Floor Statements

Mr. President, I ask unanimous consent the Senate proceed to the immediate consideration of H. Con. Res. 228 at the desk and just received from the House.

I ask unanimous consent the concurrent resolution be agreed to and the motion to reconsider be laid upon the table.

Mr. President, I ask unanimous consent that H.R. 1854 be discharged from the Senate Committee on Energy and Natural Resources and then be referred to the Committee on Environment and Public Works.

Mr. President, I understand there is a bill at the desk. I ask for its first reading.

I now ask for a second reading and, in order to place the bill on the calendar under the provisions of rule XIV, I object to my own request.

Mr. President, I ask unanimous consent the Presiding Officer of the Senate be authorized to appoint a committee on the part of the Senate to join with a like committee on the part of the House of Representatives to escort the President of the United States to the House Chamber for the joint session to be held at 9 p.m. on Wednesday, January 27, 2010.

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

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 9:30 a.m. Thursday, January 21; that following the prayer and pledge, the Journal of proceedings be approved to date, the morning hour be deemed expired, the time for the two leaders be reserved for their use later in the day, and the Senate proceed to a period of morning business for 1 hour equally divided and controlled between the two leaders or their designees with Senators permitted to speak therein for up to 10 minutes each, with the Republicans controlling the first half and the majority controlling the final half; that following morning business the Senate resume consideration of H.J. Res. 45, the debt limit bill.

Mr. President, there are three amendments pending to the joint resolution. We hope to reach time agreements on those amendments and, therefore, votes are expected tomorrow. Senators will be notified when these votes are scheduled.

Mr. President, if there is no further business to come before the Senate, I ask unanimous consent that it adjourn under the previous order.

What is the regular order?

Mr. President, it has been more than a month since the majority leader moved to proceed to the health care reform bill before us today. At long last, the Senate is now in the final throes of passing this historic legislation.

From the beginning, this Senator has sought out what Abraham Lincoln called ``the better angels of our nature.'' That is the way this Senator has always sought to legislate.

A year and a half ago, I convened a bipartisan retreat at the Library of Congress. Half a year ago, I convened three bipartisan roundtables with health care experts. Half a year ago, the Finance Committee conducted three bipartisan walk-throughs of the major concepts behind the bill before us today.

We went the extra mile. I reached out to my good friend, the ranking Republican member of the Finance Committee. I reached out to the ranking Republican member of the HELP Committee.

We sought to craft a bill that would appeal to the broad middle. We sought to craft a bill that could win the support of Republicans and Democrats alike.

We met, a group of six of us, three Democrats and three Republicans. We met more than 30 times. We met for months, encouraged by the President to do so. Our group met with the President several times. The President encouraged us to keep pursuing our negotiations, hoping to reach bipartisan agreements.

No, we did not reach a formal agreement. The leadership on the other side of the aisle went to great lengths to stop us from doing so.

But even though we did not reach a formal agreement, we came very close to doing so. The principles that we discussed are very much the principles upon which the Finance Committee built its bill. The principles that we discussed are very much the principles reflected in the bill before us today. Our work began much earlier than I have indicated. We met all the preceding year, held about ten hearings in the Finance Committee working toward health care reform. We also finished a white paper in November 2008. I say with trepidation that basically that is the foundation from which almost all ideas in health care reform emanated. To be fair, the ideas in that paper had been floating around, principles from the Massachusetts health care reform, for example. Most policy experts and health care economists who had been working on reform published their ideas. We sought the best, compiled them, and put together that white paper published in November of last year.

From the debate that the Senate has conducted this past month, you would not know it. During this debate, some on the other side of the aisle have mischaracterized the bill before us. Some on the other side of the aisle have set about a systematic campaign to demonize this bill.

Through bare assertion alone, with the thinnest connection to fact, they have sought to vilify our work. If one listened to their assertions alone, one would not recognize the bill before us.

And so, let me, quite simply, state the facts.

Some on the other side of the aisle assert that this bill is a government takeover of health care.

The fact is that the nonpartisan Congressional Budget Office says that this bill would reduce the government's fiscal role in health care. Just 3 days ago, CBO wrote, and I quote:

CBO expects that the proposal would generate a reduction in

the federal budgetary commitment to health care during the

decade following the 10-year budget window.

Some on the other side of the aisle assert that this bill would add to our Nation's burden of debt.

The fact is that the nonpartisan Congressional Budget Office says that this bill would reduce the deficit by $132 billion in the first 10 years and by between $650 billion and $1.3 trillion in the second 10 years. The fact is that this is the most serious deficit reduction effort in more than a decade.

Some on the other side of the aisle assert that this bill would harm Medicare.

The fact is that Medicare's independent actuary says that this bill would extend the life of Medicare by 9 years. The fact is that this is the most responsible effort to shore up Medicare in more than a decade.

Some on the other side of the aisle assert that this bill does not do enough to ensure the uninsured.

The fact is that the nonpartisan Congressional Budget Office says that this bill would extend access to health care to 31 million Americans who otherwise would have to go without. The fact is that CBO says, and I quote:

The share of legal nonelderly residents with insurance

coverage would rise from about 83 percent currently to about

94 percent.

Nothing that Senators on the other side of the aisle have proposed would come close. CBO estimated that the Republican substitute offered in the House of Representatives would have extended coverage to just 3 million people. The fact is that CBO says of that plan, and I quote:

The share of legal nonelderly residents with insurance

coverage in 2019 would be about 83 percent, roughly in line

with the current share.

I would cite the facts about the Republican substitute in the Senate. But the fact is that there is no Republican substitute.

Some on the other side of the aisle assert that they simply prefer a more modest reform of health care.

The fact is that the Republicans controlled the Senate from 1995 to 2001 and from 2003 to 2006. The fact is that before they took control, in 1994, 36 million Americans, 15.8 percent of nonelderly Americans were without health insurance coverage. In the last year of their control, in 2006, nearly 47 million Americans, 17.8 percent of non- elderly Americans were without health insurance coverage. The legacy of Republican control was 10 million more Americans uninsured.

Some on the other side of the aisle say that we are moving too fast.

The fact is that it was 1912, when former President Theodore Roosevelt first made national health insurance part of the Progressive Party's campaign platform. The fact is that people of good will have been working at this for nearly a century.

The fact is, health care reform for America is now within reach. The fact is, the most serious effort to control health care costs is now within reach. The fact is, life-saving health care coverage for 31 million Americans is now within reach.

Let us, at long last, grasp that result. Let us, this time, not let this good thing slip through our hands. And let us, at long last, enact health care reform for all.

I suggest the absence of a quorum and ask unanimous consent that the time be charged equally to each side.

Mr. President, will the Senator yield for a question?

Mr. President, I just have a couple statements to make, points to make, in view of the last statement, to correct some misimpressions given by the last statement.

The last speaker said Medicare cuts apply and this is going to cut Medicare. The fact is--I wish the previous speaker would stay on the floor, but he is fleeing the floor because he knows I am going to mention facts in total refutation to the assertions he is making. He leaves the floor. He will not stay with me to talk about what is going on. He makes statements that are misrepresentations and then he leaves the floor.

Let me talk about some of the things he said which are incorrect. One, he basically says Medicare is going to be hurt by these huge cuts to Medicare. The fact is, we are helping the Medicare trust fund with this legislation. The fact is, the Chief Actuary at HHS has said this legislation before us will increase the solvency of the Medicare trust fund another 9 years. That is a fact.

Second, he is trying to say there are a lot of big tax increases here. He is trying to direct the public away from what the fact is. The fact is, the Joint Committee on Taxation says there are $436 billion of tax cuts in this legislation, reductions in taxes; $436 billion in tax cuts in the form of tax credits for people who purchase insurance in the exchange. It is a tax cut of $436 billion of tax cuts in the exchange. I might say $40 billion of that is small business tax cuts. They are not increases, they are tax cuts for small business and the tax cuts for individuals is $436 billion.

Frankly, I wish I had a lot of the data before me. I don't have it right now to refute other points he made. He talked about premiums going up. The Congressional Budget Office basically says 93 percent of Americans will find their premiums will come down because of this legislation, and for a certain class of individuals--those in the individual market and the small group market will get very significant reductions in premiums on account of this bill.

It irritates me, frankly, when Senators come to the floor and make all these misstatements and they are not based at all on fact.

In fact, what we need to do around here is get more and more institutions to objectively analyze policy so we know what the facts are. It is pretty hard to argue the facts. The CBO does a pretty good job. The Joint Committee on Taxation does a pretty good job. But if somehow this country could turn to an organization or organizations to find the facts--just the facts--I think it would help a little bit because it is hard to argue the facts. If you have good facts, you generally can create good policy.

Back to premiums. CBO says 93 percent of premiums go down. Actually, for about five-sixths of those insured--that is, those who work for larger companies, it is called the large group markets--premiums will go down not a lot but a little. According to CBO, it is up to a 3- percent reduction in premiums. They look at the year 2016 as a benchmark year, so CBO says that for those, about 70 percent of Americans who work for large markets, premiums will actually go down 3 percent.

What about 13 percent of Americans who work for small groups, small companies? Basically, CBO and the Joint Committee on Taxation say those could go up 1 percentage point as well as down 2 percentage points. It is about even. It is difficult to tell. But those who get credits in the small group market will find their premiums down by about 8 to 11 percent. Those who work for small companies will find their premiums go down 8 to 11 percent.

What about the nongroup market--individuals. Well, basically, if you compare today's insurance premiums with what it might be in the future, the premiums will go down 14 to 20 percent, but because of better benefits, premiums could go up 10 to 13 percent for 7 percent of Americans. As I mentioned earlier, 93 percent will find their premiums go down. For 7 percent they will go up, but for those 7 percent, they are going to have a lot better coverage, a lot better insurance in 2016. All the insurance market reforms will have kicked in: denial of preexisting conditions, market status, health status and so on and so forth.

Get this: For the nongroup market, 17 percent of Americans who buy insurance through the nongroup market, 10 percent of that 17 percent, because of tax credits, will find their premiums go down by--guess how much--56 to 59 percent. Once more: 17 percent of Americans buy insurance individually. Of those 17 percent, 10 percent of them will find their premiums will be reduced 56 to 59 percent. That is according to the Joint Committee on Taxation. Only one small group, according to the Joint Committee on Taxation, will find an increase in 2016. That is 7 percent of Americans in 2016, but that will be compensated with a lot better insurance, high-quality insurance. No more rescissions. No more denial based on preexisting conditions. The rating reforms will have kicked in and the annual limits, the lifetime limits will have been repealed. It will be a heck of a lot better insurance. So maybe their premiums will go up a little bit, but they will get a heck of a lot better buy for what they are getting. It is similar to buying a new car instead of a used car--hopefully, a good new car. All in all, in a very real sense, all Americans are going to find his or her premiums will go down. Seven percent will find them go up a little bit, but they will get a heck of a lot better insurance for the premiums they will be paying.

The previous speaker is wrong when he says it will increase premiums. The Joint Committee on Taxation says it will not. I didn't hear him quote the Joint Committee on Taxation saying premiums will go up. If you look at the actual analysis by the Joint Committee on Taxation, they find the premiums will go down.

Seeing nobody who wishes to speak, I wish to address the question of the constitutionality of the individual mandate. Let me read into the Record an analysis by Mark Hall, prepared by the O'Neill Institute. Basically, he says the following:

Health insurance mandates have been a component of many

recent health care reform proposals. Because a Federal

requirement that individuals transfer money to a private

party is unprecedented, a number of legal issues must be

examined. This paper analyzes whether Congress can legislate

a health insurance mandate and the potential legal challenges

that might arise given such a mandate. The analysis of legal

challenges to health insurance mandates applies to federal

individual mandates, but can also apply to a federal mandate

requiring employers to purchase health insurance for their

employees. There are no constitutional barriers for Congress

to legislate a health insurance mandate as long as the

mandate is properly designed and executed as discussed below.

This paper also considers the likelihood of any change in the

current judicial approach to these legal questions.

Potential solutions. Congress's Authority to Regulate

Commerce: The federal government has the authority to

legislate a health insurance mandate under the Commerce

Clause of the United States Constitution. A federal mandate

to purchase health insurance is well within the breadth of

Congress's power to regulate interstate commerce. Congress

can avoid legal challenges related to the 10th Amendment and

states' rights by preempting state insurance laws and

implementing the mandate on a Federal level. If Congress

wants states to implement a federal mandate, it has the

following two options:

Conditional Spending: Congress may condition federal

funding, such as that for Medicaid or public health, on state

compliance with federal initiatives. Conditional Preemption:

Congress may allow states to opt out of complying with direct

federal regulation as long as states implement a similar

regulation that meets Federal requirements.

Congress's Authority to Tax and Spend for the General

Welfare: Congress also has the authority to legislate a

health insurance mandate under its Constitutional authority

to tax and spend.

There are no plausible Tenth Amendment and states' rights

issues arising from Congress's taxing and spending power.

However, Congress's taxation power cannot be

used in a way that burdens a fundamental right recognized in

the Constitution's Bill of Rights and judicial

interpretations by the U.S. Supreme Court. Since there is no

fundamental right to be uninsured, no fundamental right

challenge exists.

Other Relevant Constitutional Rights: Challenges under the

First and Fifth Amendments relating to individual rights may

rise, but are unlikely to succeed. The federal government

should include an exemption on religious grounds to a health

insurance mandate as an added measure of protection from

legal challenges based on religious freedom. In the

alternative, the federal government can simply exempt a

federal insurance mandate from existing federal legislation

protecting religious freedom.

Considerations: To avoid a heightened level of security in

any judicial review, the federal government should articulate

its substantive rationale for mandating health insurance

during the legislative process.

It goes on, and it is probably too lengthy to read. Professor Hall wrote this. He is a professor at Wake Forest University.

I will read the conclusion:

The Constitution permits Congress to legislate a health

insurance mandate. Congress can use its Commerce Clause

powers or its taxing and spending powers to create such a

mandate. Congress can impose a tax on those who do not

purchase insurance, or provide tax benefits to those that do

purchase insurance. . . . If Congress would like the States

to implement an insurance mandate, it can avoid conflicts

with the anti-commandeering principle by either preempting

state insurance laws or by conditioning federal funds on

State compliance. A federal employer mandate for state and

local government workers may be subject to a challenge;

however, such a challenge is unlikely to be successful.

Individual rights challenges under the First Amendment's Free

Exercise Clause or RFRA are unlikely to succeed, although a

federal insurance mandate should include a statement that

RFRA does not apply or provide for a religious exemption.

Fifth Amendment Due Process and Takings Clause challenges are

also unlikely to be successful. A legal analysis presented is

likely to endure, as the Supreme Court's current position and

approach to interpreting relevant constitutional issues

appear to be stable.

Mr. President, I have a unanimous consent request that I understand has been cleared by both sides.

I ask unanimous consent that after Senator Ensign raises the point of order that the Reid substitute amendment No. 2786 is in violation of the Constitution, the point of order be set aside to recur on Wednesday, December 23, at a time to be determined by the majority and Republican leaders.

Madam President, I appreciate the Senator's desire to want to cut the payments to his own State, but I object.

Madam President, I would like to address a colloquy with Senator Grassley, as he said, on another subject that is not related to this bill.

Madam President, the Senate is wrapping up legislative business shortly, but there are a few expiring tax provisions that have unfortunately not been extended. These provisions include tax benefits for individuals and businesses. These provisions would help teachers who purchase supplies for their classrooms and families with college students.

Further, a great number of U.S. businesses rely on important tax benefits, such as the research and development tax credit and the active financing exception, both of which expire at the end of this year. The energy industry also relies on several provisions that expire on December 31. Unfortunately, this is not the first time we have allowed important tax benefits to expire. As soon as the Senate reconvenes next year, my intention is that we take up legislation to extend these important provisions.

That is why Senator Grassley and I have written a letter to the Senate leadership. I ask unanimous consent to have this letter printed in the Record.

Madam President, the letter states our intention to work together to get the extenders done as quickly as possible in the new year.

Senator Grassley and I both understand that expiration of these provisions creates uncertainty and complexity in the tax law. Taxpayers need notice of the availability of these provisions to fully and effectively utilize their intended benefits. Finally, we must act quickly to cause the least disruptions and administrative problems for the Internal Revenue Service.

I hope when the Senate convenes early in 2010, we can address these expiring provisions as soon as possible. I wonder if that is also the intention of the my good friend from Iowa, Senator Grassley.

Madam President, I thank the Senator for his statement. I look forward to working with him and other Senators so we can pass this legislation as soon as possible next year.

Again, I commend my colleague and friend. It is true that much more often than not we are working on the same side of an issue. Even on the few occasions when we are on the opposite side, I do say we do it agreeably. I wish more of the Senate would act the same way.

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

Madam President, this chart shows very graphically--this is data put together by the Joint Committee on Tax, combining all the various provisions in the bill. Basically, it shows that in 2015--that is the bar on the far left--there will be a $26.8 billion net tax cut for individuals--net tax cut. Two years later in 2017--that is the middle vertical bar--there is a net tax cut of $40 billion for all Americans--a net tax cut. Not for all Americans. Some will not get it, but most Americans by far will. Then, of course, 2 years later in 2019, there is a net tax cut of $40.8 billion.

I wanted to make it clear that there is a net tax cut in this bill, according to Joint Tax. This is the distribution over 3 different years--2015, 2017, and 2019. That is information prepared by the Joint Committee on Tax. I want Americans to know there are tax cuts in this bill, and they are very significant.

Madam President, I yield the floor.

Mr. President, I have control of the Democratic block of time, and I yield 25 minutes to the good Senator from Rhode Island.

Mr. President, pending a potential unanimous consent request by the two leaders, I now yield such time as the Senator from Massachusetts desires.

Mr. President, reserving the right to object, I wish to inquire whether, under that consent request that is being propounded, secondary amendments would be in order to any of the first-degree amendments on that list.

I do not object.

Mr. President, I very much thank my good friend from North Dakota for his generous statements. As he knows, this is all teamwork. We are all in this together, all Senators, especially on this side of the aisle, with the President, to get health care reform finally passed for all Americans. Teddy Roosevelt started this many years ago, and many Presidents since have been unable to get health care reform passed. I think finally this time we are going to do it, and it is a moment of which we are all very proud.

Mr. President, I yield the remainder of my time to the Senator from Washington. I don't know how much that is, but whatever it is, it is all hers.

I wonder if the Senator would yield briefly.

I am pointing out, as the Senators know, for example, under this legislation, the Federal Government pays all the costs of eligible enrollees through 2016. In this legislation, we are talking about the so-called expansion population. That is those between 100 percent of poverty on Medicaid and 133 percent of poverty, and under the underlying statute----

In 2016, all States are treated the same.

Beginning next year, when this goes into effect, 2010 through 2016, all States will get 100 percent payments for that expansion coverage.

Afterward, under current legislation--one sentence of background. Today, as the Senator well knows, different States receive different Federal contributions to Medicaid. It varies according to States. The average is about 57 percent Federal. The average for all States on average is 57 percent of the cost of Medicaid is paid for----

Let me finish.

Let me answer the question.

I can answer only one question at a time. The first question is from the Senator from Mississippi. Then, after 2017, all States get 90 percent--we are talking about expansion of population.

Reserving the right to object, I think it would be highly imprudent for me not to object, so I will object to that request. I also point out that on average, Uncle Sam pays 90 percent of the Medicaid payments for this expansion of population after the year 2016.

The Senator carried my State too.

Mr. President, I have several points to make. First, as a matter of personal privilege, on behalf of the people of Libby, MT, the Senator from Arizona made it sound as if the folks in Libby were getting some kind of a sweetheart deal. I wish the Senator would not leave so he can hear what is actually going on. I think the Senator from Arizona would agree with me that he would not want his constituents to suffer an environmental calamity. He would not want his constituents to not get some redress because of a declaration of public emergency due to contamination of asbestos. I assume the Senator from Arizona would very much stand up for his constituents.

Let me explain. Congress passed a law in 1980 called CERCLA. That legislation said that whenever there was a declaration of a public emergency because of contamination at a Superfund site, the government has an opportunity to declare a public emergency and help those people get medical care because of contamination of asbestos; in this case especially, something called tremolite, which causes even greater damage than ordinary asbestos. I would assume the Senator from Arizona would want his constituents to

get some help from contamination from asbestos.

Absolutely.

This is health care. Reclaiming my right to the floor.

I reclaim my right to the floor because he doesn't want to deal in good faith with this issue.

My second point. It is disrespectful, it is unseemly for Senators in this body to invoke the names of Ted Kennedy and Jack Kennedy in opposition to this bill. It is disrespectful and unseemly. I, frankly, am very much surprised that Senators would go to that level and invoke the names of Ted Kennedy and Jack Kennedy in opposition to this legislation. Talk about profiles in courage. I hear Senators on the other side say: Where is the courage of one Senator to stand up and vote against health care reform? That is what I keep hearing. Where is the courage? Where is the courage of one Senator on the Democratic side to stand up and vote against health care reform?

Mr. President, I want to turn that around. ``Profiles in Courage''-- Jack Kennedy and Ted Kennedy were Senators who worked to try to find resolutions to agreements. They wanted to compromise. They wanted to work together to get just results.

I ask, where is the Senator on that side of the aisle who has the courage to break from their leadership, break from the partisanship they are exercising on their side of the aisle to work together to pass health care reform? I ask, where is the courage? Where are the Senators who have the courage on that side of the aisle to stand up and work together on a bipartisan basis to get health care reform passed? Where?

We on this side reached out our hands for bipartisan agreement on health care reform, probably to a fault. I say ``to a fault'' because for months and months this Senator, anyway, extended the hand to work with other Senators on a bipartisan basis. I know the current occupant of the chair knows that. He watched this. He saw it happen in the Finance Committee.

Senator Grassley and I worked very hard to get Senators on both sides of the aisle to work to pass health care reform, very hard. Then after a while we had to work toward another approach. The Group of 6--3 Republicans, 3 Democrats--worked for months on a bipartisan basis to get health care reform passed. Do you know what happened? I watched it happen. Those Senators in the room were acting in good faith. They were in good faith. They wanted to mutually work together to pass health care reform. They asked good questions. Senator Enzi from Wyoming, for example, asked very good questions. Senator Snowe asked very good questions. Senator Grassley asked very good questions. We worked to get health care reform.

But do you know what happened? I could feel it happening. One by one by one, they started to drift away. They wanted to pass health care reform. They wanted to act in a bipartisan basis. But they were pressured--pressured from their political party not to do it, not to do it, not to do it. Why were they pressured not to do it? Unfortunately, they gave in to the pressure because their leadership wanted to make a political statement. One of the Senators on the floor here said: Let's make health care Obama's Waterloo. They did not want to work with us, that side of the aisle. They did not want to work with us because they thought it was better to make a political statement: Attack the bill, attack the bill, attack the bill, attack the bill in order to make political points for the 2010 election. That is what they were trying to do.

I ask, where is the courage? Where is the courage? Where is the Republican Senator who will stand up and say: Boy, let's work together to pass health care reform. Where is the Senator who will stand up and say: We want to work together to pass health care reform.

This Senator tried mightily to get bipartisan support. Ask Senator Grassley from Iowa, with whom I have been working for a long, long time. They were pulled away. Senator Grassley--I don't want to speak for him, but I know he wanted to get health care reform passed on a bipartisan basis. I know that is the case. Frankly, he got pressured, pressured, and he just couldn't do it. I have the highest respect and regard for him, but he just couldn't do it.

Absolutely.

That is how they started out, that is true.

Reclaiming my time.

That is not what happened. I was in the room constantly. I talked to those Senators many times. That is not what happened. I will tell you what did happen. Your leadership pressured them, pressured them, pressured them not to work together. There was no European-style effort in that room. That is a totally untruthful statement--a totally untruthful statement. None whatsoever. We are passing a bill here that is a uniquely American solution. It provides competition. It helps the doctor-patient relationship. That assertion of working toward a European solution is entirely untrue. It is entirely false.

The fact is, those Senators did not want to work with us. It is regrettable. It is highly regrettable. One of the biggest travesties here is there was not a good-faith effort on that side of the aisle to come up with a constructive, comprehensive alternative to the Democratic version of health care reform. If there had been a constructive, honest, alternative health care reform, we could have had a really good debate. What is the better approach to solving the health care problem? That did not ever happen. It did not ever happen at all. Rather, they didn't have anything. They didn't have a health care bill. None whatsoever.

The only one that came up a little bit was over in the House. Because of all the criticism about Republicans not having an alternative, finally the Republicans in the House came up with an alternative. It was very small. There wasn't much to it. To be honest, the CBO said it would hardly increase any coverage whatsoever. It was not really a comprehensive health care reform bill. And there has been none in the U.S. Senate on the Republican side, no alternative for a comprehensive health care reform bill.

I want the public to know we worked very hard to get a bipartisan bill. That side of the aisle started without working with us, but gradually they began to believe that politically they would have a better chance in the 2010 elections by just not working with us but just attack, attack, attack, attack, trying to score political points to defeat any honest effort to get health care reform.

I now yield such time as he would like to the Senator from Nebraska.

Mr. President, I yield 15 minutes to the Senator from Delaware.

Mr. President, I want to begin by saying I agree with my colleague from Delaware. This partisanship has to stop. It is just too much. It is ironic, it is bittersweet that we are reaching a high point because we are going to pass health care reform legislation, but we are reaching a low point, too, in terms of partisanship. It is very unfortunate. Many of us over the last several days have been scratching our heads just trying to figure out what we can do to avoid this next year. Hope springs eternal.

I know this Senator and I know the occupant of the chair want to try to find ways for this body to be much more civil. We are not just blowing smoke here. We really mean it. I thank very much the Senator from Delaware for raising that point. It is needed, and I do think this country is in trouble if we don't find some solution to handle this excessive partisanship which is certainly hurting our country.

On another matter, some of my colleagues on the other side of the aisle have asserted that the penalty that is proposed under the bill before us for failing to maintain health coverage is unconstitutional. One Senator has raised a point of order--Senator Ensign--on that subject, and that is now pending.

Those of us who voted to proceed to the health reform bill and who voted for cloture on the substitute amendment take seriously our oath to defend the Constitution. Every Senator here takes that oath of office very seriously.

We have seriously looked at this question as well and have concluded that the penalty in the bill is constitutional.

Those who study constitutional law as a line of work have drawn that same conclusion. Most legal scholars who have considered the question of a requirement for individuals to purchase health care coverage argue forcefully that the requirement is within Congress's power to regulate interstate commerce.

Take Professor Erin Chemerinsky, a renowned constitutional law scholar, author of four popular treatises and casebooks on constitutional law and the dean of the University of California Irvine School of Law. Professor Chemerinsky has gone so far as to say that those arguing on the other side of the issue do not have ``the slightest merit from a constitutional perspective.''

In arguing that a requirement to have health care coverage falls within Congress's power to regulate interstate commerce, Professor Chemerinsky compares health care reform to the case of Gonzales v. Raich--often cited by the other side. In that case, the Supreme Court held that the Federal Government's commerce clause powers extend to the cultivation and possession of small amounts of marijuana for personal use. Professor Chemerinsky notes that the relationship between health care coverage and the national economy is even clearer than the cultivation and possession involved in Gonzalez v. Raich.

Mr. President, I ask unanimous consent that Professor Chemerinsky's Los Angeles Times article be printed in the Record.

Mr. President, as a second example, I refer my colleagues to an article by Mark Hall, a law professor at Wake Forest University. His article is a comprehensive peer-reviewed analysis of the constitutionality of a Federal individual responsibility requirement.

In this article, Professor Hall concludes that there are no plausible 10th amendment or States' rights issues arising from the imposition by Congress of an individual responsibility to maintain health coverage.

Professor Hall notes further that health care and health insurance both affect and are distributed through interstate commerce, and that gives Congress the power to legislate a coverage requirement using its commerce clause powers.

Professor Hall notes that the Supreme Court indicated in its decision in U.S. v. Morrison and U.S. v. Lopez--two other cases relied on by the other side--that the noneconomic, criminal nature of the conduct in those cases were central to the Court's decisions in those cases that the government had not appropriately exercised power under the commerce clause.

Health insurance, on the other hand, does not deal with criminal conduct. Health insurance is commercial and economic in nature and, to reiterate, substantially affects interstate commerce.

Health insurance and health care services are a significant part of the national economy. National health spending is 17.6 percent of the economy, and it is projected to increase from $2.5 trillion in 2009 to $4.7 trillion in 2019.

Private health insurance spending is projected to be $854 billion in 2009. It covers things such as medical supplies, drugs, and equipment that are shipped in interstate commerce.

Health insurance is sold by national or regional health insurance carriers. Thus, health insurance is sold in interstate commerce. As well, claims payments flow through interstate commerce.

The individual responsibility requirements, together with other provisions in the act, will add millions of new consumers to the health insurance market, increasing the supply and demand for health care services.

Under existing health and labor laws, the Federal Government has a significant role in regulating health insurance.

Other prominent legal scholars have also said that Congress has the constitutional authority to impose a requirement on individuals to maintain health coverage.

Jonathan Adler, a professor of law at Case Western Reserve University School of Law, stated:

In this case, the overall scheme would involve the

regulation of ``commerce'' as the Supreme Court has defined

it for several decades, as it would involve the regulation of

health care markets. And the success of such a regulatory

scheme would depend upon requiring all to participate.

Doug Kendall of the Constitutional Accountability Center similarly concluded:

The fundamental point behind pushing people into the

private insurance market is to make sure that uninsured

individuals who can pay for health insurance don't impose

costs on other taxpayers.

Professor Michael Dorf of the Cornell University Law School also noted:

[T]he individual mandate is ``plainly adapted'' to the

undoubtedly legitimate end of regulating the enormous and

enormously important health care sector of the national

economy. It is therefore constitutional.

Robert Shapiro, a professor of law at Emory University School of Law, stated:

When everyone thinks of the wisdom of an individual

mandate, or of health care reform generally, it would be

surprising if the Constitution prohibited a democratic

resolution of the issue. Happily, it does not.

Thus, Mr. President, the weight of authority is that health care and insurance represent interstate commerce. The individual responsibility requirement to maintain coverage would be within Congress's power to regulate interstate commerce.

Mr. President, in the last hour, several Senators on the other side listed many organizations they claim oppose the bill before us. I will indicate many organizations that favor the health care reform bill.

I will begin with the American Medical Association. That is the major doctors association that supports this legislation. In fact, the incoming president, the president-elect of AMA, at a press conference yesterday, made that statement very clear.

In addition, the American Heart Association supports the legislation. They believe the many patient-centered provisions are a significant step toward meaningful health care.

The American Hospital Association supports passage of the legislation.

The American Cancer Society Action Network supports it.

The Federation of American Hospitals also supports it.

The National Puerto Rican Coalition supports this legislation.

Mr. President, it would be unfair to say that these are all totally 100 percent endorsements. Rather, these are statements of support from these organizations. Some totally support it, and some say there are very good features in it. As far as I know, none of these groups totally oppose this legislation. Some would like to see some changes, but they favor the legislation.

The American Association of Retired People supports this legislation. That is the largest seniors group. They think this is good--I am sure for a lot of reasons, but it extends the solvency to the Medicare trust fund for another 5 years.

The Business Roundtable supports this legislation. They say:

On behalf of the members of Business Roundtable, I want to

commend you for your efforts to improve the health care

reform legislation currently being considered by the United

States Senate. The proposed legislation is a step toward our

shared goal of providing high quality, affordable health care

for all Americans. . . . As we understand it, the proposed

legislation now will include provisions to accelerate and

enhance the process for delivery reform for the Medicare

system. . . . It strengthens the match between the insurance

reforms and the individual obligation. . . . We will continue

to work with you, the Congress and the Administration to

ensure we achieve the goals we all set when this process

began.

The American Diabetes Association also supports this bill. They say it is ``long overdue improvements to our broken health care system.''

The Small Business Majority also believes the managers' amendment ``includes new provisions essential for small business protection and survival.''

Doctors for America supports passage of this bill.

The National Hospice and Palliative Care Organization strongly supports this legislation. There has been confusion as to whether they did. But they strongly support it, saying:

On behalf of hospice and palliative care providers and the

more than 1.5 million patients, and their families . . .

would like to express our strong support for the national

effort to enact health care reform. We acknowledge the

enormity and complexity . . . and we applaud your recognition

of the importance of various provisions. . . .

Families USA supports this legislation. I already mentioned AARP, which also supports it. Community Catalyst is another organization that supports it. U.S. PIRG supports it. The Center for American Progress supports it. Medco Health, Microsoft, a big company in the United States, makes a strong statement approving the measure we are considering here.

Many organizations support this legislation. I am sure there are more, but this is an example of a few.

How much time remains on our side?

Mr. President, I yield 10 minutes to the Senator from Pennsylvania.

Mr. President, I see no Senator seeking recognition. I ask unanimous consent that the next block of time begin immediately.

Reserving the right to object, and I hope my colleague will let me say a word or two in my reservation, the underlying bill, while certainly objective, was crafted with the guidance of CMS, the Office of the Inspector General, HHS, and the Justice Department for stronger antifraud. It would give CMS new screening authority to provide resources to CMS for new screening authority. It also limits providers in other ways but more oversight when fraud is suspected, such as limiting durable medical equipment providers because we know it is fraught with fraud. We also require providers to have compliance programs, make sure providers know the rules. There are increased penalties for fraudulent activity in the bill as well. Most importantly, we will give CMS, HHS, OIJ, and DOJ more tools at their disposal to preserve and protect the program's integrity. The bill does a lot to protect fraud.

I might say, I know this is on his time, but this procedure has been unusual. I appreciate the indulgence of the Chair, as well as the indulgence of the Senator from Florida.

You will not believe the number of amendments that were offered on a bipartisan basis in the Finance Committee, as well as in the HELP Committee. They were adopted in both committees. It was very transparent, open, bipartisan. Unfortunately, by the time the bill got to the floor, it became apparent we were facing less than the nature of legitimate amendments, more message amendments. So the majority leader resorted to a procedure to move this bill expeditiously.

I am taking advantage of the Senator's time to explain all this. That is not the proper procedure. There are strong antifraud provisions in this legislation, and very respectfully I must object.

I ask the Senator if he might yield using time on our side. I fully agree with the Senator. It is unfortunate we cannot proceed at this moment. But I pledge my support next year to work aggressively with very strong oversight to boost our antifraud measures even more than they are in this bill.

There will be an awful lot of oversight necessary when the bill is passed to make sure all the provisions that are intended come true. In fact, we think we are working hard to get it passed; frankly, I think we have to work harder next year to make sure the provisions work. I pledge my support to work aggressively in that area.

I would be happy to engage Senator Lincoln in a colloquy. I commend her for all her leadership over the years on this issue, because she recognizes that it is important to reimburse pharmacies adequately for the generic medications they dispense to Medicaid patients. In rural States like ours, Medicaid patients need access to their community pharmacies to obtain their medications. Sometimes community pharmacies are the only health care providers for many miles. So, it is important that we permanently fix in this health care reform bill the problems for pharmacies caused by the severe reimbursement cuts from the Deficit Reduction Act of 2005.

I would say to my colleague that the language indicating that the Secretary could set the Federal upper limit at no less than 175 percent the weighted average average manufacturer price could be used in those types of circumstances. It would give the Secretary flexibility to set the Federal upper limits in cases where there is a need to provide states with a higher match in order to assure that appropriate payment is made to pharmacies to encourage the use of generic drugs.

I thank the Senator. I would be pleased to enter into a colloquy with the Senators from Wisconsin on this subject.

I thank the Senator for the question. Yes, that is correct, and it is my understanding of the legislation as well.

Yes. I thank the Senator.

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

Mr. President, I wish to take a few moments this morning to talk about a provision in this package about which I am particularly proud. This would finally follow through on the Federal Government's responsibility to provide screening and medical care to residents at Superfund public health emergency sites.

The term ``public health emergency'' is defined by the Comprehensive Environmental Response Compensation and Liability Act of 1980, otherwise known as CERCLA. People call that the Superfund law--CERCLA. That law reserves the declaration of public health emergency for the most hazardous Superfund sites. These are sites where the release or potential release of a hazardous substance rises to the level of an emergency.

When a public health emergency is declared, the law requires that the Secretary of Health and Human Services provide screening and medical care services to people who have been exposed. But to date, the government has not created a mechanism to allow the Secretary to deliver the screening and medical care required under current law. The bill before us finally provides that mechanism.

First, it authorizes a grant program for the screening services. These screenings would determine if a medical condition is present that is attributable to environmental exposure. Then, it allows those individuals with a diagnosed medical condition due to the environmental exposure at the site to get medical care services.

It also establishes a pilot program to provide additional medical care appropriate for the residents of the Superfund site at Libby, MT. This language responds to Libby's rural nature and the lack of access to traditional care. This provision is important because it will provide vital medical services to Americans who, through no fault of their own, have suffered horrible effects from their exposure to deadly poisons. It will provide the vital medical services we owe these Americans under our commitment in prior legislation; that is, the Superfund Act.

This provision is especially important to me for a special reason. The Environmental Protection Agency currently has 1,270 sites designated where pollution contamination presents a danger to public health and welfare. Throughout the history of the program, the EPA has found only one site where conditions are so severe and the contamination so pervasive to have it warranted a declaration of a ``public health emergency.'' That declaration occurred on June 17 of this year. EPA Administrator Jackson found that a public health emergency exists at the Superfund site in Libby, MT.

Many Senators have heard me speak about Libby. Libby, MT, is a beautiful little town, a small town in northeastern Montana, surrounded by millions of acres of Federal forest lands. It appears to be an idyllic spot. It is home to families of all ages. It is a place where people spend their lives creating a sense of community not often found in the country today. It is also a town that has gone through lots of stress, lots of economic difficulties. The timber industry has virtually shut down Libby, one of the mainstays in Libby. Mining there is not quite what it used to be in years past. Here the people work together. They love Libby. It is tucked away, almost isolated in the northeastern part of Montana. Most people in Montana have never been to Libby, and some don't even know where Libby is, but they have this wonderful sense of community in their own town.

However, Libby is also a Superfund site. It is the home of a big mine. It is a place where hundreds of people have grown sick and died-- died due to pervasive presence of asbestos spewed from the vermiculite mining and milling operations of W.R. Grace.

Gold miners discovered vermiculite in Libby in 1881. In the 1920s, the Zonolite Company formed and began mining vermiculite. In 1963, W.R. Grace bought the Zonolite mining operations, operated it, and made a lot of money, frankly, and the mine closed in 1990.

The EPA first visited Libby in 1999. In October 2002, EPA declared it a Superfund site. Cleanup was begun. It was very pervasive, very difficult, and it was a hard time getting the trust between the EPA and the people in the community. A lot of people didn't trust that EPA was doing the right job, not doing it the right way. In fact, I had to get so involved in so many ways in holding EPA's feet to the fire because they weren't doing something such as a base-level study. They didn't know how clean clean was. They did not do a very good job.

A guy named Paul Peronard was the onsite coordinator, who was finally able to convince EPA back in Denver what they had to do. In my personal judgment, they didn't send Paul back because he was doing such a good job. Anyway, cleanup began in 2002, and we still have a long way to go.

For decades, the W.R. Grace operation belched 5,000 pounds of asbestos into the air in and around Libby every day. Deadly asbestos coated the town and its inhabitants. People used raw vermiculite ore or expanded vermiculite to fill their gardens, their driveways, they put the stuff on the high school track, the little league ballfield, and put the stuff up in their attics. It was used everywhere, this stuff. People sort of sensed there was something not quite right with all this vermiculite and asbestos, but it was kind of hard to put your finger on.

One day, I visited Libby, and I will never forget, when I went to the mine, I was stunned to see these miners come off the mine and into their buses. They were caked with dust. I mean, it added new meaning to a dustbin. They were just caked with the stuff on their clothes. They got on the bus, went home.

The one person I talked to and who got me interested in doing something about this--a guy named Les Scramsted--told me, when he got off the bus, he would go home--caked with dust--and embrace his wife, his kids would jump in his lap, and guess what: Les is now dead from asbestos-related vermiculite. His wife is ill, and one of his children has died as a consequence. Think of the pain he went through. He died because of mesothelioma asbestos. Also, even worse, he caused his wife to be ill and caused his son to die because of this disease.

Mine workers brought the dust home with them, as I mentioned, on their clothing. They contaminated their own families without knowing the dust was poison. We knew something was wrong, but we didn't know it was that wrong.

I think the company knew exactly what it was doing. In fact, I might say, the company has been subject to a criminal action against their officers, with allegations the officers knew they were contaminating the people and

didn't disclose it. That suit went on for a year. It is true the officers were acquitted not long ago, but in my personal judgment, it was because of a lousy prosecution. But it is an example where somebody thought--a lot of people thought--not only did the officers of this company contaminate people, but they knew they were contaminating people at Libby, MT.

Asbestos was everywhere in Libby for decades. I must say, W.R. Grace Company sure did not help matters. I might say, parenthetically, this is the same company that is the subject of a book and a movie called ``Civil Action,'' where W.R. Grace contaminated the water in Woburn, MA. In my judgment, they knew what they were doing. It is clear they knew what they were doing. As I recall, a big civil judgment was rendered against W.R. Grace because it was clear they knew what they were doing. They are now bankrupt. W.R. Grace shoved all their assets to another location so the plaintiffs in the suit against W.R. Grace could not attach their assets--and all the shenanigans this company undertook for their own benefit and at the expense of the people in Libby.

The type of asbestos in Libby is particularly deadly, and so many people in Libby are dead, dying, and sick because of this tremolite asbestos, an especially vicious, pernicious form of asbestos. This is not regular asbestos, such as chrysotile, this was tremolite asbestos mined at Libby, MT, where the fibers are deeper and they are stronger. They get in your lungs and they cause more damage and it takes longer to detect. It is that vicious.

The effect on Libby has been severe. Today, we know that nearly 300 residents of Libby have died--300. It is a small town. Thousands more have become sick with asbestos-related disease. That is 291 deaths in a county of 18,000. Lincoln County, MT, home to Libby, has the highest age-adjusted death rate due to asbestosis in the Nation.

Libby is an isolated community with limited access to health care. The median household income in Libby in 2007 was $30,000. When I say ``isolated community with limited access to medical care,'' what do I mean? There is just not that much there. And the company has reneged on its insurance policies. The company had mediocre insurance policies for folks, but as time goes on, the company just backs off--backs off. It is really what is happening in the health care reform here. They rescind--renege on their policies for one reason after another. The poor folks, when they know they have asbestos-related--either cancer or other lung-related disease, they do not have the resources to go to get the medical attention.

I have been at this for years. It is so frustrating, it is so wrong what has happened to the people of Libby, MT.

It is this combination of devastating characteristics that led the EPA Administrator in June to find that the public health emergency does exist at the Libby Superfund site. This finding was based on years of work, having originally been recommended by the EPA in 2001.

I might say, I read the transcripts between EPA Administrators and OMB back in those years. The EPA Administrator under the Republican administration recommended that this action be taken, but it was squelched at the White House by OMB. The correspondence is clear. This is exactly what happened back then in a previous administration. That is why EPA has never used this authority, and the Agency indicates there are currently no sites on the National Priorities List that come close to the conditions at Libby.

It is worth highlighting a few parts of the Administrator's findings. Let me indicate what they are. The Administrator has said:

The Libby Asbestos Site is unique with respect to the

multiplicity of exposure routes [all ways this stuff gets to

them], the cumulative exposures experienced by community

members, and the adverse health effects from asbestos

exposure already present and documented in the residents.

Investigations performed by the Agency for Toxic Substances

and Disease Registry (ATSDR) have found hundreds of cases of

asbestos-related disease in this relatively small community.

ATSDR documented a disease and death rate from asbestosis in

the Libby area significantly higher than the national average

for the period from 1979-1998. The occurrences of disease are

not limited to vermiculite facility workers or their

families, but are spread throughout the population.

This is pervasive in the town--ballfields, tracks, lawns; it is awful.

Medical care in Libby has historically been limited due to

Libby's isolated location and economic situation, thus

reducing the chance of early detection and treatment of

asbestos-related disease.

This piece bears repeating:

Let me refine that point. For a long time, we have been talking to lung specialists across the country about the Libby tremolite asbestos, and we got just so-so responses about how dangerous it was. Why? Because virtually none of those doctors had experience dealing with the pernicious kind of asbestos we have in Libby, MT. It took a long time to get their attention. We finally got some doctors to say this stuff in Libby is wicked stuff. That is why, frankly, EPA has started to understand how bad this really is.

Essentially, the lack of access to health care services in Libby--I will say it again--has actually worsened the effects of this contamination. It just worked to their disadvantage.

The language before us today helps to solve this. It allows us to fulfill the commitment we made to the people of Libby when we passed the Superfund Act 30 years ago. Heaven forbid, if in the future another Superfund site like Libby emerges, the bill before us today will allow the Secretary to use the authorities in this provision to fulfill our commitment to provide health care services for those residents as well.

I can never talk about Libby without remembering my friend Les Skramsted. I mentioned his name a few moments ago. I first met Les in the year 2000 at the home of Gayla Benefield. Les was there, Gayla was there, and lots of other miners were there pleading for help, for some attention: We are dying. Someone pay attention to us. We are a small, isolated community up here in northwestern Montana. Please, someone, pay attention to us.

This did get our attention. I was stunned by the stories they told. I was talking to Les over coffee and huckleberry pie--a very popular pie up in Libby. Les was watching me very closely when I said: You bet, I will help do something about this. He was very wary.

After his neighbors and friends had finished telling me their stories, I will never forget that Les came up to me and said: Senator, a lot of people have come to Libby, and they told us they would help. Then they leave and nothing happens.

He told me, I remember, I think at that instant--you know, in life sometimes you find four, five, six, seven instances, man to man, whatever it takes, you are going to make sure they get justice; whatever it takes, whatever it takes. Such a commitment. That was one. I said to myself: Boy, I am going to do whatever it takes to take care of this because these people of Libby deserve justice. They have not received it.

He said: Senator, I heard you say that, but I will be watching you.

I knew he would watch. I knew that would help. I didn't actually say it because I was going to do it anyway. I accepted Les's offer, and I have a big photograph of Les behind my desk.

Les passed away a couple or 3 years ago. I spent a lot of time with him and his family at the hospital. I have a wonderful picture of Les Skramsted that reminds me what we have to do for the people of Libby but also for all the people in the Nation, people like Les Skramsted. It means that much to me.

I have not forgotten Les. I will not forget Les. That is why this provision is in here. I think Les, right now, up there, may be smiling, saying: Yup, he did not forget Libby, he did not forget Les. That is what this provision is all about.

This is a photograph behind me of Les Skramsted in Libby, MT. He is in a cemetery there, graves of lots of people in Libby who died. Les played a pretty mean guitar. He was a great guy--still is, always will be.

I yield to my colleague from Montana, Senator Tester.

Mr. President, I ask unanimous consent that the Senate proceed en bloc to the following bills: Calendar Nos. 235 through 242; that the bills be read a third time and passed en bloc, the motion to reconsider be laid upon the table, with no intervening action or debate, and that any statements relating to these matters be printed in the Record.

These are post office bills.

I yield 20 minutes to the chairman of the HELP Committee, Senator Harkin, and 18 minutes to the Senator from Colorado, Senator Bennet.

Mr. President, I ask unanimous consent that Daniel Barlava, an intern in Senator Dodd's office, be granted the privilege of the floor for the remainder of today's session.

Madam President, it has been more than a month since the majority leader moved to proceed to the health care bill before us today. This bill will provide real reform for our Nation's flawed health care system. This bill is the product of years of hard work, study, and deliberation in both the Finance Committee and the HELP Committee--and I mean years--all transparent, all aboveboard, all out in the open. In fact, in the Finance Committee, we initiated a new requirement that all amendments to the bill would have to be posted in advance on the Internet so everybody could know what they were, the same with the bill itself. The mark was on the Internet for a couple 3 days before we even went to markup. It is unprecedented how open and transparent the process has been. The same is true in the HELP Committee.

The culmination of these efforts has been the weeks of debate on this bill in the Senate. These provisions have been in the public domain for a long time. It is true there could be minor changes here and there, but most of this has been in the public domain for a long time. We have considered numerous amendments. We have engaged in a full and healthy discussion. The bill before us is fully paid for. It is important to keep reminding colleagues over and over again: This is fully paid for. Don't take my word for it. That is what the CBO said. The American people trust and realize, according to the Congressional Budget Office, a nonpartisan organization, that this bill is fully paid for. It does not add one thin dime to the deficit. You are going to hear others who don't have their own proposals just want to be negative, want to try to shoot holes in this, try to say it adds to the deficit. That is their opinion. That is not the opinion of the CBO. CBO says it does not add one thin dime.

This bill will also reduce the Federal deficit in the short term and over the long term. It reduces the Federal deficit. We are so very concerned about deficits. We in the Congress are and the country is. We have to begin as soon as we can to start getting those deficits down and the national debt lowered. This health care reform bill not only provides health insurance coverage and reforms the insurance industry dramatically, it also takes the steps of lowering the deficit and lowering the long-term debt.

Let me quote from the Congressional Budget Office letter of yesterday:

CBO and [Joint Committee on Taxation] estimate that, on

balance, the direct spending and revenue effects of enacting

the Patient Protection and Affordable Care Act incorporating

the managers' amendment would yield a net reduction in

federal deficits of $132 billion over the [10-year] period.

A net reduction of $132 billion. That is even better than the merged bill was just before we included the managers' amendment. That was a $130 reduction in the national deficit. With the managers' amendment, according to the CBO, there is a net reduction in the Federal deficit of $132 billion over the 10-year period. What about later? Often people say: Gee, I hear you, Senator, you are taking care of things in the short term, but you are enacting legislation that will have an adverse long-term effect. That is what you guys do back there.

You hear that often. Let me disclose what the Congressional Budget Office says about that. This legislation will reduce the deficit markedly in the outyears. Here is what the CBO says in a letter released today:

All told, the [Congressional Budget Office] expects that

the legislation, if enacted, would reduce federal budget

deficits over the decade after 2019 relative to those

projected under current law--with a total effect during that

decade that is in the broad range [of] between one-quarter

and one-half percent of GDP.

What are they saying? They are saying that in the second 10 years, the deficit will be reduced between one-quarter and one-half percent of GDP. That is between $630 billion and $1.3 trillion. That is real money. We are going to reduce the Federal deficit by this legislation alone. Let's take the between $630 billion and $1.3 trillion--roughly, $1 trillion in the next decade. That is important. That is significant. That is a good start.

The legislation before us will extend insurance coverage to more than 30 million Americans. Think of that, 30 million Americans who today do not have insurance will get health insurance. That is so important. I have forgotten the exact figure, but I remember there was a Harvard study that concluded that 45,000 Americans die every year because they have no health insurance. Obviously, people without health insurance die earlier, at an earlier age. Just for the sake of their own health, it is good those people get health insurance, let alone the benefit to hospitals by reducing uncompensated care.

This legislation will increase insurance coverage to more than 30 million Americans. I have just been passed a note that people have a 40-percent higher chance of dying without health insurance. We are saying to those folks, those 31 million Americans, we are going to figure out a way so you have health insurance so you do not have that 40-percent higher risk of death.

Here is what CBO says about coverage:

By 2019, the CBO and [Joint Committee on Taxation] estimate

that the number of nonelderly people who are uninsured will

be reduced by about 31 million.

CBO goes on to say:

Under the legislation, the share of legal nonelderly

residents with insurance coverage would rise from 83 percent

currently to about 94 percent.

That is 94 percent of the folks in our country, excluding seniors, because they have insurance under Medicare, excluding them and excluding the unauthorized, the total number of Americans who have health insurance will rise from the current number of 83 percent to about 94 percent.

This legislation will drive down premium costs for virtually all of us. It will drive down premium costs for virtually all. In an earlier letter, the CBO indicated premiums would go down for roughly 93 percent of Americans under the underlying bill. Premiums would go down about 93 percent for Americans. I was going to put a table in the record, but our rules don't allow us to put tables in, so I summarized. The conclusion of that summary is 93 percent of Americans will experience lower premiums--not dramatic for some folks but nevertheless down, and down is better than not down.

Insurance costs would go down significantly for those receiving tax credits in the new insurance exchanges. It will protect consumers from harmful insurance company practices. This is so important. As you know, no longer will insurance companies be able to deny coverage for those with preexisting conditions. It is an outrage how much insurance companies deny coverage based on preexisting conditions. We all hear stories many times, if not from direct family members, from friends of family who run into this. It is so common, especially in the individual market as people buy insurance for themselves. Insurance companies deny coverage, deny giving health insurance to somebody because of a preexisting condition. It is wrong.

No longer will insurance companies be able to drop coverage for those who are sick. That is very important too. Companies often rescind willy-nilly.

They found something in the background of the person, you didn't tell us about that so we are rescinding your policy. That is not right. That is just not right. We prevent that from happening in this legislation.

It will also improve choice and competition in the insurance market. We talk a lot about choice and competition. This legislation provides more choice in choosing policies and more competition in the insurance market. It will also create a true marketplace where plans compete on cost and quality rather than on their ability to cherry-pick the healthiest among us.

It will represent the largest tax cut for American families that Congress has passed since 2001. This legislation includes the largest tax cut for American families that Congress has passed since that tax cut bill in 2001, the largest. It is the tax credits people will receive to help them buy insurance. That totals up, I think, to $440 billion. I have forgotten the exact figures. But this is the largest tax cut for American families since 2001. It will provide billions of dollars in tax credits to help families, workers, and small businesses to buy quality, affordable health care insurance. The managers' amendment makes this good bill even better. It will provide even more consumer protections against harmful insurance industry practices.

For example, it will hold companies accountable for excessive premium rate increases. It will require them to spend more on consumer benefits and less on administrative costs and profits. That is new. That is even better consumer protection compared with the underlying bill. It will restrict the ability of health plans to impose annual limits on benefits. That is new, restricting the ability of health plans to impose annual limits on benefits. It is wrong if you have an insurance policy that, lo and behold, the company says: We didn't know you were going to be that sick so we stopped the benefits you can get, annually and also lifetime. We do both. We restrict the ability of health plans to impose not only annual limits but also lifetime limits on benefits.

This managers' package will ensure that companies cannot discriminate against children with preexisting conditions and do so right away, beginning with plans that become effective midyear next year. The preexisting condition restriction would ordinarily not take effect for a couple years, but for children the preexisting condition prohibition will take effect right away. There are other provisions to help people between now and 2014. There is high-risk pooling, for example, lots of different provisions in this bill which will help people get good benefits and protection very quickly.

This legislation will provide tax credits to even more small businesses. The managers' amendment will provide even more tax credits than the underlying bill. These benefits will now be available right away, in 2010. It is also a concern when will the tax credits for small business go into effect--shouldn't they go into effect earlier. Under this managers' amendment, these benefits will be available in 2010.

This will also provide more health insurance choices through a new multistate option. That option offers consumers the same health insurance Congress has today--no small matter. It will extend extra funding for the Children's Health Insurance Program for 2 additional years. We are all very concerned about kids' health care. The children's health care program has done a pretty good job. This has been extended, under the managers' amendment, for an additional 2 years. It will do even more to control rising health care costs and reward even more providers for providing quality care to seniors through the Medicare Program. It will invest $10 billion in community health centers. They are so important, community health centers, for folks who need help right away and don't have insurance, just need the care right away. Especially in rural communities, it will provide access to critical care where often that care is most needed.

These are the reforms which Americans have been waiting for, for decades. Americans are waiting for these changes. They are waiting for these reforms and have been for a long time. Decades may be an understatement. Our health insurance system just doesn't do what it should for Americans, the people we represent. Finally, we are taking a very significant first step to providing those reforms. These are reforms American families, workers, and businesses desperately need. They are reforms on which our economic stability depends. That is no small matter either. If we get our insurance costs under control, that is more economic stability for everyone. It is not just for families who don't know what the insurance company is or is not going to do, it is for small businesses that don't know whether premiums will be up or by how much next year. Why? It is more economic stability for families and small businesses and soon more economic stability for budgets, State budgets, our Federal budget.

We need to get a little more control over all the excessive costs that are going up, and also the volatility, the yo-yo effect that premiums have and out-of-pocket cost impositions have on people. This will help them very significantly.

So by and large, to be honest--I know this sounds a little naive, perhaps--I do not know why this bill does not get an overwhelming endorsement. This is a big vote on both sides of the aisle. Then we can, next year, keep going from there; add new provisions that need to be added, correct mistakes that probably this legislation is going to have, but work together because most Americans want us to work together back here. They do not like us being partisan or political.

I must say, this place is getting a little more partisan over the last couple years than it was earlier. It is not what the American people want. They want us to do our job, do what is right. This bill clearly is in the bounds of reasonableness of what is right and what is the right thing to do to get control of our health care system.

Again, I hope we can get this passed by a large margin. It will pass. But I would like it passed by a large margin.

Madam President, I now yield 20 minutes to the Senator from Rhode Island, Mr. Whitehouse.

Mr. President, I yield 15 minutes to the Senator from Oregon.

Mr. President, I wish to thank the Senator from Oregon for many reasons, one of which is his kind words, which are really appreciated but, much more important than that, his long dedication to health care reform. He even worked for the Gray Panthers way back before he came here. I remember the name Ron Wyden, Gray Panthers, a good number of years ago. Then, lo and behold, both Houses of Congress together--we worked together on reforming Medigap coverage. It was an outrage. Today we talk about medical loss ratios of maybe 80 percent, 85 percent, up to 90 percent, and so forth. I can remember back when it was an outrage, the degree to which Medigap insurance coverage had medical loss ratios of not 80 percent, not 70 percent, not 60 percent; it would be below 50 percent. Insurance companies were selling insurance to seniors trying to cover that gap between what Medicare would and would not cover, and just tragically low, embarrassingly low, outrageously low medical loss ratios.

Senator Wyden and I got together and got legislation passed to reform the Medigap market--to make Medigap insurance plans more fair. They were ripping seniors off, there was no doubt about it, and we got that changed.

Now, on health care reform, an ardent advocate of more competition, more choice in our health care system--it is clear we need more competition. It is clear we need more choice. On the competition side, in many of our States we find there is only one or two insurance companies that dominate the entire State. That is very true around our country. There is just not the competition there should be.

In addition, there is not the choice. A lot of employees would like to have more choice among insurance companies in their kinds of policies, and so on and so forth. We have a system where most employees are tied to their employer; it is pretty much insurance coverage the employer offers.

If we were starting from scratch maybe 20, 30, 40, 60, maybe 80 years ago, we may not have had such an employer-based system as we have today. Our current Tax Code also tends to encourage excessive insurance coverage because of our employer-based system.

Anyway, I am digressing. Senator Wyden got us thinking a lot earlier about the problems that caused, and, frankly, I think he is right. I think a lot of Americans think he is right. You can only take things a step at a time here, and we are probably not going nearly as far as the Senator from Oregon wishes to go. But I thank him. He is there, he is dogged, and he works hard on behalf of seniors. He is an advocate of American consumers, respected by health insurance companies, not letting the companies take advantage of citizens. I thank the Senator for that.

I do not see any Senators on the floor on our side. If there were, it would be a good time for them to speak. Pending the arrival of the Democratic Senators, let me say a few things about small business.

Clearly, one of the goals of health care reform is to ensure that employees of small businesses have good, quality, affordable health care options. We all know that is clear. I have talked to small businesspeople.

I will never forget a conversation I had with a logger who has four or five or six people working for him. It was about 2 or 3 years ago. I asked him if he had health insurance. He said, yes, for his family--his wife and himself.

I asked: How about your employees? He said, no; he didn't. You could tell he wanted to, and he wasn't just blowing smoke. He clearly wanted to provide insurance for his employees, but it just pained him because it was too expensive.

We all hear stories like that; they are legion. I can remember talking to another small businessman in my State of Montana, a contractor, who has 5, 6, 8, 10, people working for him. He is just beside himself because the insurance company told him his premiums are going to go up 40 percent next year.

He said: Max, I can't deal with that.

I asked: Why are they going up 40 percent?

He said: Well, they found a preexisting condition with respect to one of my employees. He said: Max, I was beside myself. I can't afford a 40-percent increase. They said it would only be a 20-percent increase if I let him go. But he has been with me 15, 20 years and is one of my best employees. I can't let him go.

He found another carrier and kept his employee. So he did find another insurance carrier, but he had to pay about a 20-percent increase in premiums. He was able to keep his employee, but that is just wrong. It is so hard for small businesses to provide health insurance to their employees. I know it is a trite thing to say, but most jobs in our country are created by small businessmen. That is where most of the jobs are, and it is where most of the creativity is. That is, in many cases, where the greatest need is to help encourage entrepreneurism, American ingenuity, and where a small businessperson can do a good job with the service he is providing.

Last year, 62 percent of small businesses did offer health insurance to their employees. Compare that with other companies that have, say, 200 employees. Among all companies in America that have 200 or more employees, 99 percent of them have offered their employees health insurance. Contrast 62 percent of small businesses offer health insurance and 99 percent of businesses with more than 200 employees offer health insurance.

Among the very small businesses in our country it is lower, lower than 69 percent. Now it is only 49 percent--a very small number of employees--that have health insurance through their small business employer. There are clearly very significant reasons for that. There are barriers that prevent small businesses from finding affordable health insurance options. What are they?

Small businesspeople tell us the main reason--at least one of them-- is that the premiums are just too high. I mentioned an example of the contractor I talked with in my State, who said they are going to charge a 40-percent increase in premiums as further evidence that premiums are too high. It is understandable that is one of the main reasons small businesses can't get health insurance.

In the past 10 years, premiums have risen 82 percent for single workers and 93 percent for families employed by small business-- virtually doubled premiums in the last 10 years if you are a single person and work for a very small business. That is not true for big business.

As health care costs rise, small businesses are forced to make workers pay a greater portion of these expensive premiums. In 2008, for example, employees at small businesses that did provide health insurance paid more than twice what they paid just 8 years earlier-- twice as much.

The low rate of offering and higher cost-sharing responsibilities for employees in small businesses often limit the ability of small businesses to attract and retain employees.

That is why the health care bill before us includes many provisions to make quality coverage for small business more affordable not only for the businesspeople but for their employees. Before the managers' amendment, the bill did include $24 billion in tax credits to help small businesses and charitable organizations purchase health insurance for their employees.

The managers' amendment dedicates additional billions to providing tax credits to small businesses to make health insurance more affordable. The Congressional Budget Office and the Joint Committee on Taxation, which I know is near and dear to the heart of the Presiding Officer--after all, they are an independent arbiter. They can tell us with objectivity what this legislation is or is not--they estimate that the tax credit for small businesses will provide $40 billion in tax relief to small businesses over their first 10 years.

In addition, we start the tax credits a year early; that is, we start them in 2010. In the earlier bill, it was 2011. In the managers' amendment, we start in 2010, right away. This means that in just over a week, after the legislation is passed and signed into law, eligible small businesses will be able to receive tax credits to help them buy health insurance for their employees. This expansion of the tax credits means eligible small businesses will now be able to receive up to 6 years of tax credits. So now starting in 2010, eligible small businesses will receive tax credits worth up to 35 percent of the employer's contribution to employee health insurance plans--35 percent.

Then in 2014, it is even better. Eligible small businesses will receive tax credits worth up to 50 percent of the employer's contribution to employee health insurance plans purchased in health insurance exchanges. The employer would get 50 percent of the cost of the health insurance, that would be available for credit; that is, the employer can credit 50 percent, subtract from his income taxes 50 percent of the cost of insurance.

What do you have to do to qualify? Businesses must cover at least 50 percent of employee premium costs. If you cover half the employee costs, you get to subtract your half from your income taxes. The value tax credit is based on the size of the business and the average wage paid to its employees.

The managers' amendment strengthens the assistance to small businesses by expanding the small business tax credit. In the managers' amendment, the tax credit will be available to small businesses with fewer than 25 employees and less than $50,000 average annual wages. And the full value of the tax credit is now available to small businesses with 10 or fewer employees and $25,000 or less in average annual wages. It moved up from $20,000 to $25,000 so more small businesses can qualify and take advantage of that tax credit. By expanding the wage thresholds, which I just described, more small businesses will be able to claim the tax credits. And tax credits will phase out more slowly as wages increase. This was a high priority for small businesses. We recognized that and responded to it.

The small business tax credit will help make insurance affordable for many small businesses. In 2011, 4.2 million Americans will be covered by quality, affordable health coverage; 4.2 million Americans will be able to take advantage of this. On average, small businesses across the country would receive a new tax credit of about $4,900 to help them purchase insurance. That is per employee, $4,900 to help them purchase insurance for their employees.

The CBO estimates that the small business tax credit will help lower insurance costs by 8 to 11 percent for the employees of small businesses receiving the credit. Let me say that again. CBO estimates that the small business credit will help lower insurance costs by 8 to 11 percent for the employees of small businesses who receive their credit. Without the small business tax credit, many people would have to buy insurance through the exchange on their own without the benefit of a contribution from their employer.

One of the reasons many small businesses are currently unable to afford health insurance is because small businesses lack the buying power larger companies have to negotiate affordable group rates. The Senate bill creates small business insurance exchanges, known as SHOP exchanges, where small businesses can band together and pool their risks, which will enhance their choice and buying power. These State- based exchanges will be a critical tool to help small businesses with fewer than 100 employees shop for health insurance plans and determine their eligibility for tax credits to buy health insurance. Small businesses that prosper and grow beyond 100 employees would be allowed to continue shopping through the exchanges--pooling. The insurance plans sold in SHOP exchanges would be subject to the same transparency requirements and consumer protections, so small businesses can feel confident they are purchasing high-quality plans that will provide quality, affordable coverage for their workers.

The legislation also institutes reforms in the insurance market that will protect individuals and small businesses purchasing plans both inside and outside these SHOP exchanges. These reforms will stop insurance companies from denying coverage based on a person's preexisting health condition or increasing a person's health insurance premiums based on health status or on gender and occupation--a practice that just has to be stopped.

These new regulations are essential to helping small businesses keep health care costs predictable from year to year. That is one of the big problems. Small businesses face this sea of chaos, of volatility, uncertainty, unpredictability in knowing what their insurance costs will or will not be. That is why insurance companies cherry-pick and take advantage for themselves to maximize their profits, but it has the opposite effect on small businesses. This will help, frankly, to buy a lot more certainty that we desperately need.

The changes in the managers' amendment will go the extra step and ensure this bill provides small businesses with the help they so desperately need. Passing health care reform is critical to small businesses. Without reform--this is no small matter; I am not blowing smoke here--without reform, many small businesses will be forced to drop their health insurance coverage they may already have because they can no longer afford it. They cannot afford the increase in premiums. This will leave many employees to fend for themselves in the individual market. We know without this bill passing how unfair the individual market is to people.

Many of the provisions in this bill were designed with small businesses in mind. The bill gives small businesses access to a reformed marketplace where they will have improved buying power to negotiate rates. And the Senate bill provides tax credits to help small businesses buy health insurance for their employees.

Data from CBO tells us that these reforms will make coverage more affordable for millions of small business employees. The small business tax credit will help reduce health care costs for small businesses and their employees. As a result of the larger health reform proposals in the bill, there will be an increase in the percentage of small firms that offer health insurance coverage.

We must act to help small businesses access to quality, affordable health care options for their employees. Too many small businesses around the country are waiting.

Will the Senator yield for one brief minute?

I thank the Senator.

Reserving the right to object.

Reserving the right to object, and I will object, we have been----

I object.

Mr. President, clearly this is a stunt. I object.

Reserving the right to object, this is the fourth time today Senators on the other side----

I object.

For the fifth time, I object.

Will the Senator yield so I can show him?

He doesn't----

For the sixth time we are engaged in this stunt, so I object.

Mr. President, just a couple, three points here, and I see the Senator from Ohio wishes to speak.

Several times during this afternoon, Senators on the other side of the aisle, in my judgment, put on a little demonstration of trying to offer amendments. They repeatedly asked consent to suspend the normal working of the cloture rule to offer amendments. Earlier, I note for the Record, they slow-walked the process when an amendment was in order. They wanted the whole amendment read. And now they are trying to offer amendments, again, to slow down the process. This is clearly a tactic to slow the process. It is not part of the regular order. That is clearly what is going on here. Those were not, despite the protestations to the contrary, serious amendments.

Normally, when a Senator offers a unanimous consent request, they allow the other side to speak briefly on the subject, at least on the reservation of the right to object. That was not allowed here. My colleagues did not allow me that courtesy earlier today, to comment with a reservation of the right to object. So I want to take a moment now to explain what they are really up to. I could not because they would not give me the courtesy to say any words during the reservation. That is why I made that statement.

I heard one Senator from the other side of the aisle complain that the majority is holding tonight's vote at 1 a.m. in the morning on the cloture motion. Let me set the record straight. The majority would be happy to have this vote earlier. We would be happy to have this vote maybe in 10 or 15 minutes from now. We would be happy to have this vote at a decent time. It does not have to be at 1 a.m. tomorrow. It is the other side which is insisting that vote be at 1 a.m. in the morning. So it is they who are insisting on enforcing the letter of the Senate rules. It is their right, but it is also they who are insisting on delay.

I also want to put to bed some of the assertions that they claim this bill does not do real health care reform. Let me mention a few health care reform provisions in this bill.

Mr. President, I do not know if you or any of my colleagues have read this second article in the New Yorker magazine by Atul Gawande. The first article talks about two towns in Texas, basically. The second is basically looking to see whether this bill does reform health care and whether it does cut down health care costs. It is an article I highly recommend to all of my colleagues in a recent issue of the New Yorker magazine.

But, basically, Dr. Gawande concludes this bill includes all of the constructive provisions health care economists, stakeholders, and people who have studied this issue suggest should be part of health care reform. That is his conclusion anyway. I am happy he said that because we worked mightily to make sure we have all the provisions we can here to help constrain health care costs.

What are they? Well, one--although some may disagree with the policy--is an excise tax on high-cost plans, so-called Cadillac plans. It is a bit debatable. Last night I saw a TV ad where a group was advocating passage of this bill: But just not my high-cost plan. Pass the bill, but just not my high-cost plan. I understand the tenor and import of that TV ad, but the main point is, we do have to begin to limit to some degree the excessive cost of some plans, and I think we are very fair and modest here in proposing an excise tax on those high- cost plans. The trick is to set the level at the proper level, not too high, not too low. I think this bill does that.

In addition, all the delivery system reforms this bill enacts with respect to Medicare are so important to improving quality and reducing excess costs. We all know through history that when we reform Medicare and make changes in Medicare, the private sector follows. So the private commercial market will follow whatever Congress does with respect to Medicare; and that is, make good, positive changes. Why? Because Medicare is such a large provider of care, it tends to have a real effect on what other providers do.

What are some of those? Well, basically, we start to change the way we pay doctors and hospitals; that is, we start to pay on the basis of value rather than volume, that is quality rather than quantity. The paradox of that is, when people stop to think about it, we are going to both cut down costs and increase value at the same time because we will be focused on quality. When you focus on quality--not just quantity, not the whole volume of services, but, rather, focus on quality--you are going to get better quality, but your costs are going to go down because you are not reimbursing things such as excessive MRIs, excessive CAT scans, excessive high-cost procedures that do not, in many cases, get to the quality of health care but, rather, are very expensive, and Medicare pays for them. So we are moving more toward reimbursing based on quality and value than quantity.

What else is reform of the health care industry? One is bundled payments and the shared-savings program, which we refer to as accountable care organizations. This allows hospitals and groups to get together to cut down costs. We have bundling in here, which is another idea that moves along the same lines. I might add, too, the CMS Innovation Center and the Independent Payment Advisory Board suggest some of these.

The bill makes it easier for employers to offer workplace wellness programs. We give employers greater flexibility to offer premium discounts for workers who are committed to leading healthier lifestyles. There is a lot of emphasis here on wellness and lifestyles. We give incentives to employers to have wellness programs and preventive programs, which will help, obviously, the worker, but, in addition to that, cut down costs.

There are other provisions here. This bill keeps getting stronger. The so-called freshmen package, led by Senator Warner, will give the Secretary additional authority to expand delivery system reforms. It expands the scope of the Medicare board to the private sector.

There are many other provisions in here.

The Nation's employers, through the leadership of the BRT, played an important role in developing that package.

And the manager's amendment included a provision that will provide greater access to Medicare data to measure performance.

It is no exaggeration to say that this bill will revolutionize health care.

But don't take my word for it. The 23 economists who wrote to the President agree.

Mr. President, I ask unanimous consent that letter from these economists be printed in the Record.

The CMS Actuary agrees that this bill bends the cost curve. The folks at the Commonwealth Fund say the bill will save families $2,000 per year.

Mr. President, I ask unanimous consent that an excerpt from Dr. Gawande's article from the New Yorker be printed in the Record.

Mr. President, the Senator from Oklahoma at one point questioned the constitutionality of the mandate to buy health insurance. I might say, we thoroughly studied this issue. I believe there is ample authority for Congress to enact such a provision under the Commerce Clause, and also under the congressional authority to tax and spend for the general welfare provided for in the Constitution.

I might also add, Prof. Mark Hall of Wake Forest University has done an excellent survey article on this subject. Mr. President, I ask unanimous consent that the conclusion of Professor Hall's article, found at www.oneillinstitute.org, be printed in the Record.

I might also say, Mr. President, the Senator from Oklahoma said the independent Medicare advisory board would ration care. In fact, he even accused us in the Congress--myself included--of voting against a prohibition on rationing. But, I might say, I am not for rationing care in the sense that the Senator from Oklahoma talked about. I do not think anybody in this Congress is. We have to find a system that starts to control costs in a fair way, that increases quality but also cuts costs. That is the underlying premise of the delivery system reforms in this bill. But do not just take my word for it. Right here in the bill, on page 1004, the bill says, with regard to the advisory board:

The proposal shall not include any recommendation to ration

health care.

I chuckle a little bit when I say that because the Senator from Oklahoma is very concerned about using the word ``shall.'' If he does not like ``shall,'' then I suppose he means the board would have discretion. But we say ``shall not include any recommendation to ration health care.'' That is on page 1004 of the bill. It is right there in black and white letters. Read the bill. The prohibition against rationing of health care is right there.

Mr. President, I see the Senator from Ohio, who wishes to speak.

Mr. President, I yield 10 minutes to the Senator from Colorado, Mr. Udall.

Mr. President, I yield 10 minutes to the senior Senator from Michigan.

I yield 10 minutes to the Senator from Illinois.

Will my colleague yield on that point?

I wish to ask my colleague, who knows the Senate procedures so very well, why are we having a 1 a.m. vote? Isn't it possible it could be a different time?

The requests on this side for a vote at a reasonable hour--now it is 10 after 5 say maybe 5, 6, 7, 8 eight clock--a reasonable time, instead of 1 a.m., have been rejected by the other side?

Mr. President, I will be a bit presumptuous here that I can speak for most Senators and probably most of the American people. One thing in life that is so difficult to deal with is when you are working with somebody, irrespective of a situation, and trying to resolve an issue, a problem, and the person you are talking to or working with is not dealing in good faith. When each side is dealing in good faith, then each side will begin to recognize the merits of the other person's point of view and each person tends to recognize the deficiencies and faults of his own point of view. It is a good-faith exchange.

Not very many things in life are black and white and not many issues are black and white. Most of them are some shade of gray. I may think that even though my issues--I am not white and the other guy is black, I like to think my shade of gray is more light than his shade of gray. That is not relevant. What works is when both sides talk to each other and try to make an accommodation.

I think I can safely say most Americans think our health care system needs some repair. It is too costly. There are too many cases when the insurance industry cherry-picks and takes advantage of people. It is not the right thing to do.

Also, we have to find a different way to pay for doctors and hospitals, reimbursing on basic quality, not quantity. Almost all doctors agree we should move in that direction.

A few minutes earlier, one Senator got up and said CBO has made this huge error, a $\1/2\ trillion error. He goes on and on about this $\1/ 2\ trillion error. To be honest, if we are going to deal in good faith, we should mention the pluses and the minuses, and let the Senators and the public figure out where all this nets out.

CBO has made many statements, most of which I think the Democratic side has relied on, and CBO has made statements that the Republican side has relied on. It is not black and white. It is a shade of gray.

In this case, it is true that CBO sent a letter, I think it was today--in fact, I have it here with me--that said they made a $\1/2\ trillion error in the second 10 years. What was the error? I don't remember the exact figure, but essentially I think CBO said this legislation will reduce the debt in the last 10 years by I think it was \1/2\ percent of GDP which comes out to about $1.3 trillion to the good. It reduces the debt by $1.3 trillion.

CBO in a letter to us came back and said they made a mistake. This legislation does reduce the Federal budget deficits over the subsequent 10 years but not by as much. A \1/2\ percent GDP should have been between a \1/4\ percent GDP and \1/2\ percent GDP.

Half the story is CBO said they made an error of \1/2\ percent GDP. But the full story is, still, nevertheless, the Congressional Budget Office says:

All told, CBO expects that the legislation, if enacted,

would reduce federal budget deficits over the decade over

2019 relative to those projected under current law--with the

total effect during that decade that is in a broad range

between one-quarter and one-half percent of GDP.

Essentially, they are saying: We made a mistake at CBO, but still this is going to reduce deficits between $615 billion and, say, $1.3 trillion. That is the full story.

I hope when we debate here that we give both sides of the story. That way we can work more toward common ground what is right. Nobody is totally right. Each of us is here serving in good faith. We want to do what is best for our people in our home States, and we are trying. Different States have different points of view. We are going to get better solutions in health care reform if we talk to each other in good faith and give the whole story, not just part of it.

Mr. President, reserving the right to object, the doughnut hole will be filled. I have made that promise. Senator Reid has made that promise. The White House made that promise. When the bill is presented on the President's desk, the doughnut hole will be filled but not in the way suggested by my friend from Iowa. He is one of my best friends in the Senate, and it is with regret that I must object.

I object.

Mr. President, reserving the right to object, as enticing as that might sound, I object.

I object.

I object.