Floor Statements

Will the Senator from Nevada yield?

Talk about liability, I have real statistics. I hear the other side say: Oh, we are going to lower the cost; that is what health care reform is about, lowering the cost of health care so more people will have access to affordable options. Yet the main one that is clearly available is medical malpractice reform, tort reform.

I know the Senator from Nevada has an amendment, and I am a cosponsor. Let me give some statistics about how we could save money.

Exactly. And let me tell you what it has done in Texas and something we could do, and I think we would have bipartisan, 100 percent support in this body because that would be reform that would help health care.

Since medical malpractice and tort reform has been passed in Texas, over 7,000 new physicians have flooded into our State--a 7,000 increase. The reason? Tort reform. Since passed just 5, 6 years ago, physicians in Texas have saved $574 million in liability premiums, and their liability rates have been cut an average of 27.6 percent, almost a 30-percent cut in premiums.

What has this done? Today in rural counties, the number of obstetricians has increased by 27 percent. Twelve counties did not have one obstetrician before this was passed, and now they do; 24 counties had no emergency room physicians, and now they do; and 58 counties, in addition to that, have added one more.

Rural counties are the ones that have suffered the most, and every State in this Union has rural counties--every one. They are the ones who are hurt the most. Yet the Medicare cuts will take $135 billion out of rural hospitals' ability to serve Medicare patients. There is no medical malpractice reform unless, of course, in a huge bipartisan effort and gesture we can adopt the Ensign amendment which we are offering to try to make this a bipartisan bill that can work.

We have seen from Senator Ensign's charts that Democrats have supported limits on lawyer fees so that we would be able to cut back on the frivolous lawsuits that have been hampering our ability to cut the costs in Medicare.

I appreciate so much that Senator Ensign is offering this amendment because Texas can show us that this will work. It would be meaningful reform. It would cut the costs and make health care more available and, most important, it will give patients the opportunity to have doctors in their rural communities who will not practice today because their liability premiums are so high they cannot afford to stay in medicine and give this care to those rural patients. That is what we need.

If the Senator will yield, in addition to that, the House said: We have medical malpractice reform. They put it in their bill. You know what it says? There will be a State grant program and States can apply if they can show that they have made a meaningful effort at curbing frivolous lawsuits. But the only two reasons a State would not be eligible are if lawyer fees are capped or if damages are capped. Lawyer fees capped, damages capped--that is off the table. So I am thinking to myself--maybe the Senator from Nevada could tell me, if you don't curb lawyer fees and you don't curb the caps, what meaningful reform do you think we could get in medical malpractice?

I so appreciate the opportunity to talk about these different areas of cuts and then the increase in spending overall, because everyone in America today is concerned about the spending and the debt and the ceiling we are about to reach.

I wanted to bring up one more point on hospitals, because this affects every State in America. In Texas, 29 percent of our hospitals are in rural areas. The cuts in this bill will especially affect hospitals in rural areas. In fact, out of the $135 billion in Medicare cuts to hospitals, $20 billion is cuts in Medicare payments for treating low-income seniors and another $23 billion in Medicaid payments to hospitals for treating low-income patients.

I want to read an excerpt of a letter I received this week from the Texas Organization of Rural and Community Hospitals, which represents 150 rural hospitals in the State. They write:

We also fear the Medicare cuts as proposed could

disproportionately hurt rural hospitals, which are the health

care safety net for more than 2 million rural Texans. Because

of lower financial margins and higher percentage of Medicare

patients, rural hospitals will be impacted more than urban

hospitals by any reductions in reimbursement. These proposed

Medicare cuts could have a devastating effect on many of the

hospitals, which could lead to curtailing of certain

services. And, the closure of some of these Texas hospitals

is a real possibility. It has happened every time previously

when Congress imposed so-called large-scale, cost-saving

measures.

Well, this is the granddaddy of large-scale cost cuts--$500 billion, or $\1/2\ trillion--taken out of the hide of the hospitals that are treating low-income patients and seniors.

I ask the Senator from Nevada if he is experiencing that same thing, and if he feels that hospitals all over our country are going to be hurt by this bill?

Mr. President, I very much appreciate what the Senators have been talking about because what Senator McCain is saying is that these seniors who are low income have an affordable option, and it is less expensive than the AARP option that would give them this extra care--the eye care, the dental care, the hearing aids. It is an affordable extra option.

In Texas, we have over 500,000 seniors enrolled in Medicare Advantage. One of the great things about Medicare Advantage is that it is available in rural areas, and it gives them choices that they might not be able to afford with other programs that are Medigap. This one is affordable. That is why we are fighting so hard to restore the cuts to Medicare Advantage.

Medicare Advantage costs about 14 percent more than traditional Medicare because it provides a wide range of these extra benefits we have discussed--dental, eye care, hearing aids and, in many cases, it pays providers more. Republicans, of course, are open to discussing how to improve the Medicare Advantage payment formula. We want to be more efficient with taxpayer dollars, but do we want to do that in the context of creating a massive new entitlement program and ask Medicare to pay for it or to cut lifesaving benefits for seniors? Is that what we want to do, I ask Senator Crapo?

Mr. President, I ask the distinguished Senator from Utah to also respond to the arguments that claim that the government cannot afford now to continue overpaying these private plans and that the Medicare trust fund is going broke. Of course, we tried actually several years ago to shore up the Medicare Program, trying to do it in a responsible way, not cutting out the Medicare benefits these seniors can receive as an affordable option. What does the Senator say to that?

Five hundred thousand of my constituents are on Medicare Advantage.

Yes, I would say to the Senator from Arizona, I was wondering if every State could have the same treatment. Why not have every State get this shielding for their Medicare Advantage? That is 11 million people in this country who would then be helped by a fair assessment of this all over the country.

But let me just point out one other provision. The way they have been shielded is through grandfathering. What about people who----

Oh, no. Now, amazingly----

The white smoke, that is correct. But then the question arises: What about the future, where people will say: That is what I can afford and what I want to have. But grandfathering doesn't include anyone who might want to join in the future; it is only the people already in the system. And for how long they live, that is great, but what about the future?

So this is a great program. It is affordable for the lower income people. This shielding is only for three States now, but I would like to see us all have the same capabilities for our constituents. And what about our future constituents?

Mr. President, I would like to return to a point that was made earlier about the President promising, and it being understood by everyone, that if you like what you have, you can keep it. On Medicare Advantage, once again, the CMS has estimated--and I would ask the distinguished Senator from Utah to verify this--that enrollment in Medicare Advantage will decrease by 64 percent under this bill.

And 8.5 million seniors would be deprived.

We have been talking about Medicare Advantage and losing this great option for lower income seniors, which is so important. I was reminded that we have not even talked about the $135 billion that would be taken out of hospitals in this bill. These are the care providers. We are talking about taking away benefit options in eye care and dental care and hearing aids, sort of basic things seniors need, but also undercutting the hospitals that treat them, so the care provided in the hospitals themselves would also have to be cut back.

It does not pass common sense to cut Medicare in order to create a new big entitlement program. We have all said that Medicare is on life support anyway, everyone understands that. So you take almost a $\1/2\ trillion out of a program that is working for seniors, that gives options to seniors such as Medicare Advantage, and you take away their care to pay for another entitlement program that is not specifically designed for them.

I thank the Senator from Arizona and ask him to finish the comments on what is happening to this bill, this country, and our seniors. We need to stop it.

Mr. President, I appreciate what the distinguished Senator from Iowa has discussed. I specifically liked the fact that he is relating this to where we are today. Sometimes it seems as though we are in a vacuum, not realizing how stretched people are right now. We are in a time of joblessness, people are worried about keeping their jobs, worried about having lost their jobs, where they are going to get their health care. We have seniors who are stretched because they are not able to earn income. We are in a distressed time. There is no doubt about it. To talk about cutting Medicare by almost $500 billion is astounding. I am concerned about hospitals. We talked for the last 45 minutes about the cuts to benefits--the hearing aids, the dental work seniors need, the eye care seniors need.

What about the cuts to care provided in a hospital? Hospitals that treat a large share of low-income seniors get an extra payment from Medicare. Medicare already makes reduced payments to providers, to doctors but also to hospitals, to hospice, to nursing homes, and home health agencies for senior services. And yet proposed is a cut of almost $500 billion. All of these serve our seniors in such great ways. Look at the cuts, almost a $\1/2\ trillion over 10 years. This is not sustainable. We cannot take away from Medicare, cut services, cut reimbursements to providers. What is going to happen to a hospital? What is going to happen to a hospital in a rural area, especially that is barely hanging on right now because they are trying to make ends meet in a more expensive treatment area and they lose the added payment that would make them whole in the treatment of low-income seniors?

The Texas Hospital Association estimates that $2 billion will cut in payments to hospitals for treating a large volume of low-income Medicare patients, $2 billion out of our economy. Mr. President, 254 counties in Texas, more than one-fourth, do not even have an acute care hospital within their boundaries. With these kinds of cuts to rural hospitals, we are talking about losing more hospitals. There is no doubt about it. They are already struggling. Why would we pay for health care reform on the backs of our senior citizens? Why would we take away a program they have that is tailored for their needs in order to pay for another big government program that is going to cost $2.5 trillion, most of which is going to be added to the deficit, added to the debt, and we are already hitting the ceiling of the debt at $12 trillion? We are in a very tough financial time. We are in a time that is hard for people who have lost jobs, hard for seniors stretched to make ends meet, hard for hospitals serving seniors and not getting paid the full cost of the treatment. Yet we are talking about cutting these services.

Of the $135 billion in Medicare cuts to hospitals, $2 billion is for the reimbursement rates that will no longer be making hospitals whole. I went to the major medical centers in Texas--in Dallas, Houston. Then I went to rural areas. It is the topic of conversation. Anyone who is dealing with a hospital in a rural area, they are all saying: What are you doing?

Of course, we are not doing anything. We are fighting these health care cuts. But we have to make sure they know what is happening so we can achieve that result.

I understand my time has expired. I think the Senator from Oklahoma has the rest of the time on our side.

I yield the floor.

I yield 30 seconds to Senator McCain.

Mr. President, to put this in perspective, when I hear all of this debate, it is as though everything has to be more government, bigger government, government is better than the private sector. Medicare Advantage is an option. It is not a mandate. It is an option that allows seniors another choice to get eye care, hearing aids. Let's let seniors have this option. Let's not cut it away from them. We need more competition, not less.

Mr. President, parliamentary inquiry: Are the next 3 votes 10-minute votes?

Thank you, Mr. President.

Madam President, I rise to speak on the Mikulski amendment and the Murkowski amendment because I feel very passionate about women's issues. In fact, Senator Mikulski and I have worked throughout my time in the Senate and her time before me on these very issues--assuring that women's health care concerns, which are different from men's in many instances, are a part of any health care coverage in our country, and ongoing we must assure the same.

I have been an advocate for cancer screening services for women, and I was dismayed when I saw the U.S. Preventive Services Task Force a few weeks ago issuing new guidelines for cancer screening for women--breast cancer screening for women. We have all lived with breast cancer throughout the course of the history of women, but especially in the last probably 25 years the strides that we have made in saving lives and in the survivability of women with breast cancer is because we have had early detection. We don't have a cure for breast cancer, and we are all fighting for that cure, but until we get it, the first line of defense is early detection.

So now we have a new task force recommendation that says everything we have had and enjoyed over the last 25 years in saving women's lives is no longer relevant because now, before the age of 50, you don't need a mammogram, and after the age of 50 it is every other year.

Well, I know Senator Mikulski and I agree we do not think that is right. Neither did any other woman in the Senate when that was proposed years ago by President Clinton. We all stood up and said no. I am standing up and I am saying no once again, and I am sure every woman in the Senate is, as many women in America are.

But the Mikulski amendment doesn't actually fully address the problem of having the task force--which is relied on 14 times in the bill before us--as the arbiter of what is necessary for our government program and that it then will surely become the private sector standard as well. That task force even has money allocated to advertize its task force recommendations. So rather than the Mikulski amendment severing the ties with the task force, the amendment now has another government agency that has the same capability to basically interfere between the woman and her doctor, which is where we want the decisions to be made. Coverage decisions will be dictated by both the task force and a new Health Resources and Services Administration entry into the mix.

While I certainly agree with Senator Mikulski about the importance of preventive services for women and insurance coverage decisions, I can't support her amendment because we still have not one but two government task forces and committees that will be in the middle of these health care coverage decisions. I think the coverage decisions should be made by doctors and their patients. That is why I have joined with Senator Murkowski in offering the alternative approach. This is what we should expect from any future health care reform, and it is certainly what we expect today.

The Murkowski amendment will leave the medical decisions to the guidelines established by those who know medical treatment best, which is our own doctors. In fact, we have just received a CBO assessment of what the Murkowski amendment would cost, and it actually says there will be a savings. So rather than the Mikulski amendment, which would spend $1 billion over 10 years, the Murkowski amendment would actually save $1.4 billion over 10 years. Why? Because the Murkowski amendment relies on the combined commonsense and clinical judgment of American physicians.

So, Madam President, I urge a vote for the Murkowski amendment. I know we have the same goals as Senator Mikulski and her amendment, but I don't believe the Mikulski amendment achieves the goal of having a woman and her doctor make the decisions for her. That is the key that I think is so important in this debate. I urge a vote for the Murkowski amendment.

I thank the Chair, and I yield the floor.

Mr. President, I want to talk about health care legislation. That is what we have been talking about now on the Senate floor for the last week. I expect we will be talking about it for quite a long time.

We have just begun considering this bill, and the American people are growing in their opposition. According to a new Gallup Poll released yesterday, American independent voters now oppose this bill by an 18- point margin: 53 percent against it, 37 percent for it. This Gallup Poll states:

Despite the considerable efforts of Congress and the

President to pass health insurance reform, the public remains

reluctant to endorse that goal.

But this poll is just confirming what we have really known for months; that is, the bill before us--and the one that passed the House before that--is the wrong approach.

We are not against reform of health care; we need reform of health care. People are concerned about the rise of premiums in health care. So we ought to be looking at ways to address that issue. By doing what? By cutting the costs in the system and by allowing people to have more affordable health care options, none of which is in this bill.

Americans do not support $\1/2\ trillion in Medicare cuts. They do not support $\1/2\ trillion in new taxes. They do not support mandates. They do not support our growing national debt, which has hit its ceiling at $12 trillion. They certainly do not support a government takeover of our health care system.

Let's talk about the Medicare cuts. The Americans who are most impacted are those we are usually trying to protect: our seniors. I hear others on the Senate floor saying there are no cuts to Medicare. I am looking at the language in the bill. I am looking at the description of the bill, and the fact is there is $135 billion in cuts to hospitals, $120 billion in cuts to Medicare Advantage, $15 billion in cuts to nursing homes, $8 billion in cuts to hospice care. That is nearly $\1/2\ trillion in Medicare cuts. That is $500 billion.

In Texas, over half a million seniors are enrolled in Medicare Advantage. We know this bill will reduce their choices and the benefits they have today--benefits such as eyeglasses, hearing aids, dental benefits, preventive screenings, flu shots, home care, medical equipment, and more. So more and more seniors are not going to take the Medicare Advantage option which they now take and enjoy. This is not a solid approach.

I have heard others on the Senate floor on the other side of the aisle say it was Republicans who attempted to cut Medicare in previous years. The Republican effort to cut Medicare growth was $10 billion over 5 years. Not one Democrat voted for a $10 billion cut over 5 years. Yet today they are touting a $500 billion cut over 10 years.

Mr. President, $10 billion was out of the question, and $500 billion is now something that can be accepted? There is no reason to cut Medicare by $\1/2\ trillion. We should save Medicare. We should make it last longer and be more stable. But $500 billion in cuts is just going to make it worse. It is going to make it insupportable. Health care for our seniors will surely suffer on its face. That is a fact.

It is a fair question to ask: Well, what are Republicans for? Are you for health care reform? Well, of course we are for health care reform. Every one of us pays health insurance premiums, and we know people who are complaining about the rise in premium costs, especially small businesspeople. I sympathize with that. We all do.

So what is our approach? Step-by-step reform. What the American people are looking for is reform that does not cripple the health care industry in our country, that does not bankrupt our country, and that does not include a government takeover of the health care system.

There are commonsense, fiscally responsible reforms that Republicans have been promoting for years and would support today if we could have a bill that had any Republican input whatsoever, which this one does not--allowing small businesses to pull together and purchase insurance.

Sitting on the floor with us today is Senator Mike Enzi. Senator Enzi was the chairman, previously, of the HELP Committee. He produced a bill. He produced a bill that would have given more people coverage than the bill before us today--allowing small businesses to come together and pool their risk pool, make it larger, and give much more affordable premiums to more small businesses so they could afford to do what every small business wants to do; and that is, offer health care coverage to their employees.

But the Democrats killed Senator Enzi's bill. That would have been the first step to health care reform. We could have passed that years ago and been on the right track increasing the number of people who have affordable options for health care.

No. 2, reducing frivolous lawsuits. Where States have taken the measure to reduce frivolous lawsuits, such as Texas and a few other States, it has been a phenomenal success. It has brought down the cost of medical malpractice premiums for doctors. It has increased the number of doctors who are willing to practice medicine again. It has increased the number of doctors who will go into rural areas that are underserved. It works.

The estimates are that if we had a part of this bill that would reduce frivolous lawsuits, it would save about $50 billion a year. If we could reduce $50 billion out of the cost in the system that is not going for anything productive, we could then put that into either helping shore up Medicare or give the Medicare reimbursements to doctors and health care providers, to hospitals. We could help the system by cutting those costs. That is something Republicans would support in a heartbeat.

How about tax incentives to people who are buying their own health care insurance? If we provided families with a tax credit worth $5,000, it would give them the ability to put that on a health care policy for their families. It would cut the cost and allow them to have an affordable option. Another is a tax deduction above the line or a tax credit, which would be a huge incentive to employers, as well as to individuals, who would be able to have that kind of help in covering the cost of health care. We are willing to support that.

Another is allowing individuals to purchase insurance across State lines; tear down that bureaucracy that keeps people from going across State lines and getting the very best deal for themselves and their families.

Even an exchange could work. That is something that is embedded in the bill, but it is an exchange that has so many mandates that it is going to raise the cost for everyone. Just a simple exchange that has competition and transparency could actually make a difference in cutting the costs of health care.

So I think there are many things we could do to reform health care, if we could have Republican input and a bipartisan bill that would offer more affordable health care coverage to more people in our country. These are ideas that would improve competition in the marketplace, reduce costs, increase access. We do not need a government-run plan to achieve that objective.

I will be offering an amendment that will allow States to opt out, without penalties, of this plan, if it passes, not just the government part of the plan, but all of the harmful measures. We should be providing choices, not forcing people into government plans. States should not be forced to participate in the government plan. They should not be forced to subsidize it. They should not pay for a plan through increased taxes, nor mandates on businesses.

We want businesses to grow. We want businesses to hire people. We want to have jobs created. This bill is a job killer. Has anyone noticed we have one of the worst recessions since the Great Depression in this country, that over 3 million people in this country have lost their jobs this year? Mr. President, 300,000 of them live in my home State of Texas. Yet we are talking about a bill that is going to increase mandates on businesses and surely will reduce the number of people who can be hired. There is a disconnect we need to put back together. We need to talk about options that can work, that can give more people health insurance coverage at a reasonable price and most certainly not be job killers, with mandates and taxes on small businesses that already are having a hard time staying afloat, creating jobs, and providing health care for their employees.

The first amendment we will vote on tonight is the Mikulski amendment that has to do with breast cancer screening and other preventive services for women. Senator Mikulski and I have worked together on women's health issues for a long time in this body. Two years ago, we championed the reauthorization of the National Breast and Cervical Cancer Early Detection Program, which provides screening and diagnostic services. So we know how important it is to address women's health care issues.

I was in complete disagreement with this new task force recommendation on

mammograms and the need for mammograms for women under the age of 50. But I am very concerned that with the recent recommendations of the task force and how this health care bill that is before us relies on the task force, that the amendment is not going to do anything to solve that problem. The health care reform bill relies on the task force 14 times, and it even allocates money to pay for advertising the task force recommendations. This amendment does not address the problem. Rather than severing the ties with that task force so it will not become the norm, the amendment now allows yet another government agency, the Health Resources and Services Administration, to interfere with the relationship between a woman and her doctor. So now coverage decisions will be dictated by both the task force and the Health Resources and Services Administration. Instead of letting doctors and their patients make the decision about when a woman needs a mammogram, we have now not one government task force but two that we will have to intervene in that decision. Oh, my gosh, that does not make any kind of common sense. While I agree with Senator Mikulski about the great importance of preventive care for women, I disagree with this approach because it still injects a government agency or task force into the decision that is going to determine whether women have access, easy access, full access to the health care of their choice.

The item we will be considering after the Mikulski amendment and the Murkowski amendment is the McCain motion. The McCain motion is going to strike the Medicare cuts from this bill. His motion, which I certainly endorse and support, would send the bill back for a rewrite. It would send it back to the Finance Committee with instructions to give us a new bill that does not include $\1/2\ trillion in Medicare cuts, a bill that would not be paid for on the backs of our seniors whom we should be protecting. As I mentioned previously, the bill that is before us would cut nearly $\1/2\ trillion--$500 billion--from Medicare. It will not make it stronger; it will fund more government spending, more government takeover in our health care system. Health care reform should not mean slashing Medicare by cutting $\1/2\ trillion from seniors' care. This is not reform.

If we can support the McCain motion to go back to the drawing board and look for a way we can have a bipartisan bill that would have Republican as well as Democratic input and agree to step-by-step reforms that would increase access, reduce costs and not take away choices of seniors and certainly not have a government takeover of health care, then I think we could produce something the President would sign and the American people would embrace. Right now, everyone I talk to in Texas is scared to death. They are scared to death of this big government takeover of our health care system because they know that when government gets involved, we are not going to have the quality we have known in the past, that the jobs are not going to be in the private sector, that we are not going to have the choice. When this bill--which relies on this task force 14 times to make the recommendations that would determine what the coverage is of the government plan--was put before us, all of a sudden people started to say women don't need mammograms before the age of 50, when we have always said it was after the age of 40; and after the age of 50, with a doctor's input, and that it would generally be on an annual basis.

The former head of the Red Cross, Bernadine Healy, and many of our health care agencies and task forces said that is going to kill women. That is going to kill women if they don't have early detection. Early detection is all we have for breast cancer right now. We don't have a cure. We only have early detection as a way to fight breast cancer. But all of a sudden, the task force that is relied on by this bill says we don't need mammograms before the age of 50; and after the age of 50, every 2 years, not every year; and after the age of 72, not at all. That is not health care reform. That is not what the President promised, and it is certainly not what Congress ought to assent to.

We can produce health care reform. We can lower the cost. We can give people access. We can give people choices. We don't have to mandate taxes and hurt businesses in this economic climate to do it. We have the capability to do something right. If we pass the McCain motion, we can go back to the drawing boards and do this right. That is the most important thing I hope we will do this week in the Senate for the American people, and they deserve it.

Thank you. I yield the floor.

Mr. President, as has been mentioned several times, the majority leader unveiled the Democrats' health care reform bill yesterday around 5 o'clock. This bill was drafted behind closed doors. There was no Republican input. It didn't have any transparency until yesterday at 5 o'clock, despite the promises we have heard that government would be more transparent in this new administration. The 2,000-page bill released yesterday is expected to have a vote to proceed to it within the next 2 days. The bill is 354,654 words. To put it in perspective, the Bill of Rights is stated in 463 words; Lincoln's Gettysburg Address contained 266 words; the Ten Commandments has 297 words. This is over 350,000 words.

Why don't we have time to read this bill, digest it, allow our amendments to be put in the bill language, because, clearly, this bill will need amendments?

The health care of our citizens may be the most personal of all things to every person and every family. We are a democracy and the American people have a right to be heard on all issues but especially on this type of issue. We should be given the opportunity to read and hear what is in this bill, to hear it discussed, to hear from our constituents because it ought to be on the Internet. That is why we have the Internet access to bills that are introduced in the Senate. But by the time our constituents have a chance to read it, we will already have had a vote on whether to proceed to the bill.

Even after a cursory review, I know this bill includes changes that are disastrous to families, health care providers, and the economy. Higher taxes, mandates--especially for small businesses--penalties, cuts to Medicare, higher premiums, restricted choices, a government plan--the list goes on. The bill includes almost $1 trillion in taxes, including a new Medicare payroll tax; $8 billion in taxes on individuals who don't buy coverage; $149 billion in taxes on employers who don't offer the right percentage of coverage to employees; $102 billion in taxes on insurance plans, pharmaceutical companies, and medical device companies which study after study have shown will be passed on to the people who get these services and equipment.

To make matters worse, the bill includes almost $1 trillion in cuts to Medicare. It is guaranteed to reduce choices and coverage for seniors. In my State of Texas, 400,000 people love their Medicare Advantage, or at least they have it and are satisfied. They will lose Medicare Advantage under this bill. The Democrats are touting the cost of the bill as meeting the President's goal of being under $1 trillion because CBO scored it at $849 billion. But this is a budgetary sleight of hand, because what is actually being scored is the years 2010 to 2019. The actual spending in this bill won't take effect until 2014. They are taking the 10 years with 4 years where the bill is not spending anything. If you score it for the 10 years following when it actually comes into being, 2014 to 2023, the bill costs $2.5 trillion, not $849 billion.

Given more time to analyze this bill, who knows what else we would discover? If the Democrats think this is the reform Americans wanted, why rush the bill through the Senate? Why rush it through before we have the ability to review details?

The right approach is available. My colleagues and I have proposed commonsense and fiscally responsible ways to improve affordable access to health care. We need to do that. We have never said we don't need reform. What we have said is we need reform that will give more affordable access for coverage to Americans who do not have that access today.

We should reassess the goals of health care reform and implement policies that we know will reduce costs. For sure, reducing frivolous lawsuits. Study after study has shown the benefits of medical malpractice reform. In Texas, we have tort reform. We have seen a dramatic increase in physicians who are willing to practice medicine. It has lowered the cost of medical malpractice premiums, and doctors have been able to do their work with their patients with much more freedom, knowing they do not need to order unnecessary tests just to cover themselves in case they get sued. The majority insists on rejecting this suggestion that we have medical malpractice reform in the bill. Yet there is probably not anything that will save as much money as medical malpractice reform, that puts commonsense standards in place for frivolous lawsuits or lawsuits at all.

I will offer an amendment, or at least prepare one and hope to be able to offer it, that would cap damages, reduce malpractice premiums, and encourage doctors to practice in medically underserved areas. So many of our underserved areas, especially rural areas, have no doctors. There are counties in Texas that don't have a doctor within hundreds of miles and several counties. That is because the medical malpractice premiums are so high, they cannot afford to do it.

The small business premiums are going to go up, if this bill is passed. Small businesses already have a hard time offering coverage to their employees. Why would we make the problem worse, especially when we have the highest unemployment in decades? We should be allowing small businesses to pool together and buy plans. We have

championed that proposal for years in the Senate, but we have never been able to get over the hurdles to pass a small business health plan. If we could do that, we could spread the risk. The bigger risk pools would produce lower premiums and allow more small businesses to have access to and offer their employees affordable health care coverage. Allowing businesses to pool doesn't cost the government anything. Therefore, it would not require tax increases, as we see in the bill before us.

The Democrats are trying to address the problem of unaffordable insurance by offering credits to small businesses to offset the cost of premiums. But the credit only lasts for 2 years. That is hardly anything that is going to encourage businesses to take on the added cost when the credit lasts for 2 years. I will be preparing amendments that at least double that to 4 years, expand the eligibility and duration of these credits so we can help small business people. But even 4 years is not enough. We should offer credits all the way through.

Offering tax incentives. There are small businesses and individuals in this country who have no access to affordable coverage. Why not give every individual who purchases their own health insurance the same tax break a corporation gets for offering health care coverage to their employees? Employees who receive insurance through their place of employment do not pay taxes on the premiums they spend for insurance. Why should individuals who purchase their own health care coverage be treated differently? I have a bill, with Senator DeMint, that will help provide insurance for more Americans through tax credits and competition. Our approach would be a tax credit for every individual, $2,000 per year, and for families $5,000 per year for their purchase of health insurance. This would allow individuals to purchase their policies and own them so they would not have to be affected by what their employer offers or if they change jobs. This is the kind of reform that could make a difference.

How about creating a transparent marketplace online for consumers to go in and shop and hopefully have bigger risk pools, more competition, bringing the cost down? That is not the kind of marketplace that is in this bill. This exchange has so many mandates on the plans that, like the Massachusetts exchange, it would raise the cost of premiums and would not help in any way bring the cost down so that premiums are more affordable.

These are the ideas that would improve competition in the marketplace.

I can tell you, from the input I have received from my constituents since the bills have been out of committee, before the bill came to the floor or is on its way to the floor yesterday, because there were two committees that wrote bills that were put together and released yesterday, I have listened to what people say. I can tell you they don't want Medicare cuts. They don't want more taxes. Small businesses certainly don't want more mandates. They don't want government-run insurance. They know that a government plan is eventually going to crowd out the private insurance company plans throughout the country.

I am going to be preparing an amendment that will allow States to opt out without penalties, not just of the government insurance plan but of all the harmful measures. Why would we have a government opt-out by States, if they are going to still have to pay the higher taxes, if they are going to have to pay higher premiums to pay for the other States that have the plan? States should not be forced to participate in the government plan, nor subsidize and pay for such a plan through increased taxes.

I will prepare amendments that will exempt individuals and employers from the mandate to buy insurance, if this bill causes premiums to rise above their currently projected values.

The solution to health care issues is not to give more power to the government. The solution is to give more power to the American people. They deserve a system that assures that America will have the best health care in the world.

Which brings me to the new government task force that came out this week that is causing confusion at best and outrage at worst. That is the guidelines regarding screening for breast cancer. Breast cancer is the second leading cause of death in women in this country. Whether and when to screen for breast cancer has been debated for decades. In 1993, the Clinton administration proposed the government takeover of health care. In that proposal put forward by the Clinton administration, there would be no payment for mammograms for women under the age of 50. After the age of 50, there would be payment in the government plan for a mammogram every 2 years, exactly what has just been recommended by the Federal task force.

Since we have had the guidelines, which have been in place for many years, death rates from breast cancer have been declining. Since 1990, there are larger decreases seen in women younger than 50. The American Cancer Society states that these decreases are believed to be the result of early detection and increased awareness. The evidence has repeatedly shown that screening and early detection save lives.

Unbelievably, the United States Preventive Services Task Force has recommended against routine mammograms for women under 50, saying it is not worth subjecting some patients to unnecessary biopsies, radiation, and stress. The task force also recommended against teaching women to do regular self-exams. We have to ask the questions: Why this change? Why now? Nothing substantial in the clinical evidence, but the panel decided to review the data with health care spending in mind. Nearly everyone realizes that fewer screenings mean insurance plans, including a government-run plan, will save money.

This is how rationing begins. I hope America wakes up. This is how rationing begins.

In an article by the Wall Street Journal today, they recognized that. It reads:

Every Democratic version of ObamaCare makes this Task Force

an arbiter of the benefits that private insurers will be

required to cover as they are converted into government

contractors. What are now merely recommendations will become

de facto rules, and under national health care these kinds of

cost analyses will inevitably become more common as

government decides where finite tax dollars are allowed to

go.

That is a quote from the Wall Street Journal today.

The American Cancer Society came out after this incredible recommendation and said, with its new recommendations, the task force is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them. So if the screening is going to save your life or your mother's or your sister's or your wife's, would that screening be worth it?

Decisions about care must be between a doctor and a patient, not a doctor who has a loyalty to anyone but the patient, not a doctor who is working for the government and having to maintain government task force guidelines, such as the one we have just seen.

That is the crux of the debate on this health care bill that has been released in the last 15 hours. I am so worried we are now beginning to see the handwriting on the wall. The President said once there is no reason we should not be catching diseases such as breast cancer and colon cancer before they get worse. It turns out, there is a reason: cost.

The insurance companies have sort of said in the last day or so that they are not going to stop the coverage of mammograms for women starting at the age of 40. But when the government plan comes into effect, you know that every insurance company is going to say: If we are going to be competitive, we must adhere to the same standards as the government plan. It is going to happen.

We must have time to look at this bill. We must have time to look at what is happening to the choices, to the health care, to Medicare. The cuts in services, the taxes, the mandates are going to overhaul the health care of our country. We must have time to look at this bill before we have a motion to proceed. We must have time to study it. We must let our constituency study it because they will catch things they care about and they will inform us, and that is why we are here.

So I am very concerned that we are pushing too fast on something we should be taking slowly and carefully to assure we are not going to do something we are not sure is right, and

where we have the chance, to change what we see is wrong.

Thank you, Mr. President.

Mr. President, if the Senator will yield, I appreciate him giving us these statistics because it is 1 life out of 1,904 to be saved, but the choice is not going to be yours; it is going to be someone else who has never met you, who does not know your family history.

That was in the Clinton government reform, takeover of health care in 1993, and it was soundly rejected. It was soundly rejected. It was part of the reason it was soundly rejected--this mammogram rationing before the age of 50--because we had hearings on this, and every woman in the Senate at the time rejected--rejected--that plan, rejected keeping women under the age of 50 from having mammograms paid for by insurance plans.

So I thank the Senator from Arizona for connecting this and showing the statistics because this is not the American way of looking at our health care coverage. It is not the American way, and we must stop this government takeover of our health care.

Mr. President, I yield the floor.

Mr. President, I suggest the absence of a quorum.

Mr. President, I thank Senator Johnson.

We have worked very well to accommodate the requests of our colleagues to the extent we could. We will have the first vote on his amendment. I am going to support Senator Johnson's amendment on homeless veterans. Secretary Gates and Secretary Shinseki are at this very moment practically working on a way to better accommodate veterans who are homeless. It is not right for there ever to be a homeless veteran in our country because every one of them has done so much to protect our freedom.

We do have $500 million in the bill. This would take $50 million that the Department says they do not need for other housing assistance for veterans and put it into the homeless sector so there can be a concerted effort to build facilities that would give care, as well as shelter, to these veterans. I support that.

I hope in conference we will be able to consolidate all of this into a program that will meet the needs of our veterans.

It has been great working on this bill. I am very pleased we could do it today rather than last week when so many of us in the Senate were at Fort Hood trying to show the great respect and sympathy for the community at Fort Hood and for all of our armed services, which meant we had to delay the bill from last Tuesday to this Tuesday. I think that was the right thing to do. I thank my colleague.

I thank our great staffs who worked all this week to clear amendments. To the extent we could, I think we have certainly accommodated our other colleagues in the Senate for their priorities.

Mr. President, I yield the floor.

Mr. President, I wish to ask the Senator if we could voice vote Senator Cochran before we take up the record vote we will take on Senator Johnson's amendment.

I have no objection.

Mr. President, to comply with rule XLIV, I ask unanimous consent to have printed in the Record a letter from Senator Cochran in relation to his amendment.

I thank the Chair and suggest the absence of a quorum.

Mr. President, we are working on the managers' package, and probably in the next 15 minutes we will clear what has been cleared for the managers' package. There are a couple of people working with objections. But by 12:15, we will clear the managers' package so that following that, in accordance with the previous unanimous consent agreement, at 2:15 we will vote on the Inhofe amendment, after which we will then vote on final passage. So we will have two votes starting at 2:15, and the second vote will be the final vote on Veterans Affairs-Military Construction.

I yield the floor.

Madam President, I have no objections to those amendments. I want to clarify that for amendment No. 2775, the modifications are at the desk. The same goes for amendment No. 2783; am I correct?

Again, I have no objection.

The amendments (No. 2775, as modified; No. 2777; and No. 2783, as modified) were agreed to, as follows:

Amendment No. 2775, As Modified

(Purpose: To require a study on the capacity of the Department of

Veterans Affairs to address combat stress in women veterans)

At the end of title II, add the following:

Sec. 229. (a) Study on Capacity of Department of Veterans

Affairs To Address Combat Stress in Women Veterans.--The

Inspector General of the Department of Veterans Affairs shall

carry out a study to assess the capacity of the Department of

Veterans Affairs to address combat stress in women veterans.

(b) Elements.--In carrying out the study required by

subsection (a), the Inspector General shall consider the

following:

(1) Whether women veterans are properly evaluated by the

Department for post-traumatic stress disorder (PTSD),

military-related sexual trauma, traumatic brain injury (TBI),

and other combat-related conditions.

(2) Whether women veterans with combat stress are being

properly adjudicated as service-connected disabled by the

Department for purposes of veterans disability benefits for

combat stress.

(3) Whether the Veterans Benefits Administration has

developed and disseminated to personnel who adjudicate

disability claims reference materials that thoroughly and

effectively address the management of claims of women

veterans involving military-related sexual trauma.

(4) The feasability and advisability of requiring training

and testing on military-related sexual trauma matters as part

of a certification of Veterans Benefits Administration

personnel who adjudicate disability claims involving post-

traumatic stress disorder.

(5) Such other matters as the Inspector General considers

appropriate.

(c) Reports.--

(1) Interim report.--Not later than 180 days after the date

of the enactment of this Act, the Inspector General shall

submit to the Secretary of Veterans Affairs, and to the

appropriate committees of Congress, a report setting forth

the plan of the Inspector General for the study required by

subsection (a), together with such interim findings as the

Inspector General has made as of the date of the report as a

result of the study.

(2) Final report.--Not later than one year after the date

of the enactment of this Act, the Inspector General shall

submit to the Secretary, and Congress, then the Secretary

shall make recommendations for legislative or administrative

action.

(3) Appropriate committees of congress defined.--In this

subsection, the term ``appropriate committees of Congress''

means--

(A) the Committees on Appropriations and Veterans' Affairs

of the Senate; and

(B) the Committees on Appropriations and Veterans' Affairs

of the House of Representatives.

Is the Senator from Virginia speaking on the 2\1/2\ minutes of the majority?

Mr. President, how much time is remaining?

Mr. President, I wish to speak in favor of the amendment. I do not think these prisoners from Guantanamo Bay should be in our country. I think we should stand firm, we should stand clear that this Senate, as we have voted before, does not want prisoners from Guantanamo Bay transferred to American soil. It will be a security risk to America. We do not need

to do it. This would be a way to stop this and do what is right for our country; that is, keep these prisoners where they are secure, away from any ability to harm America. I urge a vote for the Inhofe amendment.

Mr. President, if we don't want to house those prisoners here, we should not try them here. That is the answer for this. Vote for the Inhofe amendment.

I ask for the yeas and nays.

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

Madam President, I know my colleague, the chairman of the Veterans Affairs and Military Construction Subcommittee, has already spoken on the bill. I rise to make a couple of points.

First, I thank the Senate for not meeting on this bill last Tuesday, when it was scheduled to be taken up and passed and, instead, allowing so many of our colleagues to go to the memorial service at Fort Hood in Killeen. It was a wonderful service. So many of our colleagues were in attendance from all over the country to show their support for the troops, to show sympathy for the families. There were approximately 200 family members there. Of course, the President and Mrs. Obama were there. There were many House Members. It showed to the base and to the thousands of troops who attended how much we care about them. I am grateful to my colleagues for that gesture.

We have a good bill. My colleague Senator Johnson and I have worked together on this bill. We have stayed within our budget. We have tried to make sure we are covering the needs of our veterans.

The emphasis in the veterans section is in health care. We know we must do more for the mental health and getting people who have been in Afghanistan or Iraq back into the mainstream so they can lead normal lives. We have done that. We have put over $4 billion into mental health funding. We are setting up centers now for mental health excellence. I am pleased we are making that a priority.

In addition, spinal cord and traumatic brain injuries. We know so many of our wounded soldiers suffer traumatic injuries. We need to make sure we have the ability to give them all of the rehabilitation necessary for them to reenter a life of quality. We are adding one more tier 1 polytrauma center. We have four. We are adding one more in San Antonio, TX, in the VA center, which we are very pleased to be able to do.

The homeless veterans program is also being augmented in this bill, and I applaud Senator Johnson's efforts for creating the initiative last year to increase the VA footprint in our rural areas for our health care facilities. I think this is very helpful and warranted.

On the military construction side, this morning I was at Dyess Air Force Base, where we broke ground on two incredible facilities. One will be a maintenance facility for both the B-1 bombers and also the C- 130s and new C-130Js that are going to be coming into our system next year. It is going to be a great facility, and we are very excited about that. We have a Reserve training headquarters there at Dyess, as well, and we broke ground on that building today.

In addition, our BRAC has been fully funded. That was a priority of mine because I thought it was very important we fully fund our BRAC.

Thank you, Madam President. I wish to go ahead to the vote because I know it is important. But I will just say, I fully support our bill and look forward to working on the amendments and passing this bill, finally, tomorrow.

Amendment No. 2757

Madam President, I also support this amendment. I think the reporting requirements are absolutely the right thing to do.

Madam President, I yield back the rest of my time and ask for the vote to commence.

I ask for the yeas and nays.

Parliamentary inquiry: I did not understand the last unanimous consent request, that we were going to a nomination?

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

Mr. President, I believe we are now on the glidepath to finishing the Military Construction and Veterans Affairs bill. We have an order. If we can clear some of the further amendments that are listed for a vote, I know we will be able to do that. Some of these are being negotiated at this time. At least we have a way forward.

Our staffs have worked very diligently on this since we started this bill last Tuesday and, for various reasons, we are going to finish it tomorrow, a week later. We could not have done it without a lot of cooperation. I thank my distinguished colleague, the chairman of the subcommittee, Senator Johnson, and his staff: Christina Evans, Chad Schulken, and Andy Vanlandingham. My staff also has ably worked through these. When I was called away to Fort Hood, my chief clerk, Dennis Balkham, did a great job with the help of Ben Hammond in our office. I appreciate very much all the cooperation and the help we have had coming to this point.

I am pleased with our bill. I think we have a good bill that will do what all of us want, which is to assure that our veterans have the health care, the benefits, the needed outreach they should have for getting their benefits on a timely basis. This is one of the priorities we are funding in this bill. Secondly, of course, the military construction part of this bill is going to assure many quality-of-life improvements for our military personnel. Also, we will be building in faraway places where our troops are being housed right now. We want to give them every comfort we possibly can as they are fighting for our freedom.

I thank my colleagues and certainly appreciate that we are now moving toward final passage of this bill tomorrow. I appreciate all the cooperation we have had.

I yield the floor and suggest the absence of a quorum.

Mr. President, I ask unanimous consent that this body have a moment of silence in memory of 11 great soldiers at Fort Hood, TX, who have been shot down this afternoon at the base at a processing center where they were being prepared to be deployed to Iraq and Afghanistan. In addition, the person who was the main shooter has also been killed. Over 30 of our great personnel are also injured and being treated as we speak.

When I spoke to the general a few minutes ago, the base, Fort Hood, was still in lockdown to make sure they have checked every possibility that there would be no more shootings. I know all of us love our military and appreciate everything they do. For them to have to suffer even more tragedy like this, as they are on their way to protect our freedom, is unthinkable.

I ask unanimous consent that all of us show how deeply we care about them right now on the floor of the Senate.

Mr. President, I thank Senators very much.

Amendment No. 2667

Mr. President, as the ranking member of the Military Construction, Veterans Affairs, and Related Agencies Subcommittee, I appreciate the opportunity to speak on the bill before us. A lot of time and energy has gone into putting this legislation together, and I would like to thank Chairman Johnson and his staff for working hard to address the needs of our service members and veterans.

This is a bipartisan bill, and I can say with great confidence that this subcommittee makes sure that the priorities of all Senators, on both sides of the aisle, are evaluated and taken care of to the best of our ability.

As Chairman Johnson has pointed out, this Military Construction, Veterans Affairs, and Related Agencies Appropriations bill includes, for fiscal year 2010: $76.7 billion in discretionary spending, including $23.2 billion for military construction and $53.2 billion for our veterans; $55.8 billion in mandatory spending for veterans' benefits, and $1.4 billion for military construction projects to assist our troops in Afghanistan in their fight against terrorists and insurgents.

This legislation provides $23.2 billion for the Defense Department's military construction program. I am concerned that the DOD requested over $7 billion less for 2010, a 25 percent decrease from the previous year, and I hope this trend does not continue. Of all the funds we provide for our government, supporting the infrastructure needs of our soldiers is one of the most important I can think of.

I am pleased that our bill provides full funding for the Base Realignment and Closure actions at almost $7.5 billion. These funds are essential to bring our troops home, predominantly from Europe and Korea, and basing them in the United States. By fully funding BRAC we can help the DOD stay on schedule to achieve this goal by September 2011.

I wish to point out as well that our legislation contains the necessary funds for the Defense Department program specially designed to help our service members who are forced to relocate in this harsh economic housing environment, the Homeowners Assistance Fund. Chairman Johnson has been instrumental in making this program a success.

This bill funds the Guard and Reserve at $264 million above the President's request. A significant number of the troops fighting the war on terror consist of Guard and Reserve members, so I am very glad we were able to provide additional resources for them.

This summer, as our Nation was preparing for its Fourth of July celebrations, I had the honor of visiting our troops in Iraq and Kuwait. I listened to their concerns and saw first hand how the facilities we provide in this bill are instrumental in their ability to carry out their mission.

This legislation contains almost $1.4 billion in emergency funding for the war in Afghanistan. The policies of this conflict have been passionately debated on the Senate floor in recent days. But I am sure we can all agree that--independent of our views of the war--we must provide the infrastructure needs of our sailors, soldiers, airmen and marines. This bill does that.

In addition, I would like to point out that this subcommittee is committed to making sure that our NATO allies fund their fair share of all joint projects. I can assure my colleagues, and the American people, that every MILCON facility shared by allied forces is evaluated for NATO reimbursement and that we push hard for cost sharing at every possible opportunity.

Our bill provides $109 billion for the Department of Veterans Affairs, a 14 percent increase above fiscal year 2009. Veterans' healthcare is funded at $45 billion, and medical research is funded at $580 million. This bill also makes a significant investment in VA infrastructure needs, with nearly $5 billion for the maintenance and repair of VA medical facilities and $2 billion in new construction projects.

The Veterans Benefits Administration is funded at $56 billion to administer compensation, pension, and readjustment benefits earned by our veterans. We have fully funded the new education benefits provided by the post-9/11 educational assistance program, and included funding for 1,200 new claims processors to reduce the claims backlog.

This legislation addresses the many demands facing the Department of Veterans Affairs. It includes funding over 2009 levels to enhance outreach and services for mental health care, combat homelessness, further meet the needs of women veterans, and expand access to healthcare in rural areas. Finally, we included $48.2 billion in advance appropriations for veterans' medical care for fiscal year 2011. This funding will allow the Veterans Health Administration to better plan and budget for veterans' health care.

Congress has shown its resolve time and again to care for our nation's veterans and provide the infrastructure for our men and women in uniform. We

owe all of them our gratitude, and we will do our part to take care of them. I ask my colleagues to support this bill.

Again, I would like to thank Senators Inouye and Cochran for their support putting this bill together, and I would especially like to thank Chairman Johnson for his leadership and the hard work of his staff: Christina Evans, Chad Schulken, and Andy Vanlandingham.

Mr. President, I am very pleased to be able to speak this afternoon about the health care bill that we all in this country are concerned is coming through Congress at a very rapid pace.

I heard the distinguished Senator from Illinois saying the Republican complaint is how long the bill is. Well, of course, he acknowledged that there is no bill, that we actually don't have a bill that has been introduced yet in the Senate. So I think what we are talking about is the length of the bills that have been put forward by the two committees and will be put together, and it could be 3,000 pages long, if that is what it takes to cover this issue.

The concern Republicans have is, are we going to have time to read it? Are we going to have time for the public to read it, so that we understand fully, before we start debating, before we start amending, what is in every line of the bill?

The American people expect that we will know what we are voting on when we are talking about taking over one-sixth of our economy in this country. We are talking about the health care industry jobs--doctors, nurses, nurses' aides, hospital personnel, and the doctors' office personnel. We are talking about a lot of the economy of our country. Most importantly, we are talking about the relationship between a patient and a doctor, which is the most personal, most important health care relationship you can possibly have in every family.

I think maybe the distinguished deputy leader on the Democratic side has mistaken the complaints about how big the bill is with how long we have to read the big bill. That is the issue. That is why we want to see the bill in the writing that is going to become law before we are asked to debate it, before we are asked to offer amendments. And we want the public to see it, too.

In fact, there was an amendment offered in the Senate Finance Committee by Senator Bunning to reassure the American people that there would be 72 hours for this bill to be in the public domain before it would come to the floor. That amendment was defeated.

It is very important to us that we have ample time to determine every part of this bill and how it will affect every American, every American family, and for all of the many people in the health care industry--the doctors, nurses, and all the people who provide health care in our country--to know how it will affect them, too. That is the complaint, for sure.

Today I want to talk about the rising health care costs. We know that today, without any new bill, premiums are going up and Americans are being squeezed. Rising premiums are causing them to be very concerned about how much this health care coverage they have is costing. It is also squeezing small businesses, because their premiums are rising, and it is beginning to be a choice in some American businesses whether they can offer health care coverage anymore.

We do need health care reform because of these rising premiums. You would think that, with the premiums going up and costs going up, and Americans being squeezed in a tough economic time, and employers being squeezed, that the position we would be taking in the Senate regarding health care reform would be to bring down costs. That would be what you would think we would be addressing. You would think we would be talking about offering more affordable coverage to more people.

Texas, unfortunately, has the highest percentage of people today without health insurance coverage in the Nation. So I am very concerned about this issue. Unfortunately, 5.8 million uninsured Texans is the number we have

reached. So this is a huge issue for my State.

Let's look at the health care reform and how it is going to affect the rising premium costs. Inflation causes the premiums to go up every year. So what we should be looking for is a way to cut back on those costs that are hurting people so much.

Here is an example: Individuals and families buying their own insurance could see premiums increase as much as 73 percent under the new Democratic proposals that are being written right now. One study projects premium increases of roughly $1,500 a year for individuals, and $3,300 a year for family coverage, in addition to the natural rise in inflation and premiums that would be ongoing anyway. This was from a study delivered by Oliver Wyman. Think about it. All of the taxes on insurance companies, the taxes on an American individual or a family that decides not to take the coverage would add to the cost as well. Then you have the cuts in Medicare that are proposed and the increase in Medicaid that is proposed, which will cost every State and every taxpayer. So you have all these increases in costs, mandates, and taxes.

More alarming is, if you do have insurance today, you may not even be able to keep what you have. The President said if you like what you have, you can keep it. But under the Democrats' proposal that is going through, all plans include a long list of benefits that are required to be in every plan. Some of these may be benefits your family doesn't need or you would not choose as a priority, but they are there. So that will have a cost impact. Millions of Americans will be forced to buy more expensive plans in order to comply with these new Federal laws that are going to reform health care.

When it comes to a small business, you might think: What is this going to do to a small business? Small businesses are now having a hard time because they don't have the big risk pool. So their costs are higher anyway. A small business with 20 employees is going to have higher premiums anyway, and their margins are generally less because they don't have the advantage of having big risk pools and the things that can bring down costs in a bigger business. Small businesses are going to look at these rising costs and probably say, you know, I now have to decide, do I continue to offer health care coverage to my employees or do I back off? And if I back off, of course, people will have to buy their own insurance or pay a fine if they don't.

That is what is going through Congress right now. The Joint Committee on Taxation stated that ``the imposition of the excise tax on insurers can be expected to lead health insurance providers and consumers to take measures to minimize their burden from the tax. As insurers pass along the cost to the consumer by increasing prices, the cost of employer-provided insurance will increase.''

In the House bill, employers will be penalized if they don't pay for a specific percentage of employee premiums. So even if you are offering health insurance to your employees, you may still be penalized if the House bill prevails, if you don't pay the right percentage of coverage for employees. The Kaiser Family Foundation did a research study and said three out of five businesses in America that offer insurance would still have to pay the 8-percent payroll tax, because their percentages would not meet the Federal standard that would be in the House bill. That is just counterintuitive. It is counterintuitive to say if you are doing the right thing and you are offering health insurance to your employees--you are struggling to do it, but you are doing it--but if it is not the right percentage, if it is not 72.5 percent or 65 percent, then you are not going to qualify anyway, so you are going to have to pay an 8-percent fine of the entire payroll of your company.

This is not the reform we should be going after. What we should be doing is trying to have more affordable health care access for individuals and small businesses. That should be our primary objective.

Here are the principles the Republicans would put forward for health care reform.

Small business pooling: We have offered time and time again on the floor of this Senate the small business health plan that would allow small businesses to pool, to be able to offer their employees a bigger risk pool and, therefore, lower premiums for the employee and the employer. We have offered plans that would allow a State organization or a national organization--the U.S. Chamber of Commerce, the NFIB, the American Institute of Architects, whatever association that you might join as a small business person--to offer all of their members insurance plans that would have a big risk pool so that if you work for a small business, a small architecture firm, you would be able to offer this in the same basic amounts that if you worked for a big architecture firm or big corporation. But that would not cost the government anything, and it would not change anyone's coverage if they like what they have. It would offer more affordable access to more people.

If the Republicans had the ability to offer amendments to the health care bill or to offer a substitute, we would reduce frivolous lawsuits. In States where there are limits on noneconomic damages or you have an arbitration requirement before you go to a lawsuit, we have lowered the cost of medical malpractice insurance to the doctors by as much as 25 percent. Doctors have come back to practicing medicine again because these premiums have been lowered just by reducing frivolous lawsuits. This has been done in my State of Texas, California, and other States have followed suit and, no pun intended, have lowered the number of lawsuits. It has lowered the cost of the medical malpractice insurance premiums, and doctors have been able to do their work with their patients with much more freedom, knowing they do not need to order unnecessary tests just to cover themselves in case they get sued.

No. 3, why not offer tax incentives? I am a cosponsor of a bill with Senator Jim DeMint that would offer tax incentives for individuals. There are small businesses and individuals who have no access to affordable coverage. It is just way too expensive. Why not give every individual who purchases their own insurance the same tax break that a corporation gets for offering health insurance to the employees? It is a nontaxable benefit to the employee. Why shouldn't the individual get that same break? Why don't we have a $5,0000-per-family tax credit if you buy your own health insurance for your family, or $2,000-per-person tax credit so that everyone is on a level playing field? That would be a huge incentive. It is a tax credit, so it would be much less expensive than what we are talking about in this government takeover of health care.

How about creating a transparent, online marketplace for consumers to compare and purchase plans? That is something on which I think we could all agree. I think we could agree that if you had a health exchange where you could go online and companies would offer different kinds of plans, any company that wanted to come in with a credible plan for insurance coverage--again, a bigger risk pool so the company would have to be competitive, and it would have that lower cost--that would be a great boon for consumers and it would not cost the government anything to do that. It would just be a marketplace, a transparent place where people could shop for their plans and get a better deal because there would be more competition.

We should allow the purchase of insurance across State lines. Why don't we allow the insurance companies the ability to pool States and offer individuals better prices for health care coverage? We have options that would be good options for American consumers and would give more access to affordable health care. The more people who have affordable health care, the lower cost to everyone who has health care because when people are covered, they don't go to the emergency room for a fever or a common cold. They go to a doctor's office. They have checkups so they have ongoing care to detect something before its gets so bad that it is more serious, more expensive to treat, and certainly more life-threatening.

Those are the principles the Republicans would put forward. But to have a government takeover that is going to increase costs to everyone who has insurance and cause many people to lose their insurance because the employers back out is not the answer. It is not

the answer. We can do something that would give affordable access to more individuals and their families. That should be the goal of this health care reform. We need health care reform. We do. We don't need a government takeover of our health care system. That is the debate we ought to be having right now.

Mr. President, I yield the floor.

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

Mr. President, I rise today to raise serious concerns with the cap-and-trade legislation which is currently in hearings in the Senate Committee on Environment and Public Works.

The committee is holding its third hearing today on the bill that would presumably be coming to the floor of the Senate. One of the panels today is going to focus on the impact on transportation of the cap-and-trade bill. I think Members deserve to know the real costs and effects this bill will have on transportation. That is what I will talk about today.

Last week, Senator Bond and I unveiled a report that analyzed the fuel cost implications from the House bill that is making its way through the House. Our report forecasted a $3.6 trillion gas tax on the American economy for the life of the program, which is 2015 through 2050.

At this time of economic uncertainty, with 15 million people out of work, just about every American is cutting back on spending. Do we really want to put a tax on energy and increase energy costs for families and small businesses at a time like this? I think the answer is obvious. The worst thing we could do to our struggling economy is to overburden it with new taxes and more regulations. But that is exactly what the cap-and-trade bill is doing, and that is exactly what is going through Congress right now.

This past weekend, we began to see what was in the Senate bill that is being proposed. It is even more stringent than the House bill. The legislation on the Senate side would impose a huge tax on business and levy a massive economic burden on all Americans.

For most Americans, gasoline is a mandatory expense, and raising the cost of it, of course, is going to strain working families, small businesses, farmers, ranchers, and our whole economy. Last year, when consumers experienced $4 gasoline and $5 diesel, it caused enormous hardships for Americans. Fortunately, those fuel prices were temporary. But under cap and trade, those high prices will be permanent--at least until 2050.

High fuel prices don't just impact our transportation expenses; we are actually hit twice because the gas tax raises the price of every good and service--groceries, clothes--that consumers must purchase in order to live.

Energy costs are, among our businesses, top operational expenses. Companies face a variety of energy expenses, ranging from heating and cooling their plants and facilities to powering equipment and lighting. In order for businesses to withstand this heavier tax burden and to remain viable, they will be forced to pass fuel costs on to consumers through higher prices.

Several industries will be more severely penalized by the gas tax than others.

Let's take trucking. The American trucking industry is a major target of the cap-and-trade gas tax. In 2007, 1.7 million drivers of tractor trailers logged 145 billion vehicle miles, consuming 28.5 billion gallons of fuel. That equates to an annual fuel cost per vehicle of $34,560. That number will skyrocket under this cap-and-trade proposal that is going through Congress. When you consider that the average self-employed truckdriver earns only $43,000 per year in net revenue, the gas tax represents an enormous new tax on working middle-class truckers.

Of course, truckers will not suffer those higher gas taxes alone. Their additional costs will be shared by every consumer in the increased price of everything they transport. At some point, nearly everything bought or sold must be shipped to a retailer. So the sweeping effect of the gas tax on every consumer, every person, every business--certainly the trucking industry but every other business-- will harm our entire economy.

The pain doesn't stop with trucking. Our Nation's farmers and ranchers, who are tasked with producing high-quality goods for much of the world, will be irreparably harmed under the House's $2 trillion tax on gasoline and $1.3 trillion tax on diesel fuel. Gas and diesel fuel- powered equipment, ranging from tractors to combines to fertilizing systems, are the operational foundation of America's farms and ranches. Every extra penny they pay will be seen in the cost of goods and certainly the cost of food. Under the climate change legislation, they will face $550 million in higher fuel costs in 2020.

Despite all of this pain we are going to see on our truckers, on our family farmers, and on every business, what good will it do? If there is a good side, let's look at it. It is supposed to be to help our environment. But even the U.S. Environmental Protection Agency Administrator admits that unless China and India impose similar Draconian taxes and regulations, there will be no effect on world temperatures. So what is the purpose of this increase in taxes and increase in costs every American will bear? Well, there is no improvement because it is certainly common sense to know that if we do this unilaterally in the United States and put this tax on our refineries, on our exploration companies that are trying to produce more energy for our economy at a cheaper price and environmentally safely, and if others around the world don't do it--put more caps on and more regulations--and they are spewing into the world much heavier carbon emissions than the United States does now--if they don't change and we do, it will still come to our country. So there will not be any effect on the global environment.

Under the bills going through today, trillion-dollar figures have been discussed so nonchalantly in Washington that it seems as if they are losing their shock value. Americans must know that $3.6 trillion in gas taxes is a real number, and it is going to have a real effect on every American.

We can improve the environment and we can improve the economy.

One of the things that is not being discussed, as we are talking about putting more taxes on the industries that produce energy, the bread-and-butter energy of our economy, what isn't being discussed is nuclear power. Nuclear power has been shown time and again, where it is in place, that it is inexpensive, efficient, and it is environmentally safe. There is no carbon emission from a nuclear powerplant.

So why does the House bill not even address nuclear? Why are we not talking, in this administration, about nuclear power, which can be clean energy, efficient energy, and which has been proven to also have fewer consequences than once thought because the amount of nuclear waste has now been lowered to a huge extent and can be safely kept? And if we continue our research, we will probably be able to reuse the nuclear waste and put it back into more nuclear power. Why aren't we pursuing nuclear instead of just putting more taxes and regulations on the bread-and-butter energy that is produced in our country?

We need to reject the cap-and-trade bills that are going through Congress right now. We need to focus on environmental policies that will make a difference in our environment, that might make a difference in our global environment. But certainly unilateral regulations and taxes just on America has been absolutely proven not to make a difference in the global economy if no

other country adopts these Draconian measures, which they have all said they are not going to do.

While I stand ready to support clean energy technology, nuclear power, I could not possibly support a bill that is going to wreck our economy in a very precarious time and that will send jobs away from America at a time when we know we need to increase jobs in America. It will be sending American jobs overseas where it is easier to do business and where regulation is more stable.

Mr. President, what are we doing? What are we doing talking about more taxes and more regulations that will not impact the global environment? I hope that as these bills are vetted in committee, we will stop and say: Let's do something rational. Let's promote clean energy. Let's promote nuclear power. Let's don't hold back those who would be willing to make that investment and take that chance.

We should not pass cap and trade, which will tax and regulate our energy industry and it will not help the environment. That is a lose- lose proposition. I hope Congress and the majority in Congress will see that this is the wrong way and stop the cap-and-trade bill.

Mr. President, I yield the floor.

Madam President, I rise today to talk about an issue of great importance to our Nation's energy supply and our ability to continue producing affordable and reliable domestic energy. In particular, I would like to speak about a provision in the fiscal year 2010 Department of Interior, Environment and Related Agencies Appropriations Act conference report which pertains to a study on the use of hydraulic fracturing, an extremely important tool that will enable us to unlock the vast potential of our domestic oil and gas supplies.

Hydraulic fracturing is a critical technique used in producing domestic oil and gas resources. Across the country, leaders are recognizing the growing importance of natural gas to our Nation's energy supply. Natural gas is the most abundant form of clean energy in the United States. Natural gas, including gas from coal beds and other unconventional sources, is becoming an increasingly important energy source for the United States. Most experts predict that demand for natural gas is likely to increase dramatically in the next decade. The increased production of natural gas will both enhance our energy security and help us address the problem of carbon reduction.

The Interior appropriations conference report includes a provision to study the relationship between hydraulic fracturing and drinking water. It is imperative that we ensure that any study conducted is based strictly on facts and science. Specifically, any study must be conducted in a comprehensive, scientific, credible and transparent manner. It must be based upon the best available science as well as independent sources of information. Additionally, it should allow for stakeholder participation and should be conducted in coordination with states and interstate regulator agencies. Finally, the study should seek input and participation from industry and be peer reviewed. This will ensure that the study is credible and useful

I am confident that if properly conducted, the proposed study will clarify that the use of hydraulic fracturing will help to increase our domestic resource potential while posing no environmental harm.