care, in effect rationing of care? There will not be enough doctors and nurses to take care of me because they are not being paid enough to even keep their doors open.

Mr. President, I would say to my colleague from Florida that is exactly right. I was interested in that Congressional Research Service report, a totally nonpartisan report, which essentially makes the point if you vote to proceed to the bill, 97 percent of the time you are voting to approve the bill because they end up passing. Those of our colleagues who say they have problems with this bill, serious problems with the bill, are enablers if they vote to proceed to the debate of this bill. They are enabling those who want to pass a bad bill to do so because that is exactly what will happen.

In order for them to try to fix the bill it would take 60 votes to get an amendment agreed to and that is a very tall order around here.

The second part of the question, yes, this may be a little confusing, but what the majority leader has asked is that we vote on a cloture motion to proceed to a House bill that has to do with bonuses for AIG people. You say, What does that have to do with this? The answer is it has nothing to do with this. The leader ordinarily would have taken the House bill, which is the bottom half of this stack here, would have taken the House-passed health care bill and asked to proceed to that bill. If we then agree to proceed to that health care bill, he would then substitute his own version, which is the second half of the stack here, and then you would have a Senate version that we would begin to amend or act on or at least debate.

I don't think the majority leader wants those on his side of the aisle to have to vote on the House-passed health care bill. It doesn't appear to be very popular out in America. In fact, by about 2 to 1 the American people say they don't want to have anything to do with that bill. So, instead, we are going to a shell bill that has nothing to do with health care and then the leader will simply shift to his substitute health care bill. As my colleague from Florida knows, once you vote to begin the debate on this bill, you have put in motion the process by which it could, and in 97 percent of the cases does, end up getting passed into law.

For those colleagues who say I am not sure I like this bill but you know I will move the process along by at least going to it, the time to stop it and to say let's fix it before is the time right now, not after you get on the bill. It is too late.

The point is this: Unless they have a way to get 60 votes to get those provisions out they are in effect endorsing them by voting to proceed to the bill because they can't get them out. My colleague is exactly right.

Mr. President, the whole point of health care reform is to bring down costs and to make health care more affordable for American families. So why have Democratic leaders produced a health care bill loaded with provisions that will increase premiums?

Independent studies from the nonpartisan Congressional Budget Office and the Joint Committee on Taxation and even a study by the chief actuary at the Department of Health and Human Services confirmed this: that the Democrats' plan will drive up premiums and overall health care spending faster than in the absence of these so-called reforms.

How is this so? Let me mention five specific ways.

First, new insurance mandates and new taxes on the insurance industry. New insurance requirements and new taxes on the insurance industry will force premiums to rise for many Americans, particularly the young and healthy. According to an independent analysis that studied the effect of the new insurance reforms and new taxes on the insurance industry, insurance premiums in my home State of Arizona could skyrocket by as much as $2,619 for individuals and $7,426 for families.

Think of that, an increase of $7,426 for families in my State. That is outrageous.

What can $7,426 buy an Arizona family? A lot of things. It could pay for a year's tuition at the University of Arizona. It could pay for a year and a half of groceries or nearly 2 years of utility bills or it could pay for 2 years' worth of gasoline. Families have a lot of expenses and a lot of ways to spend $7,426. They don't need the Federal Government intruding on them and dictating that money has to go somewhere else.

Our friends on the other side of the aisle will say they could provide subsidies. In fact, the legislation will provide subsidies to help with this increased cost. But not every family will qualify, and the subsidies may not even cover the total cost of the increase.

Moreover, what is the point of raising the cost of health insurance and then subsidizing a portion of the increase? You are still raising premiums. It is nonsensical to have a health care reform that makes families worse off and then gives them a government subsidy to help make up for part of the cost.

Second, new mandated benefits will increase costs. Under the Reid bill, the government will require insurers to cover a broad range of new medical benefits determined by Washington, regardless of whether those benefits are actually needed by each individual patient.

These additional benefits might help some patients, of course, but the government cannot provide them to everyone for free. So the cost will be shared by everyone in the insurance pool, and that means increased premiums for many Americans.

In fact, the Council for Affordable Health Insurance estimates the new mandated benefits would increase the cost of basic health coverage between 20 and 50 percent. That is the second way insurance premiums are increased.

Here is the third way: limits on plan types. Under this Reid bill, insurers are limited to offering a total of only four specific kinds of insurance plans. So the low-cost, high-deductible plans that currently families and individuals enjoy will be virtually eliminated. They will have to buy more expensive plans, again paying more in premiums. Whatever happened to getting to keep what you have? Just as one size do not fit all, in this case, four sizes do not fit all either.

Here is the fourth way premiums increase: New taxes are imposed on groups such as medical device makers. According to the Congressional Budget Office and the Joint Committee on Taxation, a new tax on medical devices will increase premiums and increase the price of everything from wheelchairs to diabetes testing supplies, to pacemakers, and it will be paid entirely by the patients.

Its cost, according to the Joint Committee on Taxation? It is $19.3 billion over 10 years. This tax will hit cutting-edge technology such as CT scanners, replacement joints, and the arterial stents that doctors use during angioplasty. This tax will clearly stifle innovation.

As the Wall Street Journal editorialized:

This new tax will eventually be passed through to patients,

increasing healthcare costs. It will also harm innovation,

taking a big bite out of the research and development that

leads to medical advancements.

The fifth way in which this legislation will increase costs for the insured is it actually taxes the insurance plans themselves for the first time. You buy insurance, you get taxed. The Reid bill, for the first time, directly accomplishes this. As the independent Joint Committee on Taxation told us, this new tax will increase the cost of health

insurance for everyone, since insurers will pass the costs along to their patients.

This tax alone could raise some Americans' premiums by $487 per year. Because this tax is indexed to regular inflation rather than to health care inflation, just as with the alternative minimum tax, it could soon start hitting middle-income families.

According to former Congressional Budget Office Director Douglas Holtz-Eakin, half of all families making less than $100,000 per year could end up paying this tax.

Those are five specific ways in which this bill will increase your costs, increase the premiums you pay for health insurance once this bill is in effect. We believe there are better ideas. Republicans have proposed a variety of solutions to target specific problems and, in particular, the problem of cost.

I, specifically, want to conclude by mentioning the Republican health care alternative in the House of Representatives. The majority voted it down, but the truth is, it would, in fact, lower premiums for individuals, families, and small businesses. Contrast the House-passed bill which increases premiums, the Reid bill which increases premiums, but the Republican House bill which would actually decrease premiums and you will see Republicans in the Senate proposing similar ideas.

According to the Congressional Budget Office, under the Republican plan, premiums would be $5,000 lower than the cheapest plan under the Pelosi bill.

Small businesses, too, would see their premiums decrease by as much as 10 percent, again according to the Congressional Budget Office.

Those in the small group market would also see a 10-percent decrease under the House Republican bill, again according to the nonpartisan

Mr. President, I wish to compliment the Senator from Texas for sounding this warning. Being from Texas, she is undoubtedly aware of a great country-western song out right now by Brad Paisley called ``Welcome to the Future.'' I think we have seen a glimpse of the future under Obamacare here by this pronouncement of the U.S. Preventive Services Task Force recommending against the routine screening of women between ages 40 and 49 for best cancer.

I want to speak for about 60 seconds about this issue to go into the actual numbers from the study to which Senator Hutchison referred. The rationale of the study is that you would need to screen 1,339 women in their fifties to save 1 life, so screening is worthwhile. But since you would need to screen 565 additional women--in other words, 1,904, to be precise--in their forties to save 1 life, screening is not worthwhile. That is the kind of cost-benefit analysis that will result in rationing, and it is precisely Senator Hutchison's point that this is how rationing begins.

Welcome to the future.