Floor Statements

Mr. President, I was critical of the President's decisions when he canceled the so-called missile shield that would have been located in Poland and in the Czech Republic, among others things, because I was concerned about the message it sends to our allies in the region. After working with them to develop the political and public consensus for this missile shield, the United States essentially pulled the rug out from under these allies and left the consensus in Central and Eastern Europe that the United States, once again, proved to be an unreliable ally.

Throughout the Baltic States, Central Europe and other people in the world couldn't fail to notice the same. I am thinking of countries in the Persian Gulf that have relied upon the presence of the United States but have, I think, wondered from time to time whether we are the ally they want to stick with because of the fact that sometimes we have proven to be unreliable.

I am concerned about that same issue with respect to Pakistan and Afghanistan. Will our continued public debate over the recommendations that General McChrystal has made to the President result in both allies in the region as well as the leaders of Afghanistan and Pakistan concluding that they better make book with others in the area, including potentially the Taliban? Because after all, those people are going to continue to be in the area; the United States may not.

This is where I think the debate about General McChrystal's recommendations about troop levels and other resources in Afghanistan become so very important. I think we need to listen to the advice of the commander in the field, General McChrystal, who produced a very straightforward assessment of the situation in Afghanistan.

Obviously, the President is the Commander in Chief, and the decisions are his to make. It is appropriate for him to rely upon others for advice as well as on the commander in the field. But there is a point at which the President's own strategy, which he announced in March, needs to be adequately resourced and we need to move forward. Here is what the President said:

The American people must understand that this is a

downpayment on our own future.

He was talking about the resources that would be needed in Afghanistan. So he selected General McChrystal to implement his strategy. We unanimously confirmed General McChrystal, and then the President asked him to give an assessment of what it was going to take. That assessment was provided in August. It has now been about 50 days since that assessment

has been made public--since the President received it. Yet we still don't have a decision.

My concern is that this continuing public debate is going to raise doubts around the world about the staying power of the United States; about our willingness to continue commitments we make. Remember, the President himself called this a war of necessity, both during the campaign and after his inauguration. He stressed the fact that we had to do what it took to win in Afghanistan. There are those around the world who are wondering whether we mean to resource this effort to the extent that General McChrystal has said is necessary.

What did General McChrystal's assessment say? First, he speaks of what ISAF--that is the international force, including NATO forces--will require.

ISAF requires an increase in the total coalition force

capability and end strength.

In other words, more troops. He warned of the risk of not providing adequate resources, and here is what he said:

Failure to provide quality resources risks a longer

conflict, greater casualties, higher overall costs, and

ultimately, a critical loss of political support. Any of

these risks, in turn, are likely to result in mission

failure.

Is that what we want--mission failure? If we don't quickly make a decision, support the President--if he makes the decision to adequately resource our effort there, then we are not only going to be losing, we are not only going to have mission failure, but we will send a message to everybody around the world that, once again, the United States can't be trusted. Here is what the General said about why it matters:

Time matters; we must act now to reverse the negative

trends and demonstrate progress. I believe the short-term

fight will be decisive. Failure to gain the initiative and

reverse insurgent momentum in the near-term--next 12 months--

while Afghan security capacity matures--risks an outcome

where defeating the insurgency is no longer possible.

Do we want to take the risk that we take so long in getting the additional troops there that success is no longer possible? I hope not. Finally, General McChrystal underscored the reason for his conclusions during a recent speech he gave in London, where he said:

I believe that the loss of stability in Afghanistan brings

a huge risk that transnational terrorists such as al-Qaida

will operate from within Afghanistan again.

Now we are having this big public debate. Some prominent Democrats have said we shouldn't resource this the way General McChrystal has announced, and this is why I think we are sending the wrong message. I understand there is some declining support for the war, but this is where Presidential and congressional leadership comes in.

I remember, during the debate over the Iraq war, we had a lot of armchair generals and even a lot of pundits who thought they knew better. Well, General Petraeus, it turned out, was right. Thankfully, President Bush at the time followed his recommendations. As a result, the surge in Iraq was successful. General McChrystal and General Petraeus are essentially saying the same thing again.

Remember, General McChrystal is an expert in both counterterrorism and counterinsurgency policy. He understands the difference and he understands it takes resources to fight a counterinsurgency campaign because you not only have to defeat an enemy but you have to continue to hold the area you have taken until the indigenous forces--in this case the Afghan police and army--are trained in sufficient numbers to hold the territory. You have to protect the populace. In a counterinsurgency strategy, the key is not killing the enemy, the key is protecting the populace. That is why it takes more troops.

Let me read a couple other things the general said:

My conclusions were informed through a rigorous multi-

disciplinary assessment by a team of accomplished military

personnel and civilians, and my personal experience and core

beliefs. Central to my analysis is a belief that we must

respect the complexities of the operational environment and

design our strategic approach accordingly.

This is a carefully thought-out strategic assessment with a lot of support.

There is a recent article in the Weekly Standard magazine by Fred and Kim Kagan that does an excellent job of explaining why this advice is so wise. It focuses on the nature of the al-Qaida threat that emanates from Afghanistan and the network of support that is established there. Part of this is what has informed General McChrystal's assessment. The article says, and I quote:

We should fight [the Taliban and Haqqani groups]--

Another terrorist-led group--

because in practice they are integrally connected with al

Qaeda. Allowing the Taliban and the Haqqani networks to

expand their areas of control and influence would offer new

opportunities to al Qaeda that its leaders appear determined

to seize. It would relieve the pressure on al Qaeda, giving

its operative more scope to protect themselves while working

to project power and influence around the world.

In other words, against the United States. The Haqqani group he is referring to is another terrorist-led group.

Secretary of State Clinton said it quite succinctly when she stated:

If Afghanistan were taken over by the Taliban, I can't tell

you how fast al-Qaida would be back in Afghanistan.

That is the point. That is why I think we need to get on with our decision.

I noted, with interest, a column by E.J. Dionne in the Washington Post entitled ``No Rush to Escalate.'' He quotes in his column historian Robert Dallek, who recently advised President Obama:

``In my judgment,'' he recalls saying, ``war kills off

great reform movements.''

Then he goes on to talk about how World War I brought the Progressive Era to a close; that Franklin Roosevelt would have done better if not for World War II; that Vietnam hurt Lyndon Johnson's Great Society. He says:

It may just be that some of the President's senior advisers

and supporters may be urging him not to devote the necessary

resources to Afghanistan because they don't want him to

become a war president.

That would be most unfortunate. President Obama is the Commander in Chief. He campaigned to become the war President. He said he wanted to end the war in Iraq, which he called a war of choice, and he wanted to win the war in Afghanistan--a war of necessity.

He won the election and he, now, as Commander in Chief, has to make these critical decisions. Whether he likes it or not, he is a war President and he will be judged by history not only by his domestic agenda but by how well he leaves the situation in Iraq and Afghanistan. The key with Afghanistan is not to leave the country in the hands of dangerous Taliban or other terrorists who would work with al-Qaida and give them the kind of place they had before from which to train and plan attacks on the rest of the world.

Also at stake in this debate is the message we are sending to the rest of the world, to our allies in the Middle East, in the Persian Gulf, to Pakistan. Is it safe to throw in with the United States and to help us in our war against these terrorists or, because the United States may bug out when the going gets tough, do we decide to make book with the other side, as Pakistan had done in the past with various groups including the Taliban? That is part of what is at stake. It is not just Afghanistan but our reputation around the rest of the world as to how we deal with our allies and how we resolve conflicts we get involved in.

General McChrystal said it best when he said:

We must show resolve. Uncertainty disheartens our allies,

emboldens our foes.

That is the key message today. I urge the President, in continuing this debate, to bring it to a close as quickly as he can to make the decision. I know Republicans will support a decision that follows the recommendations of General Petraeus and General McChrystal.

I ask unanimous consent to have printed in the Record two articles from the Weekly Standard magazine: One, ``How Not to Defeat al-Qaeda, To Win in Afghanistan Requires Troops on the Ground'' and ``Don't Go Wobbly on Afghanistan; President Obama Was Right in March,'' both by Fred and Kimberly Kagan.

The following Senator is necessarily absent: the Senator from Texas (Mrs. Hutchison).

The following Senators are necessarily absent: the Senator from North Carolina (Mr. Burr), the Senator from Texas (Mrs. Hutchison), and the Senator from Mississippi (Mr. Wicker).

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

Reserving the right to object.

Madam President, it is my understanding that we received this an hour and a half ago. I have no doubt at the appropriate time we will be able to work out some kind of agreement. But our side is going to need some time to look at it. We will need some Republican ideas or amendments as well, and we will need a CBO score.

At this time, I will have to, on behalf of Members on our side, pose an objection.

The following Senator is necessarily absent: the Senator from North Carolina (Mr. Burr).

Mr. President, I ask for the yeas and nays.

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

Mr. President, all eyes are on the Senate now with respect to the health care debate, because the Finance Committee has essentially completed work on the legislation and sometime this week is expected to vote on it, thus making it possible for that bill to come to the Senate floor. The question is, what do people think about the bill we debated and amended in the committee over a period of 2 weeks? Going back over my notes about all of the amendments we proposed and the discussion we had, a couple of things stuck out. First, Republicans have always said we believed it was important to address some of the problems that exist in our current system, problems with insurance and also health care delivery, primarily to bring costs down for all Americans and, in particular, for small businesses that provide insurance to employees, that there were some people who simply couldn't afford to buy insurance and we needed to find a way to help them as well.

Republicans offered scores of amendments. Virtually all of them were rejected. One or two were accepted. We had a lot of good ideas. I am sorry the Democratic majority turned down our ideas. We will offer some of those alternatives when the bill comes to the floor and perhaps hope for a better reception. It isn't as if Republicans didn't have good ideas on how to address the problems. Our ideas were rejected. Instead, we end up with a bill, and I thought: What is the best way to describe the bill? I decided maybe I could identify 10 problems with it as a way of illustrating what is of concern. These may not be the most important 10 problems. There are certainly a lot of other issues, but here are 10 reasons I came up with this morning for the American people to think about and for Senators to think about that would be problems and reasons for us to oppose the bill.

The first has to do with senior citizens who are on Medicare, because the bill cuts $500 billion from Medicare. In July, President Obama spoke at the AARP tele-townhall event and said:

I think there is a misperception that's been out there that

somehow there is any discussion on Capitol Hill about

reducing Medicare benefits. Nobody is talking about reducing

Medicare benefits.

The problem is, this is not a misconception. We are not only talking about reducing Medicare benefits. That is exactly what the Finance Committee bill does. The Baucus bill will reduce Medicare benefits for millions of seniors to pay for a new health care bureaucracy.

This isn't just my word. Here is the nonpartisan Congressional Budget Office estimating that the Baucus bill would cut Medicare by nearly $500 billion in the following ways: $210.9 billion in cuts to hospitals, nursing homes, home health care, and hospice; $123.5 billion in cuts to private Medicare plans known as Medicare Advantage. Here is what the CBO says about that. They estimate that the extra benefits offered by Medicare Advantage plans, such as preventative screenings, vision and dental care, will drop from $125 per month to only $42 per month under the Baucus bill, a direct reduction in benefits for seniors.

Misconception about reducing benefits? No. Real dollars, $123.5 billion in cuts to Medicare Advantage plans which will, according to CBO, cut benefits for seniors.

There is $22.6 billion in savings supposedly from a Medicare commission which Chairman Baucus has noted are executive branch cuts. These will be direct cuts to Medicare. And there is $4.6 billion in cuts to imaging services, wheelchairs, and physician-owned hospitals. Some of these cuts will directly reduce benefits such as those benefits offered by Medicare Advantage plans I mentioned. Others will do so indirectly as, for example, when doctors are paid less or home health care is cut. The bottom line is, it is disingenuous to say that Congress can cut this much spending, $500 billion from Medicare, and not have any detrimental effect on seniors' care. Medicare savings should be used to preserve and strengthen Medicare, not shifted to pay for new entitlement programs.

Reason No. 2, rationing of care. I think at the end of the day, this is probably the most worrisome thing to me. And it is worrisome to a lot of senior and nonsenior citizens who can see their care being rationed under this legislation. The Baucus bill would create a new nonprofit corporation known as the Patient Centered Outcomes Research Institute to conduct what is known as comparative effectiveness research. Billions have been spent in the private sector to identify the best kind of treatment and care available, especially for cutting- edge technologies and treatments for patients' care. For the first time, this bill takes government money to conduct the research, and the net result of it will be to ration care.

The bill, for example, asserts that the Secretary of HHS can use this comparative effectiveness research when making coverage determinations. Coverage determinations are what Medicare is going to cover, what they will pay for; in other words, what kind of treatment one gets to have.

I am quoting now from the bill:

The secretary would be required to use an iterative and

transparent process when using research from the institute in

making coverage determinations.

That is what they intend to do.

You will hear people say: Oh, no, that is not our intention. Well, these are the words of the bill. As a matter of fact, there is over $1 billion that was passed in the stimulus bill that is going to be used by a new Federal agency called the Federal Coordinating Council, to use comparative effectiveness research as the basis for rationed care. So you have this nonprofit entity as well as a Federal entity, both of which will use this research for coverage determinations.

As I said, a lot of folks, particularly on the other side, say: Well, we don't support the rationing of care. We are against it too. Yet every single Republican amendment that was offered to make sure this research could not be used to ration care was defeated on party-line votes in the Finance Committee. The Republicans supported the amendments to ensure no rationing. The Democrats opposed all these amendments.

There is another way the bill is very arbitrary and will result in the rationing of care. It arbitrarily singles out 10 percent of the Nation's physicians every single year and cuts their reimbursements under Medicare by 5 percent. What they are doing is saying those doctors who spend more than other doctors--the doctors in the top 10 percent of spending--are going to have their reimbursements cut at the end of the year because, presumably, that spending was unnecessary. Well, how do we know that? Why isn't it the top 5 percent? Why isn't it the top 20 percent? It is a purely arbitrary number.

As I was discussing this on Saturday morning with a prominent physician, he said: The problem is the physicians who will get their reimbursements cut are the real experts to whom all the other physicians refer their toughest patients. I have seen that happen. I go to the doctor, and my physician says: I am not sure about this. I want you to go see a specialist in this area, and he sends me to somebody else. That doctor may prescribe something that costs a little more money, but he knows that is what I need. Well, he is going to get whacked by 5 percent. Obviously, this will result in a race to the bottom, where doctors will be encouraged to underspend one another rather than ensure the appropriate care is delivered to their patients.

Even the Budget Committee chairman, who sits on the Finance Committee, Senator Conrad, said the provision ``leaves me cold.'' Well, it leaves me cold too. But every Democrat on the Finance Committee voted against my amendment to eliminate this provision.

There was a recent editorial in the Washington Times that illustrates the problem with this. I quote now:

. . . if a doctor authorizes expensive care, no matter how

successfully, the government will punish him by scrimping on

what already is a low reimbursement rate for treating

Medicare patients. The incentive, therefore, is for the

doctor always to provide less

care for his patients for fear of having his payments docked.

That is wrong. The editorial concludes this way:

And because no doctor will know who falls in the top 10

percent until year's end, or what total average costs will

break the 10 percent threshold, the pressure will be intense

to withhold care, and withhold care again, and then withhold

it some more. Or at least to prescribe cheaper care, no

matter how much less effective, in order to avoid the

penalties.

Withholding care, denial of care, delay of care--it is rationing. So the rationing of care is both direct through the use of the comparative effectiveness research or, in this case, indirect, forcing the doctors, in effect, to do the dirty work for Washington by withholding care.

Here is a third reason: waste, fraud, and abuse. The bill purports to attack waste, fraud, and abuse. But let me tell you about a little provision in the bill, and you tell me whether you think this is subject to abuse. Early Friday morning; that is to say, after midnight Thursday night, the chairman rolled into the bill an amendment that would ``streamline'' enrollment in Medicaid, the Children's Health Insurance Program, and the new premium tax credits program under the bill.

Specifically, this amendment would provide a single application form for all three subsidy programs. The form can be filed online, in person, by mail or telephone. You heard me right: by telephone. How will a State Medicaid agency know if the person is truly eligible for the program, if the person is a U.S. citizen or is even the person he or she purports to be? Poll after poll shows the American people believe fraud, waste, and abuse should be addressed prior to creating new government programs. The Baucus bill exacerbates the fraud, waste, and abuse inherent in Federal public health programs.

A fourth reason: rising health insurance premiums. You all heard that under this legislation, health care is going to cost less. Wrong. Health care is going to cost more. Rather than reducing the cost of premiums, they are going to go up under the bill. Do not take my word for it. Here is the Congressional Budget Office, again, nonpartisan:

Premiums in the new insurance exchanges would tend to be

higher than the average premiums in the current-law

individual market.

That is according to the Congressional Budget Office. Premiums will be higher than the average of premiums under current law.

The bill provides that every insurance company has to offer at least two particular kinds of insurance and they cannot offer any more than four. The lowest actuarial value they can offer is 65 percent. What does that mean? Individuals will have to buy richer health insurance plans with higher premiums than they would under the current market regardless of their financial or medical circumstances.

The average actuarial value of an individual insurance plan today, according to the Congressional Budget Office, ranges ``from 40 percent to 80 percent, with an average value that is between 55 and 60 percent.'' The bill, remember, mandates that the very lowest is 65 percent, which means it is going to be more than, higher than the value that currently exists for most and for the average. In my State, the average actuarial value for an individual plan is 61 percent. The average value for a high-deductible health plan is 48 percent.

The bottom line is, the Baucus bill not only mandates that you buy insurance, but you have to buy insurance that is going to have a higher premium than the insurance you pay for today. Part of the reason insurance will cost more is because the Baucus bill would require all insurers to cover a minimum set of standardized benefits in addition to the current State-mandated benefits.

The Council for Affordable Health Insurance estimates that current mandated benefits increase the cost of basic health coverage from a little less than 20 percent to perhaps 50 percent. So get ready America, you are going to see your premiums go up under this legislation, not down.

Here is a fifth reason to oppose the bill. Under this legislation, there are penalties on your employer, which will be passed on to you in the form of lower wages. Under the Baucus bill, employers with over 50 employees, that do not offer health insurance to their workers would be required to pay a penalty for each employee who receives a tax credit to purchase coverage through the insurance exchange.

Where does the money come from to pay the penalty? Well, the CBO has warned Congress about so-called free rider proposals. Here is what they say:

Supporters of such surcharges often refer to them as ``free

rider'' penalties.

That is what is in the bill.

Although the surcharges would be imposed on the firms,

workers in those firms would ultimately bear the burden of

those fees, just as they would with pay-or-play requirements.

Continuing to quote:

Employer surcharges tend to be more targeted. . . . Many of

those workers are more likely to have earnings at or near the

minimum wage, and the size of such surcharges--if based on

actual costs imposed on government programs--could be larger

per affected worker than the assessments being considered in

many play-or-pay requirements.

What that is saying is, when you put a fee on the employer, that fee is passed on to the employees in the form of lower wages or, in some cases, even fewer workers and that it is most likely to more dramatically affect those who have earnings at or near the minimum wage than those at higher wage scales. So you are hurting the very lowest paid workers.

Senator Enzi offered an amendment in the committee that would have required the Secretary of Labor to certify that the bill would not result in lower wages or in an increase in the unemployment rate before the bill could go into effect. You would think that would be a good guarantee that the bill would not have the adverse consequences I indicated.

Well, an interesting thing happened in the committee. The amendment first passed 21 to 0. Everyone thought it was a good idea to guarantee that the bill would not reduce people's wages or result in laid-off workers. Yet early in the hours on Friday--in other words, after midnight Thursday night--the Democrats in the committee changed Senator Enzi's amendment into a mere report to Congress. So after first voting in favor of the amendment to ensure that workers' wages would not be reduced, they then came back late and undid what they had passed earlier. Why would they do that, when the first amendment passed 21 to 0? Because, of course, it is an impossible certification under the bill. The bill will reduce wages--CBO said so--and the Democrats in the committee realized, therefore, they could not stick with that certification and have the bill be effective. So wages will be lost and some jobs will be lost.

Well, here is a sixth reason to oppose the bill: If you like your current insurance, you will not be able to keep it. You have heard the President promise this over and over: If you like your current coverage, you will be able to keep it. No, you will not--not under this bill. This has been proven now time and time again. I think it is one of the reasons the President is so sensitive about this. In fact, in his speech to the Congress, he changed his terminology a little bit. He said: If you like your insurance, we will not do anything to require you to change it. He had to change his terminology because, of course, what he was saying before is absolutely false.

By saying the government will not require you to change your plan, that is technically true. But it is lawyers' words. The problem is, the insurance you have now you will not have anymore because it will not exist anymore. No one will require you to change it. It simply will not be available to you. Why not? Well, there are several different reasons.

For seniors, the Baucus bill cuts billions of dollars from the Medicare Advantage Program. That will force those plans to cut benefits under their plans or to drop coverage altogether.

For those who are privately insured, Senator Hatch offered an amendment that would have required the Secretary of HHS to certify the bill would not cause more than 1 million Americans to lose their current coverage. The amendment failed on a party-line vote. Let me repeat that. The Hatch amendment said: Well, we have to at least certify that no more than 1 million people will lose their coverage under this bill. That cannot be certified because that is not what is going to happen. A lot more than 1 million people

are going to lose their coverage. So his amendment lost on a party-line vote.

It is true the Baucus bill does not require insurers to drop coverage for people who like their current health insurance plans, but the practical effect of the bill will be to cause Americans to lose the coverage they currently enjoy.

For the seniors, by the way, under the Medicare Advantage plan, I quoted the numbers earlier. Let me quote them again. CBO estimates the extra benefits offered by the Medicare Advantage plan--such as preventive screenings, vision, and dental care--will drop from $135 per month to only $42 per month under the Baucus bill. So you are going to lose over $90 worth of care, benefits, that you currently have. No, you are not going to be able to keep the insurance you have today, even if you like it.

Here is a seventh reason: This may seem like a small thing to most people, but the precedent is enormously dangerous in our country. We have all seen what happens when the government takes over part of the economy: insurance companies or the bank bailouts or the automobile companies. When the government takes these things over, they begin to make the decisions; for example, setting the pay of the people who work in those companies. It started out just capping the high executives' pay.

Under this bill, however, insurance companies' pay for all employees would be subject to the Federal regulation. If you pay somebody a certain amount of money, you will not be able to deduct it as a part of the ordinary and business expense that you do today. So it is a way of indirectly capping pay. It would limit the tax deduction for health insurance executives and other highly paid workers at $500,000. By the way, it would not limit the deduction of pharmaceutical companies or hospital industry executives and so on. But it is another example of what happens when Washington takes over another segment of the economy.

Robert Reich, by the way, who is the former Secretary of Labor under the Clinton administration, wrote an op-ed in the Wall Street Journal in which he pointed out that sometimes these relatively high--and $500,000 is, to me, a lot of money--but there are people who are paid a lot more than that in these high-paid industries because of what they are able to do for their particular company, and he warns about the effect of legislation such as this that would effectively cap pay of employees.

Here is another thing--the eighth reason--taxing you through your health insurance plan. This is another one of the sneaky ways in which the bill actually gets at you, but they put the tax first on the insurance company. I told you the Congressional Budget Office said the wage earners would actually pay the penalty imposed on businesses. Well, here is an example of where the Baucus bill imposes a 40-percent excise tax on any health insurance plan that is above $8,000 for a single person and $21,000 for family plans. Who ends up paying the increased tax on the insurance company? Of course, you do. They pass it on to you through higher premiums.

According to the nonpartisan Joint Tax Committee, which provided the Finance Committee with a distributional analysis of this provision, the bulk of this $200 billion tax increase falls on those President Obama promised to protect. Do you remember: ``Nobody under $200,000 is going to pay any new taxes under my bill''? Well, here is what happens in the first year this tax is in place. It raises taxes on 13.8 million tax units; that is, either an individual or a family who files an income tax return; that is, it raises taxes by $13 billion on 13.8 million tax units. Of those 13.8 million tax units--individual filers or families-- only 1.2 million will have incomes above $200,000. So about 12.6 million of these tax filers who are under $200,000 in income will pay this tax. Not going to tax anybody under $200,000? Wrong. This means 91 percent of the affected taxpayers will be hit by the premium increase as a result of this tax.

By the way, the average tax increase for those earning under $200,000 is $900. This is every year, by the way. Within 6 years, the number of tax units hit by this tax would nearly triple to almost 40 million individual or family filers, and the tax would collect over $52 billion in that year.

Here is a ninth reason for opposing the bill: taxing the chronically ill. This is an amendment I offered because this is just wrong. As my colleagues know, under the tax law today, if you are so unfortunate as to be hit by a huge medical bill in any given year, and it exceeds 7.5 percent of your gross adjusted income on your income tax form, then you get to take a deduction for any amount above 7.5 percent of your income. The reason for that is because we don't want anyone in this country to have to suffer unnecessarily or out of proportion simply because of an accident, in effect. This is literally the lightning strikes situation. Most people would not have medical bills exceeding 7.5 percent of their adjusted gross income, but the few who do have been stricken enormously hard. They don't deserve it. In fact, the Internal Revenue Service actually treats this as an involuntary expense.

Under the IRS Code, there are few things that happen to you by pure luck of the draw, as it were. Most of the IRS Code applies to you based on decisions you made: You invested and lost money or you invested and made money and you get taxed on it as a result of the decision you made. You bought a house and you have a mortgage deduction, you know how much that is, you are taxed on a decision you made.

This, you had nothing to do with it; you just got sick. So your expenses are enormous compared to your income. We have always said in that case: We don't want that to hurt you; we are going to make sure you don't pay more than a certain amount in your taxes. Anything above 7.5 percent you get to deduct.

Under the Baucus bill, that 7.5 percent goes up to 10 percent, so now you are going to have to eat 10 percent of this catastrophic cost before you can even get to the point where you can have a tax deduction. Yet, as I quote the Congressional Research Service, ``the deduction can ease the financial burden imposed by costly medical expenses.'' For the most part, the Federal Tax Code regards these expenses as involuntary expenses that reduce a Federal taxpayer's ability to pay taxes by absorbing a substantial part of income.

The Joint Tax Committee has estimated that increasing the threshold to 10 percent would increase taxes by $15 billion over 10 years. Who are these unfortunate taxpayers? Are they rich people? No. Twenty-one percent of them who claim this deduction earn under $40,000, or less than 200 percent of poverty. So almost one-fourth of the people who take advantage of this are literally--they are at 200 percent of poverty. They are making $40,000 a year. Those are exactly the kinds of people you want to be able to take advantage of a tax provision like this. They get killed when they have an expense that big, and 5.8 million taxpayers or 87 percent who claim this deduction earn under $100,000, and that is not wealthy by any means. Mom and dad are working. Together they earn, let's say, $90,000. Well, 87 percent of the people who claim this deduction are in that category. Those are people we should be helping by not having them pay quite as much in taxes, but under the bill we make it harder for them. We raise the threshold from 7.5 to 10 percent.

I wanted to actually reduce it to 5 percent to help people with their health care costs. Isn't the whole point of this bill to reduce people's health care expenditures? Isn't that the whole idea? No. We are not going to reduce them; we are not even going to leave them the same. We are going to raise them.

That brings up the tenth and final reason: taxing middle-class families. Under current law, employees can make tax-free contributions for medically necessary goods and services to pay out-of-pocket expenses. We would assume that to be the case. Although there is no legal limitation, employers generally establish a $5,000 limit that they provide to their workers.

Senator Baucus is proposing to limit the contributions to $2,500 a year, and the Joint Tax Committee estimates that this limit would raise $15 billion over 10 years.

Now, why are we doing this? Is it good tax policy? No. We are doing it because we have to raise revenue. You see, the Democrats, who proposed this amendment, said at the very outset:

We are going to make sure it is ``revenue neutral.'' What does revenue neutral mean? When you are proposing to spend $800 billion, $900 billion, $1 trillion in order to make it revenue neutral, you have to come up with $800 billion, $900 billion, or $1 trillion in new taxes or revenue or savings in order to offset the cost of that. So they have to raise money by a variety of taxes--I have mentioned a couple of them-- or by penalties in ways that help them to get to this $800 million, $900 million, or $1 trillion.

Well, here is another one of the taxes. We limit the contribution limit to $2,500 a year. That way the Federal Government will bring in $15 billion more in revenue.

Who takes advantage of this? Well, the 35 million people who use these flexible spending accounts spend 43 percent on hospital admissions and physician visits, 26 percent to purchase prescription and over-the-counter drugs to manage chronic diseases, 21 percent for dental, and 10 percent for vision. These are medical expenses that help make people healthier or prevent them from getting sicker. Isn't that what we want to be promoting, rather than hurting?

Americans with chronic conditions spend nearly $4,400 a year in out- of-pocket medical expenses for ailments such as diabetes and autism. Why shouldn't we be helping them by allowing their employers to put money into these flexible spending accounts for them to offset against their medical expenses?

Well, maybe this is just for the rich. No. There again, wrong. The median income for a policyholder utilizing a flexible spending account is $55,000--hardly the rich. So, once again, we tax middle-class families in order to raise money to pay for the expense of this legislation.

These are just 10 reasons. I could keep going. There are dozens and dozens of reasons to oppose this legislation, but just start with these 10:

No. 1, $500 billion in Medicare cuts that is going to result in less care for America's seniors--benefit cuts.

No. 2, rationing of care, both directly and indirectly, through this comparative effectiveness research and through other means that force the physicians, in effect, to provide less care if they want to be paid. More fraud, waste, and abuse. We thought we were going to actually save money from waste, fraud, and abuse. No. We are going to do things such as let people register by telephone when we are not going to be able to verify their eligibility for subsidies under this program.

Rising health insurance premiums: The Congressional Budget Office says the increase in the insurance costs will be passed on to the premium holders, so our insurance premiums go up, not down.

Taxes on employers which, again, according to the people who know best--nonpartisan--reduce employees' wages.

If you like your current coverage, you would not be able to keep it. That is a reason to oppose this legislation. If you like your current coverage, you ought to be able to get to keep it.

No. 7, unwarranted government intrusion. I just cited the example of the capping of pay, but there are so many other situations in which this tangled web of government regulations will virtually create government-run health care in this country, with or without a government-run insurance plan or the so-called public option.

No. 8, taxing you through your health insurance program. Here, again, they impose a tax on the insurance company because insurance companies are bad. Well, insurance companies are bad until you want them to pay for your health care. Then they are OK, I guess. In any event, the insurance company has to pass it on to you, so your premiums go up. That is what the experts say will happen.

Taxing the chronically ill: Why should we not allow people to deduct from their income taxes the expenses of these catastrophic events in their life that all of us--none of us want these things to happen to us, and we should at least be able to deduct part of these expenses in our income taxes.

Finally, taxing middle-class families through the inability to take advantage of what their employers would otherwise provide by way of flexible spending accounts so they could actually have money to spend on chronic diseases such as diabetes--just one that I mentioned.

The whole exercise is we are going to make health care costs go down, we are going to reduce premiums, and we are going to recognize that people have too hard a time coping with these issues in today's society. We only make it worse if we adopt the Baucus bill because it will raise insurance premiums, it will lower wages, it will increase taxes, and it will reduce the care people get. How is that for a deal? Only something offered in Washington, DC, could be that bad a deal.

That is what is coming down the pike. In a couple of weeks, that bill is going to be--actually, it would not even be that bill; it will be a worse bill. I have described what many say is the best it is going to get, the bill that came out of the Finance Committee. It is only going to get worse from here because this bill is going to be combined--not by Republicans but by Democrats--behind closed doors with the bill that came out of the HELP Committee which, if anything could be worse, is. So somewhere in between this bill and that bill, that is what we are going to have on the Senate floor. It is a bad deal for the American people.

One final point. I see my friend, the Senator from Tennessee, Mr. Alexander, coming to the floor. He has been saying something over and over and over again that bears repeating. I will tell Senator Alexander, I was in church yesterday, and I don't know how many people told me exactly this: Read the bill and find out how much it costs. If we do that, and if we tell our constituents how much it costs and what is in the bill, I predict a lot of my colleagues are going to say: Thanks but no thanks; my constituents really don't want this bill.

So in addition to all of the other things I have said, maybe I should have started with the proposition: Read the bill and find out how much it costs. I suspect my friend from Tennessee might just mention that.

Thank you, Mr. President.

Mr. President, earlier this month, we paid homage to those who lost their lives in the terrorist attacks on September 11, 2001. Those attacks changed our nation forever, including how we combat the very real and continuing threat of terrorism. One of the most important changes that we made in the wake of September 11 was the enactment of the PATRIOT Act. That legislation, which had strong bipartisan support in the Congress, provided for a number of common sense changes designed to give our national security intelligence community the same tools our police and FBI agents can use against drug dealers and organized crime. Although many of the PATRIOT Act's provisions are now permanent, three critical national security tools--the ``wiretap'' authority contained in Section 206 of the PATRIOT Act; the ``business records'' authority contained in Section 215 of the PATRIOT Act; and the ``lone wolf'' authority contained in Section 6001 of the Intelligence Reform and Terrorism Prevention Act of 2004--will expire on December 31 of this year.

The tools in the PATRIOT Act are as necessary today as they were when first enacted. Just this month, the government confirmed that the Foreign Intelligence Surveillance Act of 1978, FISA, which includes PATRIOT Act provisions, was used to build a case against Najibullah Zazi. Although many details remain classified, it appears as if Najibullah Zazi was an al Qaeda associate who was planning to detonate bombs within the U.S.

Similarly, it has been reported that the FBI likely used its roving wiretap and business records authorities--two of the PATRIOT Act's expiring provisions--to thwart a terrorist plot uncovered earlier this year in New York, in which four former convicts who converted to radical Islam plotted to use

explosives to blow up synagogues and shoot down airplanes with surface- to-air missiles.

Those are two high-profile examples from just this year. There are no doubt countless of other instances, not known to the public, where PATRIOT Act authorities have been used by our national security professionals to keep Americans safe. Recognizing the importance of these tools, the Department of Justice has written the Chairman of the Judiciary Committee to urge renewal of the expiring provisions of the PATRIOT Act. In addition, FBI Director Mueller and David Kris, the Assistant Attorney General for the National Security Division, both expressed their strong support for these authorities in testimony before the Judiciary Committee this month.

The reality is that the war on terrorism is not going to sunset. Neither should the tools that our investigators and analysts rely upon to prevent attack. That is why Mr. Cornyn and I are introducing today the USA PATRIOT Reauthorization and Additional Weapons Against Terrorism Act of 2009. This legislation permanently renews the three expiring PATRIOT Act provisions and addresses other critical national security needs.

I. Renewing the Roving Wiretap Authority

The roving wiretap authority allows the Government, in certain circumstances, to focus surveillance efforts on monitoring a particular target rather than a particular telephone number. Gone are the days when you used only one phone at home or in the office. Cell phones are ubiquitous. The point is to intercept the calls of a particular person, not a particular phone. Even so, the Government may have such authority only in limited circumstances. It must provide the FISA Court with ``specific facts'' indicating that the ``actions of the target of the application may have the effect of thwarting the identification'' of third parties necessary to accomplish the ordered surveillance. This tool helps ensure that investigators and analysts may overcome a target's efforts to avoid surveillance, for example, rapidly switching cell phone numbers.

As the Department of Justice noted in its September 14, 2009, letter to Chairman Leahy, the roving wiretap authority has ``proven an important intelligence-gathering tool in a small but significant subset of FISA electronic surveillance orders.'' The Department's letter explains that the authority has been used judiciously--on average, only 22 applications for roving wiretaps have been made per year--and that ``the basic justification offered to Congress in 2001 for the roving authority remains valid today. . . . Any effective surveillance mechanism must incorporate the ability to rapidly address an unanticipated change in the target's communications behavior.''

II. Renewing the Business Records Authority

The business records authority allows the FISA Court, under appropriate circumstances, to compel the production of needed business records. In its September 14 letter, the Department of Justice expressed its strong support for the business records provision, stating that it ``addresses a gap in intelligence collection authorities and has proven valuable in a number of contexts.'' The Department stated that some of the acquired ``orders were used to support important and highly sensitive intelligence collection operations, of which both Members of the Intelligence Committee and their staffs are aware.'' Although some have questioned the scope and use of this authority, it is important to acknowledge that no one has challenged a business records order in court, even though an explicit right to file such a challenge took effect in 2006. Such authority also exists in at least 300 federal government investigative contexts.

III. Renewing the Lone Wolf Authority

The ``lone wolf'' provision fills a critical intelligence gap in situations where the government can establish that a non-United States person is engaged in international terrorism but cannot yet identify the foreign power or terrorist group to which he belongs. Although this authority has not yet been used, the Department of Justice made clear in its September 14 letter that there are foreseeable situations in which such an authority ``would be the only avenue to effective surveillance.'' The Department stated that ``it is essential to have the tool available for the rare situation in which it is necessary rather than to delay surveillance of a terrorist in the hopes that the necessary links are established.'' Had we had this authority at the time, we could have examined the computer of Zacarias Moussaoui, perhaps gaining enough information to provide some warning of 9/11. Terrorists do not carry membership cards in organizations, but it does not make them any less dangerous.

IV. Addressing Other National Security Needs

In addition to reauthorizing these important national security tools, this legislation responds to several other national security needs. For example, it clarifies what kind of information and disclosures trigger the procedures of the Classified Information Procedures Act, CIPA. This clarification is designed to resolve the difficulties created by the Fourth Circuit's approach in United States v. Moussaoui. The legislation also prohibits individuals from providing material support--for example, providing money to support a suicide bomber's family--to international terrorism efforts. It makes it illegal to conspire to violate the current prohibition on receiving military-type training from a foreign terrorist organization. It prohibits the use, transfer, mass transfer, production, and trafficking of false travel documents. Finally, it ensures that convicted terrorists and sex offenders will not be released pending sentencing or appeal.

These are good, common sense provisions that all members should be able to support. I look forward to working with my colleagues on both sides to ensure that our national security professionals have the tools they need to continue finding and apprehending terrorists before they attack.

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

Mr. President, earlier this month, we paid homage to those who lost their lives in the terrorist attacks on September 11, 2001. Those attacks changed our nation forever, including how we combat the very real and continuing threat of terrorism. One of the most important changes that we made in the wake of September 11 was the enactment of the PATRIOT Act. That legislation, which had strong bipartisan support in the Congress, provided for a number of common sense changes designed to give our national security intelligence community the same tools our police and FBI agents can use against drug dealers and organized crime. Although many of the PATRIOT Act's provisions are now permanent, three critical national security tools--the ``wiretap'' authority contained in Section 206 of the PATRIOT Act; the ``business records'' authority contained in Section 215 of the PATRIOT Act; and the ``lone wolf'' authority contained in Section 6001 of the Intelligence Reform and Terrorism Prevention Act of 2004--will expire on December 31 of this year.

The tools in the PATRIOT Act are as necessary today as they were when first enacted. Just this month, the government confirmed that the Foreign Intelligence Surveillance Act of 1978, FISA, which includes PATRIOT Act provisions, was used to build a case against Najibullah Zazi. Although many details remain classified, it appears as if Najibullah Zazi was an al Qaeda associate who was planning to detonate bombs within the U.S.

Similarly, it has been reported that the FBI likely used its roving wiretap and business records authorities--two of the PATRIOT Act's expiring provisions--to thwart a terrorist plot uncovered earlier this year in New York, in which four former convicts who converted to radical Islam plotted to use

explosives to blow up synagogues and shoot down airplanes with surface- to-air missiles.

Those are two high-profile examples from just this year. There are no doubt countless of other instances, not known to the public, where PATRIOT Act authorities have been used by our national security professionals to keep Americans safe. Recognizing the importance of these tools, the Department of Justice has written the Chairman of the Judiciary Committee to urge renewal of the expiring provisions of the PATRIOT Act. In addition, FBI Director Mueller and David Kris, the Assistant Attorney General for the National Security Division, both expressed their strong support for these authorities in testimony before the Judiciary Committee this month.

The reality is that the war on terrorism is not going to sunset. Neither should the tools that our investigators and analysts rely upon to prevent attack. That is why Mr. Cornyn and I are introducing today the USA PATRIOT Reauthorization and Additional Weapons Against Terrorism Act of 2009. This legislation permanently renews the three expiring PATRIOT Act provisions and addresses other critical national security needs.

I. Renewing the Roving Wiretap Authority

The roving wiretap authority allows the Government, in certain circumstances, to focus surveillance efforts on monitoring a particular target rather than a particular telephone number. Gone are the days when you used only one phone at home or in the office. Cell phones are ubiquitous. The point is to intercept the calls of a particular person, not a particular phone. Even so, the Government may have such authority only in limited circumstances. It must provide the FISA Court with ``specific facts'' indicating that the ``actions of the target of the application may have the effect of thwarting the identification'' of third parties necessary to accomplish the ordered surveillance. This tool helps ensure that investigators and analysts may overcome a target's efforts to avoid surveillance, for example, rapidly switching cell phone numbers.

As the Department of Justice noted in its September 14, 2009, letter to Chairman Leahy, the roving wiretap authority has ``proven an important intelligence-gathering tool in a small but significant subset of FISA electronic surveillance orders.'' The Department's letter explains that the authority has been used judiciously--on average, only 22 applications for roving wiretaps have been made per year--and that ``the basic justification offered to Congress in 2001 for the roving authority remains valid today. . . . Any effective surveillance mechanism must incorporate the ability to rapidly address an unanticipated change in the target's communications behavior.''

II. Renewing the Business Records Authority

The business records authority allows the FISA Court, under appropriate circumstances, to compel the production of needed business records. In its September 14 letter, the Department of Justice expressed its strong support for the business records provision, stating that it ``addresses a gap in intelligence collection authorities and has proven valuable in a number of contexts.'' The Department stated that some of the acquired ``orders were used to support important and highly sensitive intelligence collection operations, of which both Members of the Intelligence Committee and their staffs are aware.'' Although some have questioned the scope and use of this authority, it is important to acknowledge that no one has challenged a business records order in court, even though an explicit right to file such a challenge took effect in 2006. Such authority also exists in at least 300 federal government investigative contexts.

III. Renewing the Lone Wolf Authority

The ``lone wolf'' provision fills a critical intelligence gap in situations where the government can establish that a non-United States person is engaged in international terrorism but cannot yet identify the foreign power or terrorist group to which he belongs. Although this authority has not yet been used, the Department of Justice made clear in its September 14 letter that there are foreseeable situations in which such an authority ``would be the only avenue to effective surveillance.'' The Department stated that ``it is essential to have the tool available for the rare situation in which it is necessary rather than to delay surveillance of a terrorist in the hopes that the necessary links are established.'' Had we had this authority at the time, we could have examined the computer of Zacarias Moussaoui, perhaps gaining enough information to provide some warning of 9/11. Terrorists do not carry membership cards in organizations, but it does not make them any less dangerous.

IV. Addressing Other National Security Needs

In addition to reauthorizing these important national security tools, this legislation responds to several other national security needs. For example, it clarifies what kind of information and disclosures trigger the procedures of the Classified Information Procedures Act, CIPA. This clarification is designed to resolve the difficulties created by the Fourth Circuit's approach in United States v. Moussaoui. The legislation also prohibits individuals from providing material support--for example, providing money to support a suicide bomber's family--to international terrorism efforts. It makes it illegal to conspire to violate the current prohibition on receiving military-type training from a foreign terrorist organization. It prohibits the use, transfer, mass transfer, production, and trafficking of false travel documents. Finally, it ensures that convicted terrorists and sex offenders will not be released pending sentencing or appeal.

These are good, common sense provisions that all members should be able to support. I look forward to working with my colleagues on both sides to ensure that our national security professionals have the tools they need to continue finding and apprehending terrorists before they attack.

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

Mr. President, a September 17, 2009, editorial in the Wall Street Journal, ``Public Option Lite,'' clearly and concisely describes how the Finance Committee chairman's health care plan would result in a near total government takeover of the health care industry.

Because it does not include the public option, the chairman's plan has been touted as a more moderate proposal than other bills before Congress. But, as the Journal writes, the absence of the public option ``is a political offering without much policy difference. His plan remains a public option by other means.''

Near total government control would be achieved through the bill's two main mechanisms: an individual mandate for all Americans to purchase government-approved insurance and the regulatory insurance ``exchange.'' The inevitable outcomes of these mechanisms would be ``vast new insurance regulation'' and ``a vast increase in the government's share of U.S. health spending, forcing doctors, hospitals, insurance companies, and other health providers to serve politics, as well as, or even over and above patients.'' Thus, power would be centralized with politicians and bureaucrats, rather than patients and doctors.

Along the way, as the editorial points out, the bill would increase the

cost of insurance through new taxes and mandates, reduce consumer choice, and ultimately ration health care in an attempt to keep costs under control.

The editorial also explains that most of the Medicare cuts used to help pay for this plan ``come from supposedly automatic cuts that a future Congress is unlikely to ever approve, that is, until this entitlement spending swamps the entire federal budget.'' Then, ``The government will have no choice but to raise taxes to European welfare- state levels or impose drastic restrictions on patient care. Or likely, both.''

The article concludes that this plan is ``a recipe to ruin healthcare'' and ``bankrupt the country.''

I ask unanimous consent to have this article printed in the Record and urge my colleagues to consider the facts and arguments contained in this editorial.

The following Senator is necessarily absent: the Senator from Oklahoma (Mr. Coburn).

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

Mr. President, during the last several months Congress has been engaged in a vigorous debate about how to achieve health care reform. Despite the President's repeated claims to the contrary, we all agree, Republicans and Democrats, that some reforms are necessary.

Costs are too high for families and businesses. Too many Americans lack access to affordable options. We need to make health insurance more affordable and more portable.

There are two basic approaches before Congress: reforms that impose much more government control over health care or reforms that provide consumers with more affordable options and keep control of health care decisions with families and doctors.

I happen to believe that the latter approach is better, that we must empower patients and doctors, not bureaucrats and politicians, to make health care decisions. I think it is clear that after the August recess, a majority of Americans rejected a Washington takeover of health care, along with the mountains of new taxes and debt and bureaucracy it would create.

While I appreciate the hard work of the Finance Committee chairman in trying to write a more acceptable bill, the end result is little better than the others, that is, the government's near total control over health insurance, and therefore the delivery of your health care.

Along the way, it would also spend nearly $1 trillion and cut Medicare benefits by nearly half a trillion. The Finance Committee chairman's bill is a tangled web of federally documented insurance regulations which would control every aspect of health insurance from covered benefits to permissible premiums.

The bill would centralize the power of medical decisions with politicians and bureaucrats, not patients and doctors. It would result in higher health insurance premiums, less consumer choice, and ultimately the rationing of health care.

How would the government take over health care under this bill? There are two key provisions that would result in government-run health care for practically all Americans, and empower bureaucrats at the expense of patients.

The first is a requirement that every American buy an insurance policy. The second is a regulatory entity called the insurance exchange. First, let's talk about this mandate for everyone to buy an insurance policy. The chairman's plan imposes this individual mandate for all individuals to purchase a government-approved policy. To repeat, not just any insurance, but government-approved and therefore government-defined insurance.

Those who do not comply face steep fees--or fines, I should say-- ranging from a $750 to a $3,800 per-year fine. The mandate constitutes direct interference in health care with a host of

new regulations that control the insurance plans that would become available to consumers.

Michael Cannon, a health policy expert at the Cato Institute, says that the individual mandate would be the ``most sweeping and dangerous measure in any of the bills before Congress.''

He goes on to say: ``Compulsory health insurance is nationalized health insurance, with all that implies for health costs and quality.''

The second control mechanism is an insurance exchange through which all small business and individual market policies must be sold, and eventually large plans would participate as well.

The exchange's core function is to impose a new set of Federal rules that literally control everything the companies can and must do. Here are some examples. All companies must offer two government-specified benefit options--they define it as a silver and gold plan--or else the insurer cannot offer any insurance at all. So they have to offer two specifically defined insurance plans. But they can't offer more than four specific types regardless of consumer needs or preferences. It is like telling the car companies they each have to make two kinds of cars and they can't make any more than four kinds of cars. That is exactly what we are talking about, the Federal Government telling the insurance companies: This is the way you have to offer it--you have to offer at least two and you can't offer any more than four.

All of the plans must comply with new Federal rating rules. That is how limits on premiums are established. They have to issue coverage to everyone regardless of health status and not cap total coverage regardless of cost. They have to comply with mandatory limits on copays and deductibles. They have to cover a broad range of medical benefits in addition to State-mandated benefits regardless of whether consumers want them.

All of this is subject to change from Washington depending on what politicians or bureaucrats believe you need. Remember, it will be illegal for you not to buy this insurance. You will notice that all of these things are required, and it is Washington that is doing the requiring.

Under this plan, insurers would no longer retain the flexibility to design insurance products that would satisfy specific consumer preferences. The Federal Government would dictate that all policies must offer the same package of benefits, the same types of plans.

Rather than having the freedom to compete, insurers would in essence become prepaid health payment utilities since the Federal Government would, as the Wall Street Journal editorialized last Thursday, essentially be writing all insurance contracts. Since every aspect of insurance coverage would be controlled by Washington and everyone would have to buy the insurance, the government would control how your health care is paid for and therefore how it is delivered.

A final point about this insurance exchange. Since it will change the kind of insurance that can be sold, if you lose your current insurance, regardless of whether you bought the policy yourself or you got it through an employer, you will likely not be able to find that similar policy in the future. They will all be different. Insurers will have to comply with the new Federal rules, and that will change the coverage. This is one of the reasons the President was wrong when he repeatedly said: If you like your insurance, you get to keep it. That insurance simply is not going to be around anymore once the companies have to comply with the requirements of the exchange. There will be all new insurance policies written at that point.

The proponents of this radical change justify it on the assertion that it will bend the cost curve. In other words, it will reduce costs. But the problem is that massive new regulations will actually increase costs. The Council for Affordable Health Insurance found that mandating universal coverage and regulations in the bill, such as guaranteed issue and modified community rating, will increase the cost of health insurance between 75 and 95 percent.

In addition, note that the chairman's plan does not grandfather insurance plans currently offered by small businesses, so they would have to comply with these new Federal rating rules over a 5-year period, so that in short order premiums would rise for many small businesses and their employees as well. Of course, the newly established mandated benefits would also add to the increased cost.

Suppose, for example, a healthy individual or family prefers to have a less comprehensive package with a higher deductible. Say a young family of four with two children and two 35-year-old parents wants to buy a CIGNA PPO plan from the individual market with a $2,000 deductible. In my hometown of Phoenix, that plan currently costs $512 a month. If the reforms included in the chairman's plan were implemented, the price of that plan would nearly double to $998 per month.

The experts who said the cost of health insurance premiums would rise between 75 and 95 percent are right on the mark with regard to this real-life example I gave with a real-life insurance policy for a family of four in Phoenix. Instead of purchasing health care coverage that is personalized to their needs and budget, this family would be forced to purchase coverage they may not want for routine care that can be paid out of pocket or coverage for diseases and conditions that tend not to afflict their age group. Since insurers would not be allowed to charge according to risk, a low-risk family such as this one would have to pay more to make up for coverage needed by high-risk individuals.

Of course, I am not suggesting we turn a blind eye to the needs of Americans, for example, suffering from preexisting health conditions. They struggle to purchase affordable health insurance. We have to address that issue. But that does not require a total Washington takeover of all insurance policies, and it doesn't require raising insurance premiums for millions of other Americans and small businesses.

In my view, despite all of these other problems I have discussed, the most damaging impact of this takeover by the Federal Government is the inevitable rationing, the delay and denial of health care to American citizens. Since new Federal mandates and requirements would raise health care costs, politicians will have to search for ways to control spiraling premiums. When traditional cost-containment measures fail, such as reducing provider reimbursements or reducing how much doctors get paid, the government's only option is to control how much health care everyone receives. That means rationing.

For a preview of how this plan would lead to rationing, we need only look to the State of Massachusetts where a law was passed in 2006 requiring all residents to obtain health insurance. In fact, the State insurance market now looks like the market that would be created by the chairman's bill, with its guaranteed issue and modified community rating, State-approved plan types and benefit mandates.

Massachusetts health care spending is consuming an increasing share of the State's budget. The State passed a $1-per-pack increase in the State's cigarette tax, $89 million in fees and assessments on health care providers and insurers, and cost-sharing increases. It has even ordered insurers to cut provider reimbursements by 3 to 5 percent. But these measures still do not produce enough revenue to cover costs, leaving the State with few options. As a result, a special commission was created by the State legislature which developed a list of options to control costs, such as ``exclud[ing] coverage of services of low priority/value'' and ``limit[ing] coverage to services that produce the highest value when considering both the clinical effectiveness and cost''--in other words, rationing. You ration health care when you say: We will figure in here how much it costs, how much we have available, and therefore how much we can afford to provide. People who have to have that care are therefore going to be the ones who suffer.

This is exactly what happens under the chairman's proposal as well. It would establish a panel of health care stakeholders to identify physician services that are overvalued in the Medicare physician fee schedule and create a Medicare commission that would propose automatic Medicare cuts, even if Congress fails to adopt them. Our constituents rely upon us to protect the benefits we have promised

them, but what we are going to do in this legislation is establish a commission which would provide for automatic Medicare cuts. If Congress doesn't act affirmatively to somehow stop that from going into effect, it goes into effect. That is abdicating our responsibility to act as their representatives and, worse, putting somebody else in charge of deciding what is best for our Medicare constituents.

So when costs grow out of control, the government will adjust the volume of care provided based on how much it is willing to spend; that is to say, to ration your health care.

The fact that the Baucus bill does not include the so-called public option, the government-run insurance company, does not mean it does not otherwise totally regulate health care delivery. Together, an individual mandate to buy particular insurance and the regulatory insurance exchange, the two key provisions in the plan, facilitate the government's takeover of health care--some of it government run, all of it government controlled. No longer would families and doctors have the final say. It is almost unthinkable that this could happen in the United States.

Republicans have proposed ideas that would improve access and lower the cost of care, including real medical liability reform, allowing people to buy lower cost insurance across State lines, making the tax treatment of health care more fair for those who purchase insurance on their own, and removing barriers to health savings accounts.

These are better alternatives than the entire takeover of the system as proposed in the chairman's bill. We all favor health care reform. Republicans favor measures that lower costs and improve access and, importantly, empower patients, not government bureaucrats.

I suggest the absence of a quorum.