Floor Statements

Madam President, first, I ask unanimous consent that an article that was discussed earlier and had some objection to it--but that objection has been resolved now--from FactCheck.org be printed in the Record.

Madam President, I yield 5 minutes to the Senator from Maine.

Madam President, how much time do we have?

I ask unanimous consent that the order for the quorum call be rescinded.

That would be fine with me, and I would even allow the Senator from Minnesota to go first. I would use the same amount of time he uses.

Madam President, how much time do I have?

Madam President, the agreement was that whatever time he took, our side would get.

Thank you.

Madam President, the first thing I wish to do is mention that some of these things are facts, particularly if you go to specific situations. In Wyoming, our home health care is a specific situation, and we have had letters pouring in. I have one here from the Home Health Care Alliance of Wyoming, and I ask unanimous consent that it be printed in the Record.

Madam President, the letter says:

Over the past 10 years the Medicare home health benefit has

taken a larger hit in spending reductions than any other

benefit. As home health has become an increasingly important

part of our health system with highly skilled and often

technically complex services that enable millions of senior

citizens and disabled Americans to avoid being hospitalized

or admitted to nursing homes, these home health services save

Medicare millions of dollars each year.

I believe that further reduction in home health payments

will place the quality and availability of home health

services at risk. I urge you to oppose the cut in Medicare

dollars for home health agencies throughout our Nation.

The New York Times today pointed out that in the Reid bill:

Home care would absorb a disproportionate share of cuts. It

currently accounts for 3.7 percent of the Medicare budget,

but would account for 9.4 percent of the cuts in the Senate

bill according to the Congressional Budget Office.

That is from the New York Times.

The last time Congress made similar cuts was in the Balanced Budget Act in 1997 when about 15 percent of home health agencies ended their participation in Medicare. So there is a history on this that shows that if we do what we are talking about doing here, we will put people out of business and we will put an end to services to seniors and the more rural----

Sure.

Reserving the right to object, and I will not, I wish to make a clarification that you wouldn't object to a couple of people without alternating so that we can have a couple of people who also go without alternating. Hopefully, we can make some arrangements on the time. I would like a provision that if one goes longer, the other side can go longer too. With that provision, I have no objection.

Madam President, I yield time to the Senator from Nevada.

Mr. President, reserving the right to object, would it be possible

for the Senator from Arizona to do a 5-minute speech and then the Senator from New Jersey do his speech?

I am willing to let her go as well, and we will make up the time on our side after that.

The Senator from Arizona, the Senator from New Jersey, and then the Senator from Michigan.

Mr. President, I have found this afternoon to be very interesting. We have actually two debates going on at the same time, and sometimes they do not seem very related, but they are.

One of the amendments we are debating is the one authored by the Senator from Arkansas, and it limits the deductible compensation for insurance executives to $400,000. Then we have the Ensign amendment which suggests that we should do the same for lawyers bringing junk lawsuits, although it doesn't go quite as far or is not quite as unreasonable in that it only limits it as a portion of the lawsuit.

Of course, one of the reasons being given on the Senate floor for supporting the amendment of the Senator from Arkansas is that Republicans are funded by insurance companies. Well, I have to object to that kind of wording. We could make a lot of insinuations about who junk lawsuits are being supported by and where the money from those folks goes. The Democrats say: Well, the evidence is that the insurance companies are putting so much money into defeating this piece of legislation. Well, I found out the pharmaceutical industry is now so firmly in the President's camp that it is developing plans to spend $150 million promoting the plan on TV. That certainly makes me kind of curious as to why the Arkansas Senator did not include executives of pharmacy companies in her piece of legislation.

Mr. President, I don't begrudge anybody anything that they make, but I do find it interesting that the CEO of Abbott Laboratories makes $28 million, the Allergan CEO makes $14 million, the CEO of Bristol-Myers Squibb makes $23 million, the CEO of Eli Lilly makes $12 million, the CEO of Johnson and Johnson makes $29 million--the Senator from New Jersey was mentioning these things, so I checked--and the CEO of Merck, which is New Jersey based, makes $25 million; the CEO of Pfizer, $15 million; Schering-Plough, $18 million; Valeant Pharmaceuticals, their CEO makes $20 million; and Wyeth Pharmaceuticals' CEO makes $25 million.

Why would we want to leave these people out of the same formula? Is it because they are taking the side of passing the bill as opposed to the side of opposing the bill and informing the people? We ought not to be about that sort of thing.

Mr. President, I ask unanimous consent to have printed in the Record an article from CBS News titled, ``White House & Big Pharma: What's the Deal?''

Mr. President, I am sorry the Senator from Minnesota finished his presiding in the Chair. I will still address the question to him--I did not expect him to give me an answer at the moment anyway--because he said there was a 428-percent increase in profits for the insurance companies. I didn't quite get what the dates were, but he was talking percentages. As the accountant, I like to talk dollars. I would like to know what those dollars were from that first year to the final year because, for example, if a person makes $1 in the first year and in the last year cited they make $5.28, that is a 428-percent increase. If you start with the low number of zero, you can have an unlimited--or infinity--increase in whatever year you pick after that, if they even make a penny. So percentages can give some bad numbers.

Also, the Senator from New Jersey was talking about administrative costs, and so was the Senator from Minnesota. I would like to get the figures from Minnesota to see how that is working--to have a limitation of 91 percent of all insurance money going to evidently pay claims-- because I am not aware of the administrative costs being quite that low in almost any business. Again, as the accountant, I find that most people--and when I say most people, I would include my colleagues-- think most businesses are pretty simple. But when I visit one of those businesses, and I learn a little about it, I find that when I scratch the surface, there is a lot going on that the average person out there couldn't handle.

Some of that shows up in the legislation that we do. For instance, Cash for Clunkers. That was supposed to be a 4-month program. We ran out of money in 4 days. That shows how much we knew about the car business.

So when we are talking about these different things, I got involved with some of these administrative costs when I was working on health plans. I did small business health plans, and that is something that has been rattling around here for about 12 years. It still is, and now it is 15 years. Now, how that works is that it allows small businesses, through their associations, to group together to form a big enough pool so that they can effectively lobby against insurance companies or negotiate with providers. They can make these associations across State lines, even make them nationwide if that will work better.

Presently, they have to do it within their own State. That is the law that we have set up. But I found an example of one in Ohio that is very successful. It works well. That is kind of how I modeled my small business health plan. When I did small business health plans, I was taking on the insurance companies. They were pretty upset that I was doing anything in that area, and they joined with some other people to keep me from getting cloture on the motion to proceed to the debate on that. So I know how tough health care is to move along.

But Ohio has that association within its State boundaries, and it works because they have a huge population. We have less than 500,000 people who live in Wyoming, and so if you break that down by associations, it would be small pools, and you don't get the actuarial value out of it that you would if you go to a big population. But in Ohio they can do it within the State, and in Ohio they did do it within the State. It brought down the cost of health insurance. It brought down the cost.

Now, not only that, the biggest savings was actually in administrative costs. It costs a lot more to keep track of all of the claims and everything from a small business than it does from a big business. The bigger the pool, again, the more capable you are of handling unusual situations. But administrative costs came down from 37 percent to 12 percent, which is a 25 percent savings. Every business would like to have that. But that is how much it costs to administer small ones, so that is why they wanted to group together to form associations to form this bigger pool, which we haven't been able to do.

I would ask the Chair how much time I have remaining?

I do want to make some quick comments about the junk lawsuits. We do have to do something about that. When I am talking about junk lawsuits, I am talking about a bunch of them being filed these days that are $25,000, $45,000, $95,000, or whatever is less than what it would cost to defend that lawsuit because if it is less than what it would cost to do the lawsuit, the insurance company is going to say: Let's just pay them and we will be saving money. It is bad precedent and it leads to more junk lawsuits being filed.

It is interesting to note that both lawyers who are with the insurance companies and lawyers who are with the people who have been harmed don't want to have tort reform. That kind of surprised me. Then I thought: Well, they probably learned a lot of this in law school. In law school they probably are taught how important it is to somebody's retirement. Then I remembered the Old West and the story about how when one lawyer comes to town, he is broke. But if they can get two, they can both make a good living. It does take lawyers on both sides working these lawsuits, and it does amount to a lot of money.

So we do have to do something, particularly in the medical area, because we could save $45 billion a year if we were to have something done about junk lawsuits, particularly with OB-GYNs. We are losing all of them in Wyoming, and it is because there is such a long tail on it. Somebody can sue for 18 years after they are born. So the OB-GYNs have to pay a lot longer insurance tail than that.

We had one dramatic case of a doctor attending a basketball game in Douglas. The reason he chose to announce his retirement is because he couldn't afford the insurance he had to pay. The reason he did is because he had birthed almost every kid on both teams. So the mothers there don't have OB-GYN help as a result of his retirement, simply because of what it cost him for insurance.

I thank the Chair, and I yield the floor.

Yes, Mr. President, I wish to speak.

Mr. President, it is my understanding that I would be in charge of the next 30 minutes and then it would revert to the other side for 30 minutes after that.

It is also my understanding that at any time there is an agreement to vote, we will cancel out what we are doing. But there is no agreement yet.

I thank the Senator from Connecticut for setting up my speech so well. He said there was not anyplace that anybody can show any decline in guaranteed benefits. With what I am about to say, I will try to do that. Of course, the words ``guaranteed benefits'' do not show up anywhere in what we are doing. ``Benefits'' does but not ``guaranteed benefits.'' In my opinion, getting to be in a nursing home or being able to see a doctor, some of those ought to be considered guaranteed benefits. I will get into that a little bit in my speech and cover some of these areas that I think are very important to seniors. I am opposed to the $\1/2\ trillion of Medicare cuts in the Reid bill that are not going only to solve Medicare.

Some of my Democratic colleagues have attempted to argue this bill does not cut the Medicare Program. They further said that such cuts are justified and will not harm the program. They have also argued that no beneficiaries will lose their benefits--their guaranteed benefits. They are very careful on that, and I understand why they are careful on that because there are other benefits that are being cut that will be considered by those people who will lose that benefit to be a guaranteed benefit.

Unfortunately, all of those statements are false. It does not matter how many times my colleagues repeat these claims, they do not become any more accurate. This bill cuts $464 billion from the Medicare Program. It slashes payments to hospitals, nursing homes, home health agencies, and hospices. These are cuts to the Medicare Program, and I even have the page numbers on those.

The moneys from these cuts do not go to shore up Medicare. The money goes to new programs for others. These cuts will affect the care provided to Medicare beneficiaries.

The American Health Care Association, which represents nursing homes, said the cuts in the Reid bill would force layoffs, lower salaries, reduce benefits, and ultimately would hurt patients' quality of care. A commission was set up to make even more cuts to save Medicare. It is in the bill. There is a commission in there.

So with the side deals that have been made with lobbyists, the only place these cuts can come from is from seniors. I will cover that in a little more detail later. I have heard similar statements from home health providers, that is more than $40 billion in cuts; hospice providers, which is $8 billion in cuts; and hospitals, which is $130 billion in cuts. If these Medicare cuts go into effect, it could drive many providers out of the Medicare Program. That will mean patients do not have the care they expect and they need.

Some of my Democratic colleagues have accused us of trying to scare Medicare beneficiaries. If seniors are scared by our statements, they should be terrified by what the administration has to say about the Democrats' health reform bill. The administration's own chief actuary, Richard Foster, recently wrote that the steep Medicare cuts in the House-passed health reform bill would make it difficult for many providers to remain profitable and cause them to end their participation in Medicare. He went on to note this could jeopardize Medicare beneficiaries' access to care.

As the senior Senator from Tennessee noted yesterday, it is the Medicare cuts in the Reid bill that are actually scaring seniors. Medicare beneficiaries understand that if providers are no longer able to take Medicare patients, they--the seniors--will not get care. A lot of grandmas and grandpas have figured it out, and they are not going to stand for it.

The chairman of the Finance Committee has repeatedly said this bill will not cut or reduce any guaranteed Medicare benefit. That statement seems to ignore what this bill will do to providers. If a Medicare patient cannot get into a nursing home, they do not have nursing home benefits. If they can't find a home health aide willing to take Medicare patients, they do not have home health benefits. So the promise for coverage, when you can't get a doctor to see you, is not health care. You don't have benefits if you can't get a provider to treat you. Unfortunately, that is exactly what this bill will do.

Some of my Democratic colleagues have also attempted to justify the Medicare cuts in the Reid bill by arguing that many of the trade associations

representing health care providers have endorsed this bill. They are correct that several Washington-based trade associations and their lobbyists have endorsed the Reid bill. It is probably worth exploring why some of the groups have chosen to endorse this legislation.

In some cases, motivation is obvious. Some drug manufacturers are clearly motivated by self-interest and greed. They negotiated a secret deal with the White House that will actually increase what Medicare spends on brand-name drugs--brand-name drugs. They didn't touch the generics. They are interested in the brand-name drugs.

Under the terms of their deal, the drug manufacturers will provide discounts on brand-name prescription drugs when the seniors are in the Medicare coverage gap--known as the doughnut hole. They make the payments directly to the customer. It doesn't go through Medicare but directly to the customer. That way they can maintain the customer contact and keep them addicted to the brand name.

Generics are cheaper. A lot of people, when they go to the doughnut hole, switch to generics because that saves them money, and it saves us money. When they get through the doughnut hole, they will stay with whatever they are on while in the doughnut hole. So if they are forced to stay on a brand name to get a little extra discount as they go through the doughnut hole, they will stay with the brand name when the taxpayers are paying for it when it goes above the doughnut hole, which is the rest of the year. That could be a huge number. So while it looks generous by the drug companies, beware; their generosity is suspect with what they will make when it gets through the doughnut hole.

Under the terms of the sweetheart deal between the White House and the drugmakers, discounts are provided for these brand-name drugs. This will encourage seniors to continue to get those more expensive drugs, and it will actually cost the taxpayers $15 billion because the deal will actually increase Medicare costs.

In other cases, provider groups were promised special deals if they agreed to support the Reid bill--or whatever bill we were working on at that time. For instance, recent press reports have described how the American Medical Association was promised a permanent fix to the Medicare payment formula for doctors if they agreed to support this bill or a 1-year fix if there was an end to junk lawsuits. Under current law, doctors' Medicare payments are scheduled to be cut by more than 40 percent over the next decade. That is already in place. That is not a part of the bill. The cost of fixing the flawed government- mandated formula will be more than $250 billion. We know that because we have debated it on the Senate floor, and we decided we were going to have to pay for that if we were going to do it.

So let's see, $464 billion in Medicare money we are using on other things. That is why I keep saying Medicare money only ought to go to Medicare benefits, and that $250 billion for the doctors' fix might make it possible for people to see the doctors.

I can understand why doctors want to fix this flawed government price-control system--and that is what it is because they are telling the doctors what they can charge a customer, regardless of how long a time it is going to take them to take care of that patient. For a lot of them, they have discovered it costs more than what they are able to get. If they continue to do that, they have to go out of business. That is kind of the small business philosophy: You take in less money than what it costs to be in business, and you are out of business. So I don't think they like that kind of a government price-control system.

As a result, 40 percent of the doctors will not take a patient on Medicaid, and it is growing in percentage now on Medicare in the same way. When you fix the price, some people can't afford to provide it for that, so they can't take those patients.

I was talking to a friend of mine from Florida who said: Every time you call a doctor now, they say: Are you on Medicare? If you say yes, they say: We are not taking any new patients.

If you can't see a doctor, you don't have a benefit. It shows the exact problems that result from letting government bureaucrats use price controls to set payment rates. What I don't understand is why the AMA continues to support the bill when they got nothing for their deal. We didn't fix the $250 billion problem, and we haven't fixed the junk lawsuit problem.

I remember the President appearing at the National Convention of the American Medical Association and promising that there would be tort reform; that there would be an end to these junk lawsuits. All of our attempts, either in the HELP Committee or in the Finance Committee, to even bring that up have been either voted down or denied. As a result, there is nothing in this bill that is going to solve that problem. The bill does nothing to fix the Medicare payment formula for the doctors. Instead, it cuts $464 billion from Medicare and uses that money to cover the uninsured.

Even if these cuts can be made without hurting seniors, the Republicans are saying: Use the money only for Medicare. Medicare money for Medicare. Medicare funds should be used to fix Medicare's problems, such as this flawed payment formula that keeps doctors from taking seniors. Taking hundreds of billions of dollars out of the Medicare Program now will only guarantee that it will be much harder to permanently fix the doctor payment issue in the future.

I cannot understand why the AMA continues to support this terrible deal for doctors. If you can't see a doctor, your benefits--your guaranteed benefits--have been cut. Apparently, the members of the AMA don't like the deal either. At a recent convention, up to 40 percent of the current membership of the AMA voted to reject this deal. I know that is not a majority, but most associations survive by consensus agreements. That means almost all of their membership agrees with the tack they are taking, not just slightly more than half. Their membership is less than 20 percent of all doctors. It is a dwindling association.

Let's see, less than 20 percent of the doctors had 40 percent that opposed it. We are getting down to some pretty small percentages of those who supported what the AMA did in their deal.

Finally, many provider groups have been reluctant to speak out against this bill because they have received threats from the White House and congressional Democrats. Nursing homes, home health agencies, and hospice providers have all reportedly been threatened with further cuts--further cuts--if they speak out against the bill. Is that freedom of speech, or is it just bad ethics? They have reportedly been told that any public statements of opposition to the Reid bill will lead to even more severe cuts.

These providers have had to make the choice to silently accept devastating cuts rather than oppose them and risk being utterly destroyed. One of the Medicare Advantage providers is Humana, and I will use them as an example. CMS said they couldn't let their customers know what was about to happen, and chastised them for sending out a letter. I thought the customer deserved to know and that we were in a new era of transparency. That doesn't sound very transparent to me. So how can that happen in America?

At any rate, I hope my colleagues and the American people will take these facts into account when they hear Senators talk about provider groups supporting this bill. Unfortunately, health care provider support for this bill is being driven primarily by greed or stupidity or fear. We know this bill will not fix the problems in the American health care system. It will not lower health care costs. It will not lower insurance premiums. It will still leave 25 million people uninsured.

What this bill will do is spend $2.5 trillion and guarantee a much bigger role for the government in dictating how health care will be provided in this country. If you are not under Medicare, yes, your government is going to tell you what is adequate coverage, and they are going to force you to buy it or pay a penalty.

Given the recent experiences that doctors have had with Medicare price controls, this is not an outcome that bodes well for America's health care providers or their patients. I remind everybody that in August there was an uproar, and that uproar continues. We don't notice it as much because we are not going to get to go home this weekend to talk to our constituents. That

might be by design because we already know what our constituents are saying.

They are saying: This bill is a bad deal for us. Where is the promise that you were going to cut costs for us? Where are the other promises that were made with this health care reform?

I would mention that the CBO found that premiums in the individual market will rise by 10 to 13 percent more than if Congress did nothing. That is CBO. Family policies under the status quo are projected to cost $13,100 on the average, but under this health care bill it should jump to $15,200. That is not very good news for the people in my State or any other State. No big cost rise in U.S. premiums is seen in the study, said the New York Times.

The Washington Post declared: Senate health bill gets a boost. The White House crowed that the CBO report was more good news about what reform will mean for families struggling to keep up with skyrocketing premiums under the broken status quo. The Finance chairman, the Senator from Montana, chimed in from the Senate floor that health care reform was fundamentally about lowering health care costs.

Yes, lowering costs is what health care reform is designed to do-- lowering costs.

But then he said: And it will achieve this objective. Except that it won't.

CBO says it expects employer-sponsored insurance costs to remain roughly in line with the status quo. That is the failure of this bill. Meanwhile, fixing the individual market is expensive and unstable, largely because it does not enjoy the favorable tax treatment given to job-based coverage. You know, if you are buying insurance on your own, you are not getting a tax break on it. If companies buy insurance for the people working for them, they are getting a tax break.

In my 10 steps to solving health care, I mentioned and worked on making that fair. You have to be fair for both sides.

The Wyden-Bennett bill concentrates on making it fair for both sides. That is one of the issues people in this country are concerned about, making it fair for both sides. This bill doesn't make it fair for both sides.

Talking about fixing the individual market, that is expensive and it is largely unstable, I will say again, due to the favorable tax treatment given to job-based coverage which was supposed to be the purpose of reform. But CBO is confirming that new coverage mandates will drive premiums higher.

Democrats are declaring victory, claiming these high insurance prices don't count because they will be offset by new government subsidies. About 57 percent of the people who buy insurance through the bill's new exchanges that will supplant today's individual market will qualify for subsidies that cover about two-thirds of the total premium so the bill will increase cost but then disguise those costs by transferring them to taxpayers from individuals. Higher costs can be conjured away because they are suddenly on the government balance sheet.

The Reid bill has $371.9 billion in new health taxes that are apparently not a new cost because they would be passed along to consumers. Or perhaps they will be hidden in lost wages. This is the paleoliberal school of brute force wealth, redistribution and a very long way from the repeated White House claims that reform is all about bending the cost curve. The only thing being bent here is the budget truth.

Moreover, CBO is almost certainly underestimating the cost increases. Based on its county-by-county actuarial data, the insurer WellPoint has calculated that this bill will cause some premiums to triple in the individual market. I don't go by WellPoint, I go by what I found out in Wyoming itself and that is an accurate picture, particularly for the young people in our State. Those who are young and healthy will see a 300-percent increase. I think they are going to notice that. I don't think they are going to be happy with it. Other associations have come to similar conclusions. The reason for that is the community rating, which forces insurers to charge nearly uniform rates regardless of customer health status or habits. Habits is an important one on that. CBO does not think this will have much of an effect, but costs inevitably rise when insurers are not allowed to price based on risk. That is why today some 35 States impose no limits on premium variation and 6 allow wide differences among consumers.

That is not just WellPoint that is saying that. I have some peer- reviewed documents that also show that same thing from people from different colleges. They have found that the State community rating laws raise premiums in the individual market by 21 percent to 33 percent for families and 10 to 17 percent for singles. In New Jersey, which also requires the insurers to accept all comers, so-called guaranteed issue, premiums increased by as much as 227 percent.

Let's see, we just had some elections in New Jersey and things didn't go well there. It probably wasn't just tied to insurance costs.

The political tragedy is that there are plenty of reform alternatives that would reduce the cost of insurance. According to CBO, according to the Congressional Budget Office which we quote a lot, they did an evaluation on the relatively modest House GOP bill. The Republicans in the House were limited to one amendment. There were three amendments total in a 1-day debate and passage of the health care bill over there. That roused a lot of people in America, too. If you only get one amendment, they had to do what we have avoided doing. We have four different bills out there that solve what the President said he wanted solved. That is not counting the Wyden-Bennett bill that also solves what the President said, that is not included in this bill.

What the House put together--it is relatively modest, but it would actually reduce premiums by 5 percent to 8 percent in the individual market in 2016 and by 7 to 10 percent for small businesses. It would not increase the premiums, it would decrease the premiums.

The GOP reforms would also do so without imposing huge new taxes. We have concentrated in the last few days about talking about the Medicare money that is being stolen to provide for the changes. We have not talked yet about the extra taxes that are going to be put into place. That is the other half of the package. But the Democrats do not care because this bill, they say, is about lowering costs. No, it is about putting Washington in charge of health insurance at any cost.

I see the Senator from Wyoming is here. We have 10 minutes remaining on our time. If the Senator wishes to make some additional comments? He and I have been traveling in Wyoming.

I yield the time to my colleague.

That is the way I read it. That is the way the people in Wyoming are reading it and that is apparently the way people all over the country are reading it, particularly seniors. Seniors are the ones upset about what is happening and it is easy to see why. Even though the AARP says this is a good bill, they are saying: Wait a minute. I know people in the nursing home. I know people--some of them are saying I am in the nursing home. I am hearing what is going to happen at my nursing home if these cuts go into place.

As I said continually, we can call them anything we want but the seniors are saying those are cuts. Those are cuts in my benefits. Those are cuts in what I expect. Those are cuts in what I have been getting. Whether you call it guaranteed benefit or just plain old

benefits or whatever it is, they are saying, yes, we are being cut.

The Senator from Wyoming is absolutely correct. We are getting a lot of calls and mail, letters about that. Another thing the President promised, of course, is that everybody would have catastrophic coverage. It fascinates me that the Wyoming people and the people across America have figured out that Medicare doesn't have catastrophic coverage. But Medicare Advantage provides catastrophic coverage as well as a number of other things that Medicare does not cover. I think they realize, too, that if Medicare Advantage goes away, yes, they can get Medigap but Medigap is more expensive. It is also interesting that the AARP sells Medigap.

I am seeing what you are seeing. I am noticing some people do not know what an entitlement actually is. That is a bill that goes on forever, that the Secretary of Health and Human Services has to make sure that it is paid in perpetuity unless there is some other major Congressional action that happens. We keep paying that bill over and over again. I think the Senator from Wyoming recognizes entitlements and some of the difficulties involved with that.

We are being notified our time is up. We will continue. I have several letters from Wyoming organizations that I want to have printed in the Record, and I will do that at a later time.

I thank the Chair and yield the floor.

I appreciate the comments, some of which need correction, from yesterday and those that have just been made.

On a partisan bill, I sat through all of those days in the HELP Committee. That bill was rushed and put together. Senator Kennedy was not able to be involved in that part of it. His staff did it. They did it in a hurry. We turned in 159 amendments that were accepted. Most of those were for typos and minor corrections. There were a few that actually had some substance to them. That bill was passed on July 15 out of committee without a single Republican vote. It wasn't published. We didn't see the final version until September 17. The ones that were really something that could have made a difference were taken out without the permission of any Republican Senator. That is not bipartisan.

We talked about how many hours we spent together. If you don't accept things from the minority party, it is not bipartisan. It is still partisan. Just spending hours doesn't make any difference.

To move on to a different topic, yesterday we were talking about costs. I hope the people take a look at a Wall Street Journal article from yesterday that says:

A bill that raises prices but lowers costs, and other

miracles.

We heard all day yesterday that this bill is going to save people a lot of money. This article reads:

We have now reached the stage of the health-care debate

when all that matters is getting a bill passed, so all news

is good news, more subsidies mean lower deficits, and more

expensive insurance is really cheaper insurance. The

nonpolitical mind reels.

Consider how Washington received the Congressional Budget

Office's study Monday of how Harry Reid's Senate bill will

affect insurance costs, which by any rational measure ought

to have been a disaster for the bill.

CBO found that premiums in the individual market will rise

by 10% to 13% more than if Congress did nothing. Family

policies under the status quo are projected to cost $13,100

on average, but under ObamaCare will jump to $15,200.

Fabulous news! ``No Big Cost Rise in U.S. Premiums Is Seen in

Study,'' said the New York Times, while the Washington Post

declared, ``Senate Health Bill Gets a Boost.'' The White

House crowed that the CBO report was ``more good news about

what reform will mean for families struggling to keep up with

skyrocketing premiums under the broken status quo.'' Finance

Chairman Max Baucus chimed in from the Senate floor that

``Health-care reform is fundamentally about lower health-care

costs. Lowering costs is what health-care reform is designed

to do, lowering costs; and it will achieve this objective.''

Except it won't. CBO says it expects employer-sponsored

insurance costs to remain roughly in line with the status

quo, yet even this is a failure by Mr. Baucus's and the White

House's own standards.

Meanwhile, fixing the individual market--which is expensive

and unstable largely because it does not enjoy the favorable

tax treatment given to job-based coverage--was supposed to be

the whole purpose of ``reform.'' Instead, CBO is confirming

that new coverage mandates will drive premiums higher. But

Democrats are declaring victory, claiming that these higher

insurance prices don't count because they will be offset by

new government subsidies.

About 57% of the people who buy insurance through the

bill's new ``exchanges'' that will supplant today's

individual market will qualify for subsidies that cover about

two-thirds of the total premium. So the bill will increase

costs but it will then disguise those costs by transferring

them to taxpayers from individuals. Higher costs can be

conjured away because they're suddenly on the government

balance sheet. The Reid bill's $371.9 billion in new health

taxes are also apparently not a new cost because they can be

passed along to consumers, or perhaps will be hidden in lost

wages. This is the paleo-

liberal school of brute-force wealth redistribution, and a

very long way from the repeated White House claims that

reform is all about ``bending the cost curve.'' The only

thing being bent here is the budget truth.

Moreover, CBO is almost certainly underestimating the cost

increases. Based on its county-by-county actuarial data, the

insurer WellPoint has calculated that Mr. Baucus's bill would

cause some premiums to triple in the individual market. The

Blue Cross Blue Shield Association came to similar

conclusions. One reason is community rating, which forces

insurers to charge nearly uniform rates regardless of

customer health status or habits. CBO doesn't think this will

have much of an effect, but costs inevitably rise when

insurers aren't allowed to price based on risk. This is why

today some 35 states impose no limits on premium variation

and six allow wide differences among consumers.

The White House decided to shoot messengers like WellPoint

to avoid rebutting their message. But Amanda Kowalski of MIT,

William Congdon of the Brookings Institution and Mark

Showalter of Brigham Young have found similar results. In a

2008 paper in the peer-reviewed Forum for Health Economics

and Policy, these economists found that state community

rating laws raise premiums in the individual market by 20.9%

to 33.1% for families and 10.2% to 17.1% for singles. In New

Jersey, which also requires insurers to accept all comers

(so-called guaranteed issue), premiums increased by as much

as 227%.

The political tragedy is that there are plenty of reform

alternatives that really would reduce the cost of insurance.

According to CBO, the relatively modest House GOP bill would

actually reduce premiums by 5% to 8% in the individual market

in 2016, and by 7% to 10% for small businesses. The GOP

reforms would also do so without imposing huge new taxes. But

Democrats don't care because their bill isn't really about

``lowering costs.'' It's about putting Washington in charge

of health insurance, at any cost.

That is our understanding as well.

That was an editorial by the Wall Street Journal, the staff of the Wall Street Journal, confirmed by MIT, Brigham Young, and others.

Madam President, I yield 10 minutes to the Senator from Florida.

Madam President, I yield 10 minutes to the Senator from South Dakota.

Madam President, I yield 5 minutes to the Senator from Oklahoma.

Madam President, I yield 5 minutes to the Senator from Texas.

Madam President, I yield 2 minutes to the Senator from Kansas.

Mr. President, I yield 10 minutes to the Senator from Alaska so she can actually propose her amendment that we have been debating and take up to 10 minutes.

That would still leave us with 2 minutes. If it does leave us with 2 minutes, then I would have the Senator from Wyoming use that 2 minutes.

I will yield our final minute to the Senator from Wyoming.

Mr. President, I wish to raise a point as the accountant around here. You have mentioned some ways to cut Medicare to pay for this. Actually there are only two ways you can pay for a government program. You have to do it through cuts or through taxes. I don't think there is anybody in America who believes you can do $1 trillion worth of new programs and have them all paid for, unless you steal somewhere. That is what we are doing from Medicare. We say that is not going to affect Medicare. If you eliminate the DSH payments which are part of this, it is going to put some Wyoming hospitals out of business. I can assure you that if those seniors can't go to a hospital in their town, they are going to consider that a benefit cut. They are going to be upset, and they ought to be.

The same with nursing homes. If you cut back on nursing homes, the people who have to move to another town for a nursing home--because all of our towns don't have more than one nursing home--puts quite a burden not only on the patient who isn't going to get to see their family as much, but also on the family who has to travel a long way to see the patient. So I don't think we ought to be paying for the new programs by doing this when Medicare needs an extended life.

I am always fascinated when they explain that this will extend the life of Medicare because, yes, if you cut payments to everybody, that maybe saves money and extends the life of it, if we did that. Is there anybody who thinks we are going to cut the doctors over the next 10 years by $250 billion? No, we are not going to do that. We never have.

Yes.

Mr. President, I wish to ask the Senator from Idaho what he thinks will happen with these Medicare cuts as they affect jobs and the economy. That is one of the biggest things on people's minds right now, jobs and the economy. We are concentrating on something here where we are going to maybe make a difference, even though CBO says it won't be much of a difference.

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

Mr. President, first, I wish to thank the Senator from Alaska for the tremendous work she has done on this issue and for the dozens of people she has talked to over the last couple days to try to come up with an amendment that would actually solve the problem everybody has been talking about.

I appreciate the Senator from Maryland recognizing this major flaw in the bill, and it is in the bill. The U.S. Preventive Services Task Force is in the bill. That is exactly the group that specified this new policy on mammograms that has upset people all across the country. It upset everybody so much that we have an amendment on the floor by the Senator from Maryland reacting to that and reacting to the fact that it is in the bill at the current time.

So I appreciate the Senator from Alaska coming up with a plan that actually is more comprehensive than the amendment from the Senator from Maryland because the Senator has had a little bit longer to work on it. I appreciate the words the Senator has in there that ``you cannot deny.'' The Senator is on the Health, Education, Labor, and Pensions Committee with me, and I know we have worked on this issue in committee. I hoped this kind of a realization would have been made at that time. We had some amendments where you could not deny based on this or the comparative effectiveness or could not prohibit based on it. We know all those amendments failed, meaning there was probably some intention to deny or to prohibit based on these groups.

So I appreciate the Senator bringing up the fact that it is the caregivers who will have some say in this so Washington cannot come between you and your doctor. I wish the Senator would go into a little bit of some of her background from Alaska because the Senator and Alaska have been very involved in breast cancer for a long time, and people ought to be aware of the kind of services that are available out there and what the costs of those services are.

Mr. President, I know there is not any word that probably turns a family upside down as much as the word ``cancer,'' and it does not matter which form of cancer it is. It is just drastic because we do not know all the implications of it. Maybe someday we will. Maybe someday we will know how people get it, and we will be able to cure it with a vaccine. But, so far, what we have are some mechanisms for putting it into remission.

One of the reasons I know how upsetting that is and how it turns the world upside down is, 3\1/2\, 3\3/4\ years ago my wife was diagnosed with colon cancer. She had screenings, but she listened to her body. She said: Something is the matter here. She kept going to doctors. So even if they do not recommend the screenings, if your body is saying something is the matter, pursue it until you are either convinced nothing is the matter or a doctor finds what is the matter. That is the advice she gives to everybody. These are things that need to be between the patient and the doctor.

Now that she is in remission, one of the things the doctor recommended was that she take Celebrex. That is something normally for arthritic pain, but what they found was in some patients that will keep polyps from growing that will turn into cancer in the colon, and we definitely do not want that to recur again. So she is taking that. But it is a constant fight with making sure that is an approved medication and that it can be done and that it will be paid for.

If that were just a task force recommendation--first of all, since she had the screening, they would say she does not have a problem and, later, she would die from it. But she was able to listen to her body, get the treatment she needed, and now is continuing to get the treatment without a task force saying: No, 99 percent of the people do not need that. Her doctor and she are able to determine what she needs.

On other screenings, once you have cancer, there are other times you need to have MRIs, other kinds of tests run. That, again, has to be up to the doctor and the patient to determine how often those are needed. Again, I know from talking to a number of people whom I know--not just ladies either--who have had cancer, once you have had cancer and you are in remission, you would actually prefer to have your screening a little bit earlier for the mental reassurance you get with it.

Again, from talking to people--and we have talked to more now because we are trying to give some reassurances to them when this terrible word comes up--when they go to the doctor, one of the first things that happens is they weigh in, they take your blood pressure. When you are waiting for a decision on how the blood test you got turned out or the MRI you got turned out or whatever it was, that blood pressure goes through the roof. Quite frequently, you cannot leave the doctor's office until you have--you went there for the information, so, of course, you stay for the information, but they will not let you leave until they do the blood pressure test again, to make sure it goes down below the critical stage. That is how much impact this has on people.

So I am glad the Senator did something that goes a little bit further, covers a few more things, and makes sure people have access to their doctor, to the tests they need, and not to be relying on some government bureaucracy to say: Well, in 99 percent of the cases or 85 percent of the cases--who knows how far down they will take it, depending on what the costs are. We do not want that to happen.

I think the Senator's amendment allows patients to get these preventive benefits and stops government bureaucrats and outside experts from ever blocking patients' access to those types of services.

I appreciate the Senator from Maryland who put up an amendment. I do not think it meets that standard. They still rely on government experts called the U.S. Preventive Services Task Force to decide what preventive benefits should be covered under private health insurance. This is the same Preventive Services Task Force that made this decision that women under the age of 50 should not receive annual mammograms.

In fact, I think I even remember in there that they were not necessarily recommending self-examination. Most people I know who are very young discovered it with self-examination. I certainly would not want them to quit doing that because there is a recommendation from somebody who does not understand them or their body.

Patients do want to receive preventive screenings. Sometimes they are a little reluctant to do it because nobody wants the possibility of hearing that word given to them.

Americans should be able to get screened for high blood pressure and diabetes when a doctor recommends they get these tests. I think the Senator and I agree they should be able to get colonoscopies, prostate exams, and mammograms, so they can prevent deadly cancers from progressing to the point where they are no longer curable. Many of these diseases are preventable or curable or can be put into remission if they are discovered early enough.

I think we agree with Senator Mikulski's goal that all Americans should be able to get preventive benefits, but we disagree that her amendment achieves that stated goal. Her amendment does not ensure access to mammograms for women who are under the age of 50. Part of that I am taking from an Associated Press article.

As most Americans know, last month the U.S. Preventive Services Task Force revised the recommendations for screening for breast cancer, advising women between the ages of 40 and 49 against receiving routine mammograms and women ages 50 and over to receive a mammogram just once every 2 years. The U.S. Preventive Services Task Force lowered its grade for these screenings to a C.

That sparked the political firestorm, as many women became confused about what services they could get and when they could get them. The health care bills before Congress further confused the issue because they rely heavily on the recommendations of the task force. That is what is in the bill. The underlying Reid bill says--and the Mikulski amendment restates--that all health plans must cover preventive services that receive an A or B grade from the task force. Let's see, we just said that was a C grade.

Because breast cancer screenings for women under the age of 50 are no longer classified by the task force as an A or B, plans would not have to cover those services. So Senator Mikulski drafted an amendment to try to fix this problem, but I think it confuses the matter some more.

I say to the Senator, I appreciate the effort you have gone to, to try to clarify that and expand it to some other areas--and to not add another layer of bureaucracy--by saying that all services and screenings must be covered by health plans.

However, the previous amendment does not have any guidelines that are specifically for women or prevention.

Mr. President, I congratulate the Senator from Alaska also.

Isn't it true that the Senator's amendment ensures that the Secretary of Health and Human Services won't be able to deny any of these services based on any recommendation? That is one of the things we have been concerned about. Again, that is an unelected bureaucrat who could come between you and your doctor and your health care. I know the Senator has covered that in her amendment, too, and I do appreciate it.

Mr. President, I also appreciate that the Senator from Alaska makes sure they can't deny care based on comparative effectiveness research, which actually was part of the stimulus bill that was run through at that point in time, and finally that the Senator's amendment includes a commonsense provision that would prohibit the Secretary from ever determining that abortion is a preventive service.

So I hope all of my colleagues, whether they are pro-life or pro- choice, would support this change to ensure that the controversial issues don't sidetrack the debate on the preventive issues because what we are talking about is the preventive issues, and I appreciate the Senator covering that.

Mr. President, as I said before, my wife says that she had probably never mentioned the word ``colon'' twice in her whole life, and since then she has become an encyclopedia for people who have a very similar problem. She had a colonoscopy a short time before. She was still having problems, and they had said there is no problem, but she kept getting it checked until she found that there was a problem. So people need to listen to their bodies, and they need to listen to their doctors, and they shouldn't have a bureaucrat coming in between that. So I thank the Senator.

Mr. President, I yield to the Senator from Nebraska.

Mr. President, after the speech by the Senator from Illinois, I feel compelled to make a few comments. One, he challenged us a little bit to do a bill in 2,000 pages or less. I am one of those people who do not think it can be done in less. I do not think there are nearly enough pages there to solve the biggest problem in the United States for every American.

People are not comprehending how big health care is. The bill we are doing will affect 100 percent of the people in America. I do not know if we have ever had a bill before that affected 100 percent of the people--100 percent of the people, 100 percent of the professions, 100 percent of the businesses. This is big. Everybody has a role in health care, and we are trying to condense it into 2,000 pages and make it seem a lot simpler than it is.

The reason our side has been saying you need to take this a step at a time and get it right is because that gives up some of the right. There are over 200 references in the 2,000 pages that say the Secretary of Health and Human Services will solve that particular problem; in other words, put in the details. We do not have nearly the details in there to actually run health care for America. Without the details, we do not know what the devil is, and that is the difficulty. So we really ought to break it down a step at a time.

One step I really think would calm America down is if we did Medicare as a separate step. That way we could assure seniors that Medicare was going to be for Medicare. Yes, there are savings in Medicare. Yes, Medicare is going broke. Use the savings for Medicare. It seems pretty simple to me.

One of the things they are complaining about is the doc fix we have. We are not paying doctors adequately to be willing to take Medicare patients. Of course, we are not paying them adequately to take Medicaid patients either. But we are not paying them right. It would cost about $250 billion to fix that.

Well, if we are talking about $464 billion worth of savings in Medicare, why not use that $250 billion to fix that problem so we have doctors. I do not care what kind of insurance you have, I do not care how much you pay for the insurance, if you cannot see a doctor, you really do not have insurance. That is what seniors are being faced with. That is what Medicaid people are being faced with.

Medicaid--well, that is another piece that ought to be maybe a step because 40 percent of the doctors will not take a Medicaid patient because they are not being paid adequately for it. If you are not paid adequately, you go broke. They are small businesses. They are affected by this bill in more than one way. They have to provide what we are saying is a government requirement for the minimum insurance they have, and they also have to live with whatever rules we put in there and whatever pay fixes we put in there.

On the government option, one of the things CBO said was, the only way that would ever bring down costs is if the government fixes prices for the doctors, for the hospitals. Well, we are kind of doing that in this bill for Medicare because we are telling nursing homes they are going to take a big cut. Nursing homes do not have a lot of margin, and if nursing homes go broke, people have to go a long ways, sometimes--in Wyoming, anyway, and Colorado, wherever we have rural populations--they may have to go a long way to see their loved one. They may not even be able to do it. So we have to keep those small nursing homes in business as well.

So we ought to do this in steps and get it right. That is one of the problems that the Group of 6 ran into. We were not given the time. We allocated about 13 different areas to go through. I think we made it through 5 completely and probably 3 fairly completely, and the rest we were just asking basic questions. With any business, it looks pretty easy until you scratch the surface a little bit, and when you scratch the surface, you find out that every job out there is fairly complicated. If you have never done it before, and you are trying to come up with 2,000 pages worth of laws to govern that, you are probably going to get it wrong.

That is what the doctors are telling us. That is what the other providers are telling us. This bill has it wrong, in a lot of places, enough places that it is going to cause a crisis in America if this bill passes the way it is.

We have never passed a major bill in this body with just one side voting for it. If that were to happen, the other side would take potshots at anything that turned out to be something that had not been comprehended when the bill was written. And there will be plenty of that in here.

But just as important, the American people will not have confidence in it. They do not have confidence in us now--either side. I think that is what the elections in Virginia and New Jersey said. That is what the tea parties are saying. They are saying: We don't trust any of you. Throw the whole bunch out. Start over.

Well, we need to stop and get their confidence. Just steamrolling from one side, even if they have the 60 votes, is not going to do that. I have been saying that since we started. It is something so important that we have to get it right, and we do not have it right in this bill because there are a whole bunch of things, over 200, where we said to the Secretary of Health and Human Services: You figure that one out. Well, that is going to be thousands of pages, and it is going to be done by an unelected bureaucrat. It is not going to be approved by this body.

We ought to take the responsibility for getting those things right. And we can. Yes, it takes time. Yes, we have a lot of things to do. But I am in agreement that health care is the most important thing we have to do. But we ought to take the time to get it right.

There are a lot of ideas out there that would--in fact, one of the things that always upsets me when they say: So where is the Republican version? Well, I have been working on this thing for about 4 years. I have been working on it, actually--health care--ever since I got on the committee over 13 years ago, but for the last 4 years pretty intensively.

Senator Kennedy and I sat down and worked out principles we wanted to have. The principles are still the principles we are talking about around here. We want to make sure people are covered in catastrophic situations. We want to make sure preexisting conditions are taken care of. We want to make sure they have portability when they go from one job to another. The list goes on and on. We reached agreement. He was busy working on the Higher Education Act because it was way past due for being reauthorized, so I was kind of released to go talk to everybody on health care. I worked that. I worked both sides of the aisle, finding out ideas they had, and boiled it down to a 10-step plan.

I did a tour with my 10-step plan to see what kind of problems there were with it and was really pleased with the reception. Yes, I learned some things that needed to be done differently than what I thought. But if you will check my Web site, there is a 10-step plan that is a bill that covers the things we have been promising people they would have. I would not suggest doing it in one package. I would suggest doing it in several steps, not necessarily 10 steps, which are what are in there. But it would bring down the cost of health care insurance. That is the biggest thing I hear from people out there: Bring down my cost.

Now, everybody has been real pleased with this CBO clarification that came out that said the costs were not going to rise. They did not say: Don't let them rise. They said: Bring them down. Bring them down. They said: We don't mind covering a whole bunch of other people, but don't increase my costs as a result. This bill increases their costs as a result.

There is a way to do it. There are four different bills on the Republican side. And then there is a really bipartisan bill that Senator Wyden and Senator Bennett worked out, and I think there are about 15 cosponsors on both sides of the aisle. Those are all ways that this could be solved. But they are not in the bill. Since Senator Wyden was left out of that part of the process, I am not even sure it could be considered partisan because you have to include all from one party.

But, at any rate, there are alternates out there. When we did the health care bill, which took weeks of doing the amendments, because it is very hard to do something in an amendment process and get it right-- it is easier in the committee than it is here on the floor--but in the committee, we put up one of those as an alternative. We only took one vote to vote the whole thing down. They only had to criticize about 3 parts of 20 to get enough enthusiasm against it to be able to win. All the votes were 13 to 10, pretty much.

So we said: Wait a minute. That is not a good idea for us. They should have to take a look at these germs of ideas that are in all these different sections. So we started putting them up one at a time. We still lost most of them 13 to 10. There were a couple of them that did finally pass.

But we need to get into a mode of working across the aisle, like Senator Kennedy and I did on so many bills. In fact, I think we set some records, probably, not just when I was chairman of the committee but when he was chairman of the committee. We were on our way to getting a bunch done.

Anyway, deficit reduction. I heard Senator Durbin talk about deficit reduction, and if this bill reduces the deficit. You have to be honest. If you use phony accounting, you can show huge deficits being reduced. That means leaving out some things that aren't in the bill, but they are going to be costs we have to cover. For instance, the doc fix, $250 billion. It is not in there. They say we will fix it for 1 year and then we will hold them hostage again for another year so we can get them to join us on something else. That is not the right way to do business. We ought to fix the thing and if we have all of this extra money in Medicare, that would solve some problems for Medicare.

On Medicaid, we are about to dump a whole bunch more people onto the Medicaid system. It is nice we are going to be able to do that, but there are some other ways we can take care of those same people and make sure they have insurance, and they would have insurance that didn't have the same stigma as Medicaid. One of the stigmas I am talking about is the doctors not willing to take them. If you can't see a doctor, you don't have insurance. If we dump all of these people on a system that already won't take the patients, how many of them are going to be able to see a doctor? So we could eliminate that stigma. In fact, that is what we did in the SCHIP in Wyoming. We made a provision so that it could go through the private market. When they go through the private market--or when they don't go through the private market, a problem a kid has if their dad is working, they have insurance; if he is not working, they don't have insurance, or if it is mom. Under the Wyoming one, when they go through the private market they know they have it for a year. That is the way it ought to be. That is the way Medicaid should be. Of course, you have to sign up for it. Right now you don't have to sign up. You go to the hospital, you get your fix, and we pay for it, or the State pays their share. We are dumping a huge liability on the States, so it is a real problem.

The States are very concerned. Right now they are having budget problems almost across the entire United States. They are saying, so what are you going to dump on us? Well, our Gang of 6 asked that question and we got this overall CBO score on how much it was going to cost the States as a whole, but we didn't want to know how much it was going to cost as a whole. Every one of us has to answer to our State, so we asked for it to be broken down and they broke it down. It was kind of interesting. I had to call my Governor and explain to him how much he was going to have to come up with, even under the extra protection we were trying to build in for States. But the next day we got another breakdown. I said, so did CBO change their score? No, they didn't, but we manipulated the numbers a little bit differently. Well, they manipulated the numbers for Nevada and New York, and I think that is in the bill too. Their excuse for it was that Nevada and New York are particularly hard hit by the recession. Well, one of our complaints--and part of the phony accounting--is that this doesn't even go into effect for 4 more years, so how would we know that in 4 more years Nevada and New York would be the hardest hit? How do we know it won't be Wyoming and Colorado? So the formulas ought to be formulas that are going to work for everybody all of the time, not just for some of the leadership.

There are some flaws in here we need to take a look at and we need to clear up. I am not going to keep everybody much longer because I want to go hear the President speak too and I apologize for the time I have taken. But once in a while a speech gets me kind of concerned and I have to expound a little bit on it and I think the people of America need to know. Actually, I think the people of America have figured this out. I think that is why there were problems in August and I think that is why we are not going home on the weekends, because we don't want people to hear what the people at home are saying. I was home over the Thanksgiving weekend and I got an earful, and I like what I am doing. I don't think I like what is happening in the bill.

So with that, I yield the floor and thank the President, so the Senator from Oklahoma can speak.

Reserving the right to object, neither of these requests are the requests I was just talked to about a minute and a half ago, so I object.

Mr. President, in the weeks this has been sequestered without us being able to review it and now having something that is not understandable in the short period of time we have to do it here, I have to object.

Mr. President, in light of some of the trust problems and transparency problems we have, and while it appears to lead to greater transparency, we can also see ways that this can limit the ability for the minority to offer amendments. Therefore, I object.

Mr. President, I was hoping I would have a chance to comment on the things I had to object to so I can give a more full explanation. I am happy to wait.

Mr. President, I cannot be brief on what just happened here. I will let the Senator go ahead. Frankly, I am a little upset about what has happened--combining a couple of unanimous consent agreements so that part of it would be acceptable and part would not be, leaving out the most important one, which is that we wouldn't take Medicare money from Medicare, and then not having much time to consider, or to rewrite, or to do anything with those. I have a lot of comments I wish to make on that, plus a general statement on the bill, which fits in with what just happened. I will defer to the Senator from Maryland.

Mr. President, as I mentioned earlier following the unanimous consent requests the leader made--who then introduced Senator Mikulski so that she could do her amendment, which kept me from commenting on the unanimous consent requests he made--I have to say I think those unanimous consent requests would have to be put in the category of a stunt. Unanimous consent usually means the two leaders have gotten together and negotiated some kind of agreement that we would abide by during this time. There was no agreement on this. Yet they went ahead and did the unanimous consent request solely so they could get the objection.

Nobody here, I am sure, wants to use Social Security money for anything except Social Security. So the real key to the stunt was the second one, which is the net savings generated by the CLASS program. That is a long-term care program that wound up in the Health, Education, Labor, and Pensions Committee bill.

The flaw with that particular amendment was that it collected money for 10 years without spending any and then it wound up with a huge liability. So we put in a little provision that it had to be actuarially sound because, quite frankly, it is not very good accounting to collect $70 billion in exchange for a $2 billion--excuse me, $2 trillion--I get the b's and the t's mixed up here, because we are talking about real money here--a $2 trillion bill. That is how much we are going to have to pay out over the next 10 years to cover the $70 billion we accept in payments for this new kind of insurance that would be provided. That kind of insurance is provided--it is provided in the private sector--but for considerably more than what they were providing for in the CLASS Act.

So that was to bring a little more attention to it, and I want to bring a little more attention to it because I want people to take a closer look at the way that winds up. It is a good idea that is not paid for, and it is not paid for in such a way that it winds up, once again, adding to the deficit but in some cagey ways.

As for having the amendments posted on the Web site before they are given, I hope the initial version is posted on the Web site by everybody before they do it. But one of the things that happens on this floor is that occasionally a good idea can be built on by somebody from the other side or even somebody from your own party, and when that happens you can modify the amendment. I am not sure that agreement wouldn't have prohibited any modifications to amendments, which is kind of what we ran into in the Finance Committee when we were trying to do amendments.

So good ideas--they need a lot more work. And to just throw those out at the beginning and to have about 1\1/2\ minutes' notice that they are going to be thrown out--I just don't think that is the right way to go about this whole process.

I have been working on the Nation's broken health care system ever since I entered the Senate more than 12 years ago, and I had high hopes this would be the year the Democrats and the Republicans of the Senate would work together to provide health insurance to every American. I urged my colleagues to start with a blank piece of paper and develop a bipartisan bill that up to 80 Members of the Senate could support.

Unfortunately, the majority leadership had other ambitions, because the bill being debated today is a testament to a partisan ideological vision. It appears that the drafters of this bill took to heart the sentiments expressed by the Speaker of the House, who earlier this year said, ``We won the election, we write the bills.'' And for a number of weeks, the majority leader closed his door and wrote this bill on his own terms without any input from many of his colleagues or anybody on this side of the aisle.

This is a deeply flawed bill that fails to address the real needs of the American people. Americans overwhelmingly want reforms that will help lower their health care costs. Instead, this bill will spend $2.4 trillion when it is fully implemented and contains numerous provisions that will actually drive up the costs millions of Americans pay for their health care.

It is important to understand how we got here. At the beginning of this process, the majority staff of the HELP Committee decided they were going to draft a partisan bill based on the reforms that had recently been adopted in Massachusetts. Republicans were shut out of the process during the drafting of the HELP Committee bill. Rather than working to resolve the difficult issues, the drafters of the bill included over 200 separate instances where the bill gave the Secretary of Health and Human Services the authority to make important decisions about the types of health care plans millions of Americans can receive. Rather than confronting and debating these important policies--getting to the details, and the devil is always in the details--the majority empowered unelected government bureaucrats to make decisions that will affect the health care of every single American.

As a result of this partisan process, we were forced to file hundreds of amendments. The chairman and other Democratic members of the committee have repeatedly commented on the numerous amendments accepted by the majority during the markup. At the

same time, they ignored the reality that most of these amendments were merely technical corrections which were necessary because the underlying bill was hastily written and filled with numerous drafting errors. Unfortunately, nearly all of the accepted Republican amendments merely tinkered around the edges. Almost all of the substantive alternative-idea amendments suffered the failing fate of the party-line vote. In 12 days of markup at HELP, we had 45 rollcall votes on Republican-sponsored amendments and only 2 prevailed.

After the markup, the majority refused to release a final copy of the bill for over 2 months, denying the American people the chance to see what they had done. Once we finally got a copy of the bill, we learned that majority staff had unilaterally made numerous changes to the bill, in some cases undoing agreements that had been worked out by Members on issues such as prevention and wellness.

While this was happening, there were also ongoing bipartisan negotiations, led by Senator Max Baucus. And I have to congratulate him for the process he started and got people involved in and for his persistence and the amount of time he put into it. This dwindled down to a Gang of 6. The Gang of 6 discussions were not an honest attempt to try to develop a bipartisan health care bill that would offer real solutions to the problems that face our health care system.

Ultimately, these negotiations failed to produce a bipartisan bill. I do not believe the failure was due to a lack of effort on the part of the participants but, rather, we were unsuccessful because the Democratic leadership chose to impose arbitrary and unrealistic time deadlines on the process that we commented on. The deadline slipped a few times, moved up a week, and then became finalized. The decision was made that it was more important to move fast than it was to get it right, and the decision ultimately doomed our efforts.

This, in turn, led to another partisan markup where the Finance Committee rejected most GOP health reform ideas. Proposals such as medical liability reform were rejected on jurisdictional grounds, while the chairman unilaterally included Democratic provisions that were clearly within the jurisdiction of other committees. Republican amendments were voted on and then unilaterally changed at the eleventh hour--actually, 1:30 in the morning--by amendments offered by the chairman.

The two bills were then merged, merged in secret, with no input from the many Republicans who want to enact a bipartisan health bill. We now have a 2,074-page bill that reflects many of the worst provisions from both the HELP and the Finance Committee bills.

We did not need to end up here today with Republicans opposing a partisan health care reform bill. The Senate should develop legislation that will impact one-sixth of our Nation's economy and affect the health of every American.

The former chairman of the Senate Finance Committee, Daniel Patrick Moynihan, a Democrat from New York, once provided the following perspective on how the Senate should consider major policy changes. He said:

Never pass major legislation that affects most Americans

without real bipartisan support. It opens the doors to all

kinds of political trouble.

Chairman Moynihan noted that absent such bipartisan support, the party that didn't vote for it would feel free to take shots at the resulting program whenever things go wrong and a large segment of the public would never accept it unless it was an overwhelming success. Chairman Moynihan understood a partisan legislative process guarantees that any glitches that occur in implementing the bill would provide ammunition for future attacks; thereby, further undermining public support of the new policies. There will, unfortunately, be plenty of glitches if this bill is ever enacted.

The Reid bill will impose $493 billion in new taxes, and many of them go into effect immediately. At same time, most Americans will not see any insurance reforms or other potential benefits from this bill until at least 2014. That leads to some interesting accounting.

The Reid bill will kill jobs and cut wages. The Congressional Budget Office has told us the employer mandates in this bill will likely result in lower wages and higher unemployment. These job and wage cuts would hit low-income workers, women, and minorities the hardest. It is hard to believe that with unemployment at a generational high, Democrats would even consider putting more jobs on the chopping block. The Reid bill mandates that Washington bureaucrats ration care. The bill lays the groundwork for a government takeover of health care, giving Washington bureaucrats the power to prevent patients from seeing the doctor they choose and obtaining new and innovative medical therapies.

I think that is attested to by the first amendment we have, the amendment by the Senator from Maryland, because her amendment preempts the provision in the bill that allows the U.S. Preventive Services Task Force to determine what preventive services should be covered. This amendment recognizes the problems associated with government bureaucrats determining what benefits should be covered. The majority realized it had a political problem when the U.S. Preventive Services Task Force said that women aged less than 50 years old should not have annual breast screening exams. This amendment doesn't do anything to protect patients who might be denied access to preventive tests in the future, such as prostate exams, colonoscopies, Pap smears, and so on, if bureaucrats decide to deny access.

This bill also shows how this will never be a truly science-based process. Bureaucrats will always have to respond to political pressure for powerful constituencies.

I guess we are part of the powerful constituencies. If we decide something should or should not be in there, that eliminates the science-based part of it.

I understand what they are trying to do. In the HELP Committee, when we were doing the markup, we did numerous amendments around this clinical effectiveness research, to see what it was supposed to eliminate from the health care for the person, separating them from their doctor by making these science-based decisions.

We did a series of amendments and found there, evidently, are a lot of things they are hoping will be precluded from people being able to get. I invite people to take a look at those amendments. We may have to try those again to see exactly where this process is going. I appreciate the Senator from Maryland making an attempt to solve a part of the problem, but I am having a little trouble with the reading of the amendment itself. At any rate, enough of that.

The Reid bill spends millions--billions. There is that word again. The Reid bill spends billions of taxpayer dollars on new pork-barrel spending. The bill would build new sidewalks, jungle gyms, and farmers' markets and creates a $15 billion slush fund for additional pork-barrel projects, a real deviation from what the Appropriations Committee has ever allowed.

This bill also fails to achieve the commonsense goals Republicans and Democrats share. This bill even breaks many of the promises President Obama has made about health care reform. President Obama repeatedly called for a health care bill that will reduce costs. This bill will actually drive up health care costs for millions of Americans as a result of new mandates and taxes. President Obama has also said that if Americans like the insurance they have, they can keep it. Under the bill, millions of Americans will lose their employer-provided health insurance.

President Obama promised not to raise taxes on individuals earning less than $250,000 per year. The bill would impose several new taxes on people who make considerably less than $250,000 a year.

President Obama said the health care reform would not increase the deficit. This bill will not increase the deficit only if you believe certain things. This bill will not increase the deficit if you believe Medicare payments to physicians will be cut by 40 percent over the next decade. I don't think anybody believes that.

The bill would reduce the deficit only if you believe Medicare payments to other providers will be slashed to levels that endanger patients' ability to get the care they need. No one believes that.

The bill will also reduce the deficit if you believe Congress will allow a massive new tax to be imposed on middle-class tax payers. I hope no one believes that.

If you don't believe Congress will allow all these things to happen, then you can't believe this bill will reduce the deficit. President Obama, in his remarks to the American Medical Association this summer, acknowledged the need to address our out-of-control medical liability. Rather than addressing this issue, this partisan bill preserves the costly, dangerous, duplicative medical malpractice system.

President Obama finally said no Federal dollars will go to pay for abortion. According to the National Right to Life and the Conference of Catholic Bishops, the Reid bill fails this requirement as well.

Despite all these failures, it is still not the worst health care bill in Congress. The Wall Street Journal got it right when they described the House-passed bill as the worst bill in America. Even if the Senate passed the bill before us today, it would still have to go to conference with the House bill and any final bill would have to move toward several provisions in the House bill and poll after poll suggests that the American people are opposed to this bill, let alone the wild one from the House.

If we cannot defeat this partisan bill and get back to work for the American people and write a bill that garners the support of both parties, doing it step by step so we can assure, for instance, the seniors that Medicare money will only be spent on Medicare--that is one of the pieces that ought to have been in that unanimous consent I started talking about. That is not going to happen, though. They are going to take a bunch of money out of there.

I think this legislation fails to meaningfully address these goals and will stick the American people with a bill we cannot afford. I believe we can do better, and we owe it to the American people to do so.

I yield the floor.

Madam President, I thank the Senator from Pennsylvania for his comments. I certainly hope no one who is listening thinks that anybody wants to make any child worse off. That is a basic premise, and I appreciate his pointing out the way the House makes some children potentially worse off.

I want to constrain my comments to the Medicare amendment because I think that is one of the key parts of this whole bill. The Senator from Pennsylvania mentioned that there wasn't a Republican bill. Actually, there are four Republican bills, and there is one bipartisan bill out there that meets all of the goals the President put out. When we were going through the HELP Committee amendment process, we put one of those out, and it was voted down with one vote. We said: That didn't work very well. There were a lot of good ideas in there. They ought to have to consider every one of those.

We have been putting our ideas out one at a time so that hopefully the other side will glean something out of the amendment that will be worthwhile to be a part of the bill. All the good ideas couldn't be on one side of the aisle.

We began the day with kind of a stunt which, of course, was to have the leader propose a unanimous consent. He proposed that the Social Security money ought to stay with Social Security. I don't think there was any problem with that. But then he proposed that CLASS Act money ought to stay with the CLASS Act. That is a fund that isn't even actuarially sound to begin with. It is just a piece of the bill that is already in existence around here. He left out what he should have put in that unanimous consent request. He should have said Medicare money should be reserved for Medicare. That would have relaxed a lot of seniors. But it would have been untrue and impossible to pass this bill if that were the UC, because Medicare money is going to expansion of new programs outside of Medicare. That is what is upsetting seniors. And it ought to.

Medicare, as everybody has said, is going broke. That is a government option that is going broke. Well, never mind. But Medicare is going broke. We all agree on that. So why would we take $464 billion out of Medicare to use on other programs and then recognize that Medicare is going broke and throw in a special commission that will come to us once a year and suggest cuts to Medicare? That is not a bad idea, but some side deals have been made in this whole thing that keep that from being a very realistic option either. The hospitals can't be cut any more. The doctors, we are going to have to fix that, and that is where some of the phony accounting comes in.

The pharmaceuticals, the little deal they made for the doughnut hole, that will provide extra help to seniors through the doughnut hole, but it has to be on brand name products. We know that generics are a lot less expensive and a lot of seniors switch to generics, especially when they get to the doughnut hole and have to make decisions on their own and they want to save a few dollars. But that will not be a possibility under this bill because of the deal that was made with the

pharmaceuticals. They are going to pay their percentage on brand name products only. Why would they do that? If they can get you to use brand name products through the doughnut hole, when the government starts paying again, you will still use the brand name.

One of the ideas with health care is to get a little skin in the game with everybody so people are making good choices on health care. How much of a good choice are you going to make if you don't have to make a choice and you can keep on doing what you have been doing, whether it is the best choice for you, whether it is even what the doctor agrees with, and whether it is a whole lot more expensive for the government to keep Medicare going?

I rise to support the McCain motion to commit this bill and eliminate its Medicare cuts. Senator Reid's bill cuts $464 billion from the Medicare Program. These cuts will eliminate benefits for Medicare patients. They will make it harder for them to see doctors and other providers and will threaten the survival of hospitals, nursing homes, and home health agencies. Don't take my word for it. The administration's own chief actuary recently reviewed the House bill with its similar levels of Medicare payment cuts and reached the same conclusion I just said.

Richard Foster, chief actuary at the Centers for Medicare and Medicaid Services, CMS, wrote that if these cuts were to take effect, many providers ``could find it difficult to remain profitable and might end their participation in the program.'' He also noted that this could jeopardize Medicare beneficiaries' access to care. I have heard similar messages from doctors, home health aides, and nursing home owners back in Wyoming. They are all concerned about the one-half trillion dollars in Medicare cuts and what it will do to their ability to treat Medicare patients.

I have heard from folks at the Baggs Senior Center, the Star Valley Senior Citizens, the Southwest Sublette County Pioneers Senior Citizen Center, and from other Wyoming nursing homes about how the $15 billion in Medicare cuts to nursing home payments will devastate their ability to provide care for seniors in Wyoming. Many of these nursing homes are small businesses. They struggle to make payroll every month and deal with an ever increasing burden of government regulations. We have never cut those back. They tell me how their Medicare payment rates have already been reduced and how the additional cuts in the bill could force them to close their doors.

Connie Jenkins, executive director of the Star Valley Senior Center, recently wrote to me about the important role nursing homes play in rural towns in Wyoming. She noted that ``in a rural state such as ours, closure of nursing homes would mean families travelling farther to visit [their] loved ones and in some cases loss of access altogether.''

In rural States--and we are about as rural as you can get; we have the least population in the Nation, and we have a lot of land mass-- there is a lot of distance between towns. If the nursing home in your town closes down, it is a long way to the next nursing home. The Reid bill would also cut $135 billion in Medicare payments to hospitals. In a State such as Wyoming, with an older population, between 40 to 50 percent of our hospital revenue comes from Medicare. Medicare already pays a fraction of what private insurers pay, and the cuts in this bill will undermine those hospitals' ability to continue to operate. I have heard from several Wyoming hospital executives that because of the payment cuts in this bill, they are going to need to ask their people to work fewer hours and take pay cuts.

They also said they may need to lay some folks off and to find ways to scale back the services they offer to their patients. They do not want to compromise the care they provide, but the payment cuts in this bill will not leave them a choice.

The Reid bill also cuts nearly $8 billion in payments to hospice care. Hospice care helps to relieve the suffering of people who are dying from diseases such as cancer. These are terminal patients, terminal patients who, of course, are not going to be cured. But the hospice is intended to help manage the pain and other symptoms of the patients with the terminal illness, and working with the families, much on a volunteer basis.

According to National Hospice and Palliative Care Organization, the cuts in the Reid bill, combined with prior regulatory cuts, would reduce Medicare payments to hospice providers by 14.3 percent through 2019. According to a June 2008 report from the Medicare Payment Advisory Commission, hospices already operate with narrow profit margins that average just 3.4 percent.

Smaller nonprofits and hospices in rural areas such as Wyoming already operate with negative profit margins. Many depend on charitable fundraising to keep their doors open and to enable them to keep treating patients. Yet the Reid bill would further cut their Medicare payments by $8 billion. This will force many hospices to close, which will threaten dying seniors' access to that type of care.

The Reid bill also cuts more than $40 billion in Medicare payments to home health agencies. According to the analysis done by one industry association, this level of cuts could put nearly 70 percent of all home health agencies at risk of having to close their doors. I want to say that again. The $40 billion in Medicare cuts to home health agencies, according to an analysis done by one industry association, could put nearly 70 percent of all home health agencies at risk of having to close their doors.

There are a lot of people who are out of nursing homes because they are getting home health care. If we eliminate home health care, we drive up the cost of care. If the Senate passes this bill, it will mean that Medicare patients may not be able to get the skilled nursing care, the physical and speech therapy, and the assistance that home health aides provide with many daily activities, such as dressing, bathing, helping patients live more fully with a disability.

The Medicare cuts in the Reid bill are not limited to slashing payments to hospitals and other providers. The bill also cuts $120 billion from the 11 million seniors on Medicare Advantage. These cuts make a mockery out of President Obama's promise that if you like what you have, you can keep it. As a result of these cuts, millions of Medicare beneficiaries will lose the benefits currently provided by Medicare Advantage plans.

Supporters of Senator Reid's bill have tried to gloss over the impact these Medicare Advantage cuts will make, arguing they will only result in a loss of ``extra benefits.'' For the seniors who have come to rely on Medicare Advantage plans to provide things such as flu shots, eyeglasses, hearing aids, and protections against catastrophic costs, these are not extra benefits but items and services they depend on.

We all agree Medicare needs to be strengthened and reformed. Its financing is unsustainable. The Hospital Insurance Trust Fund, which pays for hospital services, will be insolvent in 2017. The physician payment formula, which calls for Medicare payments to doctors to be cut by more than 40 percent over the next 10 years, is fundamentally broken. We know that. We even had a vote on that in this Chamber. We said it had to be paid for.

Let's see, $464 billion coming out of Medicare. Medicare is what is being affected by the doctors' payments. Why wouldn't we use some of that? But it is a lot of money. It is a lot of money, but it is not as much money as we are taking out of Medicare.

Unfortunately, the Reid bill does nothing to fix these problems. Instead, it cuts one-half trillion dollars from Medicare to create a brandnew entitlement program for the uninsured. This approach fails to address the real problem facing Medicare; and that is the physician formula. Instead, it uses the same gimmick that Congress has repeatedly used to fix this problem and provides a temporary fix in 2010, which will actually lead to steeper cuts in subsequent years.

Physicians have grown increasingly frustrated by Congress's repeated failure to replace the current payment formula. We kind of like to keep them hanging on a year at a time. I think it is a little bit of a hostage situation, but that is the way Washington works. It should not be that way. We should redo the formula. If we do not address this problem soon, many more physicians are going to decide it is not

worth it to continue to treat Medicare patients.

The Congressional Budget Office has estimated that truly fixing the physician payment formula could cost upwards of $250 billion, yet the Reid bill does not address this problem.

Spiraling costs associated with medical liability lawsuits directly increase Medicare costs. These costs are calculated directly into payment formulas for providers such as physicians. In addition, physicians and hospitals order billions of dollars in extra tests and procedures to protect themselves from the threat of potential lawsuits.

We know that enacting commonsense medical liability reforms directly reduces the liability insurance premiums doctors pay. We have seen the results in States such as Texas, where physicians liability insurance premiums have decreased every year since the State-enacted reforms, with average liability rates dropping a total of 27 percent.

The Reid bill does nothing to address the problems of medical liability. Instead of including reforms that would help reduce Medicare costs and extend the solvency of the program, the only thing the Reid bill does is include a meaningless sense-of-the-Senate resolution on liability reform. That will not pay the bills.

We owe it to the 43 million people who depend on Medicare to reject the arbitrary cuts in the Reid bill. We need to come up with better solutions that will not endanger their ability to see a doctor or to get care at a hospital or a nursing home. Yes, if we do not pay the doctors, the doctors will not take them because in Medicaid they already will not take 40 percent of the patients; and in Medicare it is 20 percent already. A lot of people are being asked, when they call a doctor, if they are a Medicare patient. It is my contention if you cannot see a doctor, you do not have any kind of insurance at all. We do not take care of that problem, so we do need to come up with a better solution that will not endanger their ability to see a doctor or to get care at a hospital or a nursing home or to have home health care.

I believe we can do better. If the Senate passes this motion to commit, we can develop bipartisan reforms that will eliminate the unsustainable payment cuts and address the underlying problems facing the Medicare Program.

I yield the floor.

Madam President, I suggest the absence of a quorum.

Mr. President, as morning broke over our Nation today, millions of Americans woke to a typical, crisp fall day. It seemed ordinary as shop-owners opened their local grocery stores; children filled soccer fields and families made preparations for Thanksgiving holiday. It seemed ordinary. But today is anything but ordinary in the life of our Nation.

We have all heard the phrase and repeated it so many times, that we have almost grown numb to it--America is facing the worst economic crisis since the Great Depression. Think about that for a minute. What that really means is that for every single legislator in this Senate, we are in unchartered territory.

We have never been here before and recent signs of a slow, unsteady and jobless recovery are troubling. And, the American people know it. In a survey from this past week, 82 percent of Americans said that our Nation's economic conditions are poor.

Consider the news reports from just yesterday that 14 percent of all mortgage loans--meaning 7.4 million households--were delinquent or in foreclosure in the last quarter. That is the highest number since the mortgage bankers industry began this survey in 1972.

Consider the unemployment rate--it reached a 26-year high of 10.2 percent in October. We lost 190,000 jobs in just the month of October alone. And, according to the Department of Labor's broadest measure, some 17.5 percent of Americans are without a job entirely or underemployed. We have shed 3.5 million jobs since January of this year and the average work-week is now down to 33 hours for the American worker.

It is against this backdrop that the Senate majority leader has chosen to bring up this health care bill. Health reform is a huge undertaking.

Every one of the 2,074 pages in this bill will have a dramatic impact on the health care of every American. I have to tell you, that is a bridge. This is a bigger problem than anyone can imagine because it will affect every single American. This bill represents a massive government intrusion into the medical care of every American.

Under this bill, the government will review every employer health insurance plan in the Nation to determine if it satisfies all of the government mandated benefit requirements. If it does not, the government will then tax many of those employers.

The government will also now determine whether it believes your health insurance costs too much. It will decide what benefits should be covered and what preventive services you should receive.

Earlier this week, the U.S. Preventive Services Task Force recommended that women under age 50 should not receive annual mammograms. Anyone who was concerned about this decision needs to understand that this bill empowers a task force just like that to determine which preventive services should be covered by every health plan in America.

As one of the only Members of the Senate to sit on both committees of health care jurisdiction, I understand the complexities at work in comprehensive health care legislation. And I understand that this bill gets it wrong.

Instead of taking a step-by-step approach to health reform, identifying consensus reforms where we can fix what is broken and leave what works, the majority leader has chosen a different approach. Without Republican support and without the approval of a growing majority of the American people, Senator Reid has chosen to shake nearly 20 percent of our economy in its foundation in attempting to jam through a strictly partisan bill.

This bill will increase our health care costs, do nothing to improve the quality of our care, it will increase our Nation's debt and deficit and it will harm our Nation's tenuous job market.

There is no credible study and there will be no serious, unbiased economist who will say that this bill will create jobs or strengthen our economy. And that is what the people in the most recent election said was mot important.

Recently, in an op-ed in the Wall Street Journal, the dean of Harvard Medical School Dr. Jeffrey Flier gave the current health reforms a ``failing grade.'' Dean Flier wrote about the reform bills being debated in Congress, that ``there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.''

Dean Flier went on to write:

In discussions with dozens of health care leaders and

economists, I find near unanimity of opinion that, whatever

its shape, the final legislation that will emerge from

Congress will markedly accelerate national health-care

spending rather than restrain it. Likewise, nearly all agree

that the legislation would do little or nothing to improve

quality or change health-care's dysfunctional delivery

system.

I ask unanimous consent that this editorial be printed in its entirety in the Record at the conclusion of my statement.

With ratings of failed reform like the dean of the Harvard Medical School, why are we talking about taking the time to tweak a failure of ideas so we can say we did something. We are not fooling the American people. The voices of August are still echoing and coming from a vast majority.

Other experts have weighed in on the provisions in the Reid bill and their potential impact on jobs. One such provision is the job-killing tax of $28 billion that will disproportionately fall on the backs of small business employers in the form of a mandate on employers to

provide Washington government-approved insurance.

This job-killing tax has been studied by the non-partisan score keepers at the Congressional Budget Office as well as nationally recognized economists and health experts. These experts have said that the costs of this new tax will ultimately be paid by the American working men and women.

Businesses that cannot afford to provide health insurance will pass the costs of these new penalties on to their workers in the form of lower wages, reduced hours and jobs cut. Yes, this so-called health reform bill will threaten your jobs and if this vote is successful we will spend weeks debating this bill. And just like committee work so far, the majority will reject real solutions just like they have through the two amendment processes that have been merged to make this flawed bill.

According to one recent study by the Heritage Foundation, this new job-killing tax in the Reid bill will place more than 5 million low- income workers at risk of losing their jobs or having their hours reduced and an additional 10 million workers could see lower wages and reduced benefits. At a time of unprecedented economic peril, the majority has chosen to bring a bill to the Senate that will threaten our Nation's jobs and our economic growth.

This bill will also increase our Nation's growing debt and deficit. Currently, our Nation's debt is greater than $112 trillion and our deficit for fiscal year 2009 was greater than $1.4 trillion. As a percentage of the economy, our deficit is 10 percent of GDP--the highest it has been since the Second World War. Once again, we are not debating this bill in a vacuum. Rather, we are debating this bill at a time when our credit card is maxed out.

I worry about the country that I am leaving for my children and grandchildren. Our Nation is being buried under a mountain of debt, which poses a deadly threat to the future of our Nation.

The Federal Government will spend $1.4 trillion more than it receives in revenue this year. The government will make up that deficit by borrowing more money, mostly from China and other foreign governments.

These levels of debt are not sustainable and, our foreign creditors are beginning to recognize this fact. As our creditors grow more concerned about our ability to pay our debt obligations, the interest rates we pay will grow. That means that it will soon cost us considerably more to allow Washington to continue to borrow the money it needs to fund its current spending binge.

With our current and growing debt, Congress should be concerned. Think about it--our most fundamental duty as Members of Congress is to wisely manage the power of the purse for our Nation. The Framers wisely put in place a process of appropriations that would be annually checked by the representatives of the American people here in Washington.

In this bill we create yet another stream of mandatory spending in perpetuity--or until it runs out--that is not reviewed by Congress on an annual basis.

I remind my colleagues that our Federal deficit is nearly nine times the size of the deficit just 2 years ago. During the same 2-year period, our Nation lost 8 million private sector jobs. Our total Federal debt is now around 85 percent of GDP. According to David Walker, the former head of the Government Accountability Office, at the end of the fiscal year 2000, the Federal Government had about $20.4 trillion in total liabilities and commitments and unfunded promises for just Social Security and Medicare. That number rose to $56.4 trillion at the end of fiscal year 2008. That is a 176-percent increase in only 8 years. By the end of this year, that number is expected to rise to $63 trillion. With these staggering statistics, it is astonishing we are even debating the creation of a new entitlement obligation forever.

A couple days ago, Majority Leader Reid stated that this bill will be deficit neutral, but you have to understand what that means. First, the true cost of this bill is hidden by implementing the massive middle- class tax increases and Medicare cuts in the first year and pushing the massive costs in health care subsidies out to the fifth year. Republican Leader McConnell referred to this gimmick as being akin to paying a mortgage for 4 years before actually moving into the house. I wish to emphasize that a little bit. It is a gimmick. You collect the money to begin with, but you don't provide the benefits until further down the road. Then you say: We covered all those costs. But when you extend it on out, it will not continue to cover those costs. So disaster.

As the only accountant in the Senate, I am shocked to see that what would constitute as fraud in the accounting world seems to be reason to hold a press conference to do a hollow boast. The gimmicks in this bill are stunning, whether it comes to implementation of the tax on so- called Cadillac health plans or the increased taxes or the $464 billion in Medicare cuts--Medicare cuts. We are already having a problem with Medicare solvency. It is going to go broke. We are going to take $464 billion from Medicare. Then we are going to form a special commission and this commission will be able to tell us, on an annual basis, where we can make cuts in Medicare so it doesn't go broke. But let's see, there is a deal with the hospitals that they are not going to be touched. There is a deal with the doctors that they will not be touched; in fact, theirs is going to be increased. There is a deal with PhRMA where they will not be touched. Who does that leave? That means cutting benefits for seniors. They and home health care and nursing homes are the only places you can cut it, if you let those other people off the hook. That is what the bill does.

When it comes to the long-term care provisions in this bill that Budget Committee Chairman Conrad has referred to as a Ponzi scheme, you have to be a little bit worried. If Washington accounting had to come under the same laws as private business, the administration and Congress would be in jail. To attempt to claim the mantle of fiscal responsibility, the majority leader has jammed 10 pounds of entitlement spending into a 5-pound sack. Again, entitlement means the payments automatically go on forever with no further review or constraint. That is not fiscal responsibility and the American people are not buying it. They know, evidently better than we do, what we are talking about.

A large majority of Americans believe their prescription drug costs will go up under this bill and that the cost of their premiums will go up. They are right. What the CBO score doesn't provide us with and can't provide us with is the cost of this bill to each and every one of us. But we know that cost will be great. The CBO evaluation says it is going to be paid for. Paid for? That is an evaluation of whether it is going to cost the government anything. It is not an evaluation of whether it is going to cost the people anything. The only place to get that money is from the people or, in this case, also stealing it from Medicare. In order for this bill to reduce the deficit, the majority leader has to assume that the Medicare payments to physicians will be cut by 21 percent next year. He also has to assume these payments will be annually cut another 5 percent for the next 9 years.

In order for this bill to reduce the deficit, the majority leader also has to assume that more and more middle-class Americans will pay this new tax on high-cost health insurance plans. According to the Congressional Budget Office, 84 percent of the revenue collected by this new tax will come from Americans earning less than $200,000 in 2019. This reminds me of another tax which was originally intended to target just 155 individuals who made more than $200,000 and did not pay any income tax. Today the alternative minimum tax now hits millions of middle-class Americans, and every year Congress has to enact legislation to prevent it from hitting millions more. This bill is drafted that same way. It will creep up there and catch everybody in increased taxes.

In order to believe that this bill will reduce the deficit, its sponsors must believe that future Congresses will allow millions of middle-class Americans to be subject to these new taxes. While the majority leader claims all these things will happen, the American public isn't fooled.

In this morning's Washington Post, the dean of Washington journalists, David Broder, not a politically conservative columnist and someone often

cited by the other side, pointed out that a recent survey found that less than one-fifth of the American people believe that health care reform will be deficit neutral over the next 10 years. By a 16-point margin, the majority in this poll said they opposed the legislation moving through Congress. Mr. Broder called this legislation a ``budget- buster in the making.''

It is difficult to quantify the scope of this bill. I have heard some of my colleagues talk about how many years would elapse in 2\1/2\ trillion seconds. I heard some of my colleagues talk about how many cars $2.5 trillion would buy or how many school districts it would fund or how many decades it would fund State budgets across America. I don't think people are understanding how comprehensive this bill is that entails 100 percent of the people. That is the difficulty we in the Gang of 6 had coming to any conclusion because it is so big that as we get into one area and scratch the surface and find out what we don't know, it takes a lot of research time to get there to be able to make basic decisions. But it was easy to cram into a bill and say: This solves it, solves it for $1 trillion. We should never say $1 trillion because that sounds like one, and one is not a very big number.

It is $1,000 billion. We don't know what 1 billion is either, but 1 billion is 1,000 million. So we are talking about a lot of money here.

Perhaps the best way to quantify this bill is, it keeps me up nights and, more importantly, these issues we are debating keep our constituents up at night. I am sure everybody has been hearing from their constituents. We worry immensely about the cost and the obligations we are passing on to our children and grandchildren. Where is this bill taking our country, and will we have the courage in our time to preserve and protect our Nation's great strengths for future generations? These are the questions that keep me up at night, and I know these concerns are shared on the other side of the aisle. I sense it in conversations I have had with the senior Senator from Delaware and the senior Senator from Nebraska. I sensed it in my work over the summer with the chairman of the Budget Committee. I know they share these concerns on the other side. That is why I believe passionately that we must defeat the motion to proceed on this bill.

I am sometimes an optimist, and I still hope we can start over and get to work on a bipartisan bill that has the trust and support of the American people. Any major piece of legislation that has gone through this body has done so in a bipartisan way. It has been necessary to get the confidence of the American people. They don't have confidence in Congress right now. This bill is not helping.

We say we are spending our children and grandchildren's money. Actually, we are doing that plus spending seniors' money. When you take that Medicare money, that is what you are doing. The seniors have figured it out. That is why it was so raucous in August and ever since. They have been concerned about their future and the promises made to them. We have a system that is going broke, and then we are going to take money from it. We ought to back up and make sure Medicare money goes to Medicare. I know part of that is listed as fraud and abuse. I am always fascinated when government talks about fraud and abuse because we talk about it, but if we have known that these billions of dollars of fraud and abuse were out there, why haven't we been collecting that money? Once we turn it over to the government to do that, it is no longer needed. Well, it is needed to pay the bills, but it is no longer that much of a care because the paid-for has already been taken care of.

There ought to at least be a separate account set up that you have to actually collect the fraud and abuse money before you can spend it, but we are not going to do that.

Every senior can tell you some instances of fraud and abuse that they think are happening, and we have passed those on. I see some effort to collect that but not a lot.

As many of my colleagues know, before I came to the Senate, I was a small business owner. My wife and I owned three small shoestores in Wyoming and Montana. When I was showing someone a shoe and he or she said they didn't like it or couldn't afford it, I didn't try to give them a sales pitch. I knew it was time to try to find another shoe, one they liked and could afford. There is a lesson from this in this health care bill. The people of America are complaining, and we are showing them the shoe we want to show them. They don't want to see that shoe. They said: We thought you were going to lower my costs. Every person out there thought they were going to have the benefit of reduced costs, and they are not seeing it in this bill. They wanted to help out other people, and some of that is in here, to a limited extent. But that isn't the main thing that they expected to have happen from this. Small businesses out there are particularly hurting, and this will react on small businesses, those shoestores all over the United States, the grocery stores, the dry cleaners. This is even going to affect doctors. They are small businesses, for the most part.

So there is a lesson in this story when it comes to reforming health care. It is time to listen to the customers and find the alternative they expected, that they wanted, and they can afford.

Probably the biggest help to me in legislating has been the experience of working in a shoestore. The people tell you what they want, and they have told us what they want. We haven't listened. If you want to make the sale, you better listen. You better see how your inventory matches what they want. We haven't checked the inventory or we have said: We don't have anything in here that you need, but we have some things to take care of other people. That is not going to sell.

We have a big decision to make tonight. It will have a lasting effect on our country, a lasting effect in that if the motion to proceed passes, we are going to debate it for a long time. A bill this size deserves a lot of time. It is necessary. And it is more comprehensive than we are going to be able to get into, no matter how long we debate it.

So the American people are going to be surprised at the time we waste when we could be solving jobs and the economy, which is their biggest concern at the present time.

Mr. President, I yield the floor.

Exhibit 1

Health ``Reform'' Gets a Failing Grade

(By Jeffrey S. Flier)

As the dean of Harvard Medical School I am frequently asked

to comment on the health-reform debate. I'd give it a failing

grade.

Instead of forthrightly dealing with the fundamental

problems, discussion is dominated by rival factions

struggling to enact or defeat President Barack Obama's

agenda. The rhetoric on both sides is exaggerated and often

deceptive. Those of us for whom the central issue is health--

not politics--have been left in the lurch. And as controversy

heads toward a conclusion in Washington, it appears that the

people who favor the legislation are engaged in collective

denial.

Our health-care system suffers from problems of cost,

access and quality, and needs major reform. Tax policy drives

employment-based insurance; this begets overinsurance and

drives costs upward while creating inequities for the

unemployed and self-employed. A regulatory morass limits

innovation. And deep flaws in Medicare and Medicaid drive

spending without optimizing care.

Speeches and news reports can lead you to believe that

proposed congressional legislation would tackle the problems

of cost, access and quality. But that's not true. The various

bills do deal with access by expanding Medicaid and mandating

subsidized insurance at substantial cost--and thus addresses

an important social goal. However, there are no provisions to

substantively control the growth of costs or raise the

quality of care. So the overall effort will fail to qualify

as reform.

In discussions with dozens of health-care leaders and

economists, I find near unanimity of opinion that, whatever

its shape, the final legislation that will emerge from

Congress will markedly accelerate national health-care

spending rather than restrain it. Likewise, nearly all agree

that the legislation would do little or nothing to improve

quality or change health-care's dysfunctional delivery

system. The system we have now promotes fragmented care and

makes it more difficult than it should be to assess outcomes

and patient satisfaction. The true costs of health care are

disguised, competition based on price and quality are almost

impossible, and patients lose their ability to be the

ultimate judges of value.

Worse, currently proposed federal legislation would

undermine any potential for real innovation in insurance and

the provision of care. It would do so by overregulating the

health-care system in the service of special

interests such as insurance companies, hospitals,

professional organizations and pharmaceutical companies,

rather than the patients who should be our primary concern.

In effect, while the legislation would enhance access to

insurance, the trade-off would be an accelerated crisis of

health-care costs and perpetuation of the current

dysfunctional system--now with many more participants. This

will make an eventual solution even more difficult.

Ultimately, our capacity to innovate and develop new

therapies would suffer most of all.

There are important lessons to be learned from recent

experience with reform in Massachusetts. Here, insurance

mandates similar to those proposed in the federal legislation

succeeded in expanding coverage but--despite initial

predictions--increased total spending.

A ``Special Commission on the Health Care Payment System''

recently declared that the Massachusetts healthcare payment

system must be changed over the next five years, most likely

to one involving ``capitated'' payments instead of the

traditional fee-for-service system. Capitation means that

newly created organizations of physicians and other health-

care providers will be given limited dollars per patient for

all of their care, allowing for shared savings if spending is

below the targets. Unfortunately, the details of this massive

change--necessitated by skyrocketing costs and a desire to

improve quality--are completely unspecified by the

commission, although a new Massachusetts state bureaucracy

clearly will be required.

Yet it's entirely unclear how such unspecified changes

would impact physician practices and compensation, hospital

organizations and their capacity to invest, and the ability

of patients to receive the kind and quality of care they

desire. Similar challenges would eventually confront the

entire country on a more explosive scale if the current

legislation becomes law.

Selling an uncertain and potentially unwelcome outcome such

as this to the public would be a challenging task. It is

easier to assert, confidently but disingenuously, that

decreased costs and enhanced quality would result from the

current legislation.

So the majority of our representatives may congratulate

themselves on reducing the number of uninsured, while quietly

understanding this can only be the first step of a multiyear

process to more drastically change the organization and

funding of health care in America. I have met many people for

whom this strategy is conscious and explicit.

We should not be making public policy in such a crucial

area by keeping the electorate ignorant of the actual road

ahead.

Mr. President, I ask unanimous consent that the Republican Senators, during their hour, be permitted to engage in a colloquy with fellow Republican colleagues.

Mr. President, I rise to talk about the health care reform bill. This country needs health care reform. The status quo in health care is unacceptable. Health care costs are skyrocketing, insurance premiums are increasing, and too many small businesses can no longer afford to offer health insurance to their workers. No one on either side of the aisle denies we need health care reform.

We need to enact reforms to bring down costs so everyone will have access to quality, affordable health care. We need to take a step-by- step approach to reduce health care costs and lower insurance premiums for individuals and employers. We need to eliminate discrimination based on preexisting conditions and ensure that people can take their insurance with them from job to job. I support commonsense reforms that would achieve all these goals.

Unfortunately, this 2,074-page Reid bill fails to address these issues. Instead, this bill would raise taxes by $493 billion. It would cut another $464 billion from the Medicare Program. The bill would reduce wages and eliminate the jobs of millions of Americans. It would actually drive up health insurance premiums for many more Americans and still leave 24 million people without insurance coverage. We need to do better than that, and I think we can.

Our country currently faces one of the worst economies in a generation. Our unemployment rate is 10.2 percent, which means there are 15.7 million Americans without jobs.

At the same time, the bill we are debating, or will be debating when we actually get to the real thing, would impose $28 billion in new taxes on employers. This new tax will eliminate millions of American jobs and reduce wages for millions of American workers.

When employers struggle with extra costs, workers and their families feel the impact. American workers depend on a strong economy to create jobs that help them feed their families and build their dreams. Unfortunately, the policies being pushed by the majority will only make it more difficult for America's businesses to hire workers or pay current employees more.

The Congressional Budget Office, health researchers, and nationally recognized economists all agree that Senator Reid's new job-killing, employer tax will mean one thing: More Americans will be out of work if this bill becomes law.

As I mentioned, this bill will raise taxes by $\1/2\ trillion--$\1/2\ trillion. The authors of the bill truly believe the greatest problem in our health care system is that we do not pay enough taxes for our health care.

Under this flawed bill, if you take a prescription drug, you will pay a new tax. If you use any medical devices or equipment, ranging from walkers to wheelchairs, you will pay a new tax. If you do not have health insurance, you will pay a new tax. If you do have health insurance, you will also pay a new tax. If the government decides your health insurance is too expensive, there will be a new tax for that as well.

The problem with our current health system is not that we don't pay enough taxes. Americans actually want to lower their health care costs--that is the message--not just pay more taxes to the Federal Government. All these taxes will only increase costs, making health care even more unaffordable.

The third major problem with this bill is it will actually increase the cost of health insurance for millions of Americans. The bill mandates that insurance premiums for younger, healthier workers be tightly tied to the costs for older, sicker individuals. This will immediately drive up costs for the young, healthy individuals who, coincidentally, make up a significant portion of our current uninsured population.

The bill also eliminates consumer choices, requiring Americans to buy richer types of plans that cover more of the deductibles and cover more out-of-pocket expenses. These plans typically have much higher premiums.

Taken together, these insurance changes will increase costs for millions of Americans. In looking at more modest provisions included in the Senate Finance bill, nationally recognized accounting and business consulting firms found these changes would increase insurance premiums by 20 to 50 percent.

The practical effect of this bill is, Washington could dictate to every single American, even those who have insurance they now like, the coverage they would need to purchase. Washington will tell you what is good enough coverage. The bill does not give people affordable options, and it penalizes those who do not purchase high-end, expensive plans, regardless of what they want, need or can afford.

Before I was a Senator, I was a small businessman. My wife and I owned three shoe stores. When I was showing someone a shoe and he said he did didn't like it or couldn't afford it, I didn't try another sales pitch. I knew it was time to find another shoe, one he liked and could afford. If the customer is complaining, get something else to show. The customers are complaining. The voices of August are still out there, and they know this bill is just more of the same.

There is a lesson in that story when it comes to reforming health care. It is time to listen to our customers and find an alternative they want and can afford. The intensity of the country's disapproval is apparent in townhall meetings, letters to newspaper editors, citizen protests, constituent calls, and letters from all across the Nation. I received some of those that said: My Senator is not listening but you are.

I wish to find solutions. Ask most of my colleagues and they will tell you, time and time again, I have been known to work across the aisle on commonsense reforms on all kinds of issues. I have fought for years to enact commonsense reforms that will help slow health care cost growth and make the insurance market work better for small businesses.

I worked closely with Senator Ben Nelson from Nebraska on a bill that would allow small businesses to combine their purchasing power across State lines, even nationwide, and collaboratively buy health insurance at discounted rates.

I worked closely with the late Senator Ted Kennedy on a bill to reform the drug approval process at the Food and Drug Administration.

I worked closely with then-Senator Clinton on a bill to save lives and decrease costs by promoting greater use of electronic medical records.

Time after time, I have advocated that we set partisan differences aside and work on the 80 percent of the issue that will make a difference for most people.

Unfortunately, rather than working with Republicans to develop a commonsense solution, the majority drafted a flawed bill that spends too much, does too little to cut health care costs, and puts seniors' benefits on the chopping block.

The White House and Democratic leaders should have responded to these concerns with alternative ideas that actually address the health care issues that most Americans care about--their cost. Unfortunately, they decided to simply try a more aggressive sales pitch. As a result, opposition to it will only continue to grow.

If this bill continues to move forward, in spite of what most Americans are telling us, I am going to keep offering amendments geared to bringing down health care costs for American families, scaling back total health care spending, and protecting seniors.

I yield the floor to my colleague from Wyoming who has copies of the bills.

Absolutely and not just townhall meetings. That is how the letters, e-mails, and phone calls are coming in, greatly in response to what they anticipated they were going to get, which was going to be lower costs. They don't mind helping other people to have insurance and subsidizing that insurance or in some cases providing it for free. But they expected to get something out of it themselves. We miss the mark on this. You can tell they missed the mark. The bill that has been brought up to be voted on is just a little 2-page bill. Why didn't they put up the House bill? Because they couldn't get 60 votes for the House bill. They know that is wrong. This is a whole lot different from the House bill. It is different. I give them some credit for that. They couldn't put this bill up because they can't get 60 votes, and they have to get 60 votes to move on to debate.

They brought up the Service Members Home Ownership Tax Act of 2009, which is actually two pages and a summary. So there is not much to that bill. Their hope is they can get the 60 votes and people will not concentrate on the fact of what is in this bill.

I appreciate all the efforts of the Senator from Wyoming. He has been involved in the health care industry as a provider for a long time and a real student of what is in these bills. He has

looked at these bills in detail, so he knows a lot of the flaws. I appreciate him taking the time to point those out.

I would like to comment on that, in some way, unprecedented action by a committee. We agreed in committee on some amendments. Then when the bill was actually printed, which was not done for 2 months-- which was, I think, so people couldn't actually look at it during the August recess, during that 2 months--when it was finally printed, some of the things that were agreed to were left out. One of the big ones was an actual wellness program, one that worked for Safeway, that helped cut their cost in the first year by 8 percent.

Have you heard of anybody cutting their costs in health care? Their program did. Since that time it has been held level because of what they were able to do with wellness programs. We got that wellness program approved. We didn't get much approved when we were doing that bill, but we got that approved.

But when the bill was printed, that was left out. Staff, without talking to any one of the Members, had taken it out. I think that is unprecedented around here. But that was not the only instance either. I would like to direct the attention of Senators to the costs on this bill, which the Senator from Wyoming has mentioned. As an accountant, I look at those. They say they are going to reduce the deficit in the first 10 years and even more in the second 10 years. There are two ways they can do that. One of them is to raise taxes. The other is to steal money from other people, which is what they are doing from Medicare. That, maybe, means they are overtaxing? So that might mean they want to stick in some other things that will be spending. Is there anybody out there who thinks you can do a $1 trillion new program and it will not cost a dime?

I hope people are taking a look at matters such as the Wednesday editorial by the president of Harvard who made some comments about how things are working. I hope everybody reads that. This is a good way for our Nation to go broke. We are not in very good shape right now, but that is a good way to go broke, and there are a lot of gimmicks in this bill too.

I appreciate the Senator from Wyoming pointing that out, and I assume the Senator from New Hampshire, who is the chairman--ranking member on the Budget Committee now--and has a handle on a lot of these gimmicks will share some of those too.

Mr. President, I wish to thank the two doctors for their comments. I have been enthralled with what they have been saying. They have been doing a series of programs to help people understand what we could do with health care and how health care is being done. I am glad they point out that vast difference. Obviously, it was a very effective program. It was so effective that the other side decided to have a show too. They put up the two lawyers, and it shows one of the problems.

When the President did speak to us at the joint session, he talked about medical malpractice reform and how he was going to do it the next day. The only problem is what he was referring to was a bill I did with Senator Baucus that was ignored in the HELP Committee and it was ignored in the Gang of 6 and it was ignored in the Finance Committee, something that would have gotten some medical malpractice reform going. I think that only saves about $54 billion. That is still a lot of money to me. It is a lot of money even in this bill, although this is a $1 trillion bill.

I appreciate the doctors. I particularly appreciate my colleague from Wyoming who has been here all day adding comments from his medical background and making a substantial contribution to having the people of America understand this bill. But the people of America understand the bill better than the people in this Chamber. That is the problem. In August there were town meetings and people were appalled at the number of people who wanted to go to those town meetings and the way they wanted to speak, and they explained to us why this method won't work. It wasn't because anybody organized them. If Republicans were that good at organization, we would still be in the majority. These were people who were concerned about health care and where it was going. They had read a lot about what had been said, and they are still reading about it, and they are still mad. This isn't where they want to go. The average person in America thought we were going to cut their health care costs or at least keep them from escalating. That isn't what this bill does. This bill builds a whole bunch of new programs and taxes people and steals from Medicare. That is not where the country wants to go. I know that is not where the seniors want to go. I have been surprised at the AARP endorsing the bill. Their members don't think so. Their members are appalled at what is in here and how it is going to affect Medicare.

But my real intent tonight is to discuss this bill and how the increase in health care costs raises taxes and particularly affects small businesses. It makes them less competitive. Small businesses across America are the engine of the economy. I don't know how many times I hear that around here--the engine of the economy. If small business is growing, the economy is growing. If small business is stagnant, people are still losing jobs in big businesses, and it is usually the ones who lose the jobs in big businesses that eventually get absorbed into the small businesses. It is a shift of a brain trust and it makes the small businesses grow and they stay the engine in the economy.

As many of my colleagues know, before I came to the Senate I was a small business owner. My wife and I owned three small shoe stores in Wyoming and Montana. When I talk about small business, I don't talk about it in the vacuum of the Senate floor; I speak from my life experience. I know what it is like to manage a small business, to keep the books, to pay the vendors, and always to serve your customers. In the Small Business Committee I like to remind them that even though the Federal definition of small business is 500 employees or less, the real engines of the economy are much smaller than that. Some of them are the ones that are just starting, where the owner of the business sweeps the sidewalk, cleans the toilets, waits on customers, and does the books, and definitely not in that order. That is the small business. That is a small business growing. Those are the kinds of businesses that becomes the big businesses. A lot of them fail. A lot of them know they are taking a risk, but thank goodness they are willing to take that kind of risk. They never expect the government to add to their risk, but they know it does.

I faced the challenges of making payroll and trying to negotiate good, affordable benefits for my employees. I have had that experience of sitting bolt upright in the middle of the night and saying, Tomorrow is payroll. How am I going to meet payroll? Sometimes you do it without paying yourself, but the business keeps going.

I have to say in a small business the employees are very close to the business. They understand how tenuous it is. They work and they participate and in the good businesses, they are all like family. So they don't have some of the same choices that the big, flexible companies do. I see where a company in Virginia is about to lay off-- America On Line is about to lay off 2,500 people. The person who lays them off, do you think they know those 2,500 people? No, they won't know those 2,500 people. I suppose that makes it a lot easier. But in small business, they know their people. They want to do whatever they can to keep that brain trust, that skill, that ability around, and they sacrifice a lot to get to do that.

As a former small business owner, I also understand that if we pass this bill, it will harm the engine of economic growth, and it will be a disaster for millions of Americans. This bill will impose $493 billion in new taxes, and those fall disproportionately on the backs of small business men and women.

For instance, the new $54 billion increase in the Medicare payroll tax will hit approximately one-third of the small business owners across the country. These are the same businesses that

employ over 30 million Americans. So why would this affect them? Do they make that much money? Well, that much money shows up on their books. Most of them are Subchapter S corporations, which means that every dollar of profit becomes their own income, even though they have to take most of it and put it back into the business in order to keep the business going and to grow the business. But some of them look like they make a lot of money.

There are some businessmen in Gillette, WY, and they started a restaurant. They now have six restaurants. I happened to be in one of their restaurants in Casper. Sanford's is the name of it. It is a brandnew restaurant, and when I was there, the owner happened to be there and he recognized me and he came over and visited. He knew we were working on this. He said, You know, they keep piling stuff on us. They think we are rich. Sometimes the things we have to file with the government because of our Subchapter S corporation make us look rich and cost us a lot in taxes. We are helping them to keep this government going, but we don't get to put it in our pocket. He said, When we started that first business, we each had $200 in our pocket and we were able to borrow enough money to start that restaurant. Each restaurant that we built has been a little fancier and a little nicer. The one you are sitting in right now cost $500 million to build. He said, You know, me and my partner still only have $200 bucks in our pocket. The rest of it we have had to plow back into the business. And when we plow it back into the business, it creates more jobs. There are more people working. I will tell you, those are good jobs, too.

I don't understand at a time when small business owners are struggling to pay their bills and to keep the lights on, the majority leader has decided we ought to increase their taxes. These businesses are fighting for their very survival. This bill makes it harder for them. Small business owners are also health care consumers like the rest of us. They take prescription drugs to treat diseases such as cholesterol and hypertension from the stress they are under, and they might also use a pacemaker or have a hip or a knee replaced. If this bill is passed, the prices they pay for all of those items will increase. They increase for the employees they have too who have those same things done.

This bill contains over $40 billion in new fees for prescription drugs and medical devices. The nonpartisan Joint Commission on Taxation has said these types of fees will ultimately be passed through--to whom? To the consumer, meaning that the small business owner is going to pay more for his health care and for the health care of his employees.

Many small businesses still manage to provide health insurance coverage for their employees, despite the ever-increasing cost of health insurance. I understand how hard it is to pay those ever- increasing costs. That is why I fought for years to help small businesses band together so they would be able to get the same kind of discounts that insurers typically provide for the large employers. How would that work? Businesses would be able to band together through their associations across State lines, even nationwide, and build a big enough pool that they could effectively negotiate with the insurance companies or with the providers. I have to tell you, when I proposed that, the insurance companies didn't like it. We went ahead with it anyway. I got it through committee. I brought it here to the floor of the Senate, and I understand how hard it is to get health care reform done. I had a bill that was filibustered on the motion to proceed. I got 55 votes. I had three people who would have voted for it who weren't here. I got 55 votes. That wasn't enough. You have to have 60 in order to move on.

Here is the real irony. Olympia Snowe was ready to do the amendment that probably would have taken care of 80 percent of the concerns of the people, but because we couldn't do the motion to proceed, we couldn't offer that amendment. We couldn't finish the bill. As a result, there are no small business health plans that cross State lines. Yes, there are small business health plans. Ohio is the laboratory that I used to work the idea. Ohio already had this kind of thing within its State boundaries. There is a lot of population in Ohio. Wyoming doesn't have much population so we can't form these big pools, but Ohio could. I looked at what they had done and it was marvelous. It saved money. It gave more benefits than most of the insurance plans in the State. You know what they said to me? We could do better if we could cross that State line. If we could go nationwide or even across to one more State, we could do better for every one of our people, because we would have a little bigger pool and we could save more money. They said, in the initial phase of this, you know where most of the money is saved? I said, No, where? They said, In administrative costs. Each of those little businesses having to do their own buying, figuring, paying, costs a lot of money, about 38 percent of health care. That doesn't show up in premiums; that is a cost. Do you know what the Ohio small businesses were able to save? Twelve percent. Twelve percent. That is a huge savings, just in administrative costs. But, no, we weren't able to pass that on to these small businesses. Instead, we are coming up with a way to tax them more, regulate them more, which is not exactly my idea of how to fix health care.

Rather than lowering the costs, this Reid bill will actually increase the cost of insurance by creating a new $60 billion tax on insurers. Just like the new taxes on drugs and devices, the cost of the new insurance tax will be passed through to the consumers, meaning that small businesses will see their health insurance premiums go up even more.

The damage this bill will do to small business is, unfortunately, not limited to the new taxes it creates. The bill will also impose expensive new mandates and requirements on insurance that will have the effect of dramatically increasing costs for small employers. One of the worst provisions dealing with insurance market reform is the so-called shared responsibility for employers. What the authors of the bill are trying to hide behind and what sounds harmless is a $28 billion job- killing tax on employers.

Under the bill, if an employer doesn't provide health insurance benefits to any employee eligible for the new insurance subsidies, which includes families making up to $90,000 a year, then the employer has to pay a fine. The penalty is equal to $750 per employee for all the employees.

Let me say that again. If an employer doesn't provide benefits to an employee eligible for the new insurance subsidies, which includes families making up to $90,000 a year, that employer has to pay a fine. The penalty is equal to $750 per employee for all the employees, not just the one eligible for a subsidy.

The nonpartisan scorekeepers at the CBO plus nationally recognized economists have said the costs of this new tax bill will ultimately be paid by workers. Businesses that cannot afford to provide health insurance will pass the costs of these new penalties on to their workers in the form of stagnant or lower wages, reduced hours, and eliminated jobs.

According to one recent study by the Heritage Foundation, this new job-killing tax will place more than 5 million low-income workers at risk of losing their job, or having their hours reduced, and an additional 10 million workers could see lower wages and reduced benefits. That is what they have to do to stay in business.

The bill contains a narrow exemption for small businesses with 50 or fewer employees. Similar to many of the other poorly conceived provisions of the bill, even this exemption is likely to create unintended and harmful consequences.

What is the likelihood that a small employer with 50 employees right now will agree to expand their business if by adding that single extra employee they expose themselves to this new job-killing tax? Small businesses are the engine of economic growth. I cannot say that enough. They create the jobs in this country. But this provision will discourage the creation of new jobs.

Fifteen million Americans are currently unemployed and 19 percent of small businesses have reported that they reduced employment in their firms in the last 3 months. If this bill is passed, the Reid job- killing employer tax will mean that more Americans

will lose their jobs. We ought to be concentrating on jobs. Instead, we are focusing on something that will kill jobs.

The Reid bill will also impose sweeping new regulations over the health insurance marketplace. Similar to most new regulatory schemes imposed on small businesses, this one will also mean increased costs for small businesses.

Small business owners know the current market for health insurance is not sustainable. According to a recent Kaiser Family Foundation report, costs for small businesses, those with less than 200 employees, rose by 5 percent from 2008 to 2009, and they are expected to rise again next year.

We all agree the status quo for health insurance is not acceptable. Equally unacceptable, however, should be any proposals that make the current situation worse. Unfortunately, that is exactly what the Reid bill will do.

The nonpartisan Congressional Budget Office, the administration's own actuaries, the National Association of State Insurance Commissioners, and at least six other private studies have all looked at provisions similar to what is in the Reid bill, and they all found that these provisions will drive up health insurance costs.

Actuaries at the consulting firm Oliver Wyman, which did one of the studies, estimated these provisions will increase premiums for small businesses by at least 20 percent. Last year, they had an increase of 5 percent. This is going to do 20 percent. I suspect most small businessmen will notice that, and they will also know where the blame lies. WellPoint, the largest Blue Cross/Blue Shield plan in the Nation, looked at their actual claims experiences in the 14 States in which they operate and concluded that the premiums for healthier small businesses will increase in all 14 States--in Nevada by as much as 108 percent.

The bill also eliminates consumer choices, requiring Americans to buy richer types of plans that cover more deductibles and out-of-pocket expenses. These plans typically have much higher premiums. That is right. Washington is going to tell you what kind of insurance you have to have, even if it is a lot better than what you have now and you like what you have now. That is not good enough. Washington knows better for you what you need in the way of health insurance. They are going to see that you get it. Boy, are you going to get it. These plans typically have much higher premiums. We have looked at the studies to see how many people have the quality of insurance we are talking about at the lowest acceptable level. If you don't do that, you get fined. OK.

Well, these new mandates will make it more difficult for small businesses to adopt new, affordable, high-deductible health plans. These plans, when combined with health savings accounts, have been enormously successful in recent years in helping small businesses control health care costs. I know a secret here in the Senate. There are quite a few employees--particularly the younger ones--who did a little evaluation, because in the Senate everybody has the same choices and everybody gets to buy from the private market and everybody can pick how much they want to pay in premiums compared to deductibles. You can pay more premium, less deductible, or less premium and more deductible. The two balance out. People know that. Some of the astute kids in my office took a look at buying the insurance as opposed to doing the high deductible and putting it in a health savings account. They found out they could take the money it would cost for the regular plan and, instead, buy this high deductible and take the difference and put it in a savings account. The savings account grows tax free. It has to be used for health care, but it pays for health care things as they come up. In less than 3 years, the one putting in the least covered the entire deductible. So for the rest of the time, she would not have to put any more into that savings account. But she is smart. She said: I am putting that in there tax free, and someday I will need it. So she is continuing to grow that.

We have decided that is a bad deal. I will tell you, people around here are smarter than us. They are figuring out how to save money on health insurance already. I don't think they are going to like that.

Another thing you can do as an employee here is have a flexible savings account. That happens in a lot of businesses across the country. If you have company insurance, you can do a flexible savings account. This bill is going to do away with that too. That is the way to do it if you know you are going to have health expenses the next year that don't fall within your policy. You can put that money in the bank tax free and use it as those bills come due.

We are going to limit that, and that limit isn't going to have any fluctuation dealing with inflation, so in 2 or 3 years that program is gone. I don't know why these ones that encourage people to save and plan for the future are such bad ideas.

According to the Kaiser Family Foundation, 11 percent of small business employees are enrolled in HSAs. Average HSA premiums for small businesses are 20 percent lower than the traditional PPO plans, and the number of employers offering HSAs has nearly doubled over the last 3 years.

If you work for Starbucks, that is one of the small companies--not really. But Starbucks provides insurance to their people. They do it through HSAs. We are talking about getting rid of that, saying it is not good enough. There are going to be upset people.

The new mandates in the bill will prevent some high-deductible health plans from being sold because they do not provide a rich enough benefit.

Small businesses are not just purchasers of health care, they are also providers. Doctors, home health aides, and nursing home owners are all small business owners. They have a significant stake in how this bill turns out. You can tell from the two practitioners we have here who understand and had small businesses, they understand how this works. That is without even getting into the fact that the government, in Medicaid and Medicare, cuts what they pay so it is below their cost. You know how hard it is to run a business below cost? It is impossible. You have to shift the cost somewhere else so the people under private insurance pick up the costs.

I am reminded of some farmers who decided they could make a killing and drive the truck over to North Dakota and buy some eggs for just 24 cents a dozen. They could bring them back to their home State and they could sell them for a lot more. Of course, when they sold them and figured in the expense of picking them up, they found out they were only getting 20 cents a dozen for them. If that is the case, you cannot just buy a bigger truck and solve the problem. That is what doctors are finding. They are saying: I cannot afford to take Medicaid patients or Medicare patients. If you cannot see a doctor, you don't have any insurance at all. That is where we are driving this thing.

Unfortunately, a number of the provisions in the Reid bill will devastate these small health provider businesses. The bill cuts over $460 billion from Medicare over the next 10 years, slashing Medicare payments to hospitals, nursing homes, and home health agencies.

The Reid bill will cut over $15 billion in Medicare payments to the nursing homes. In a rural State such as mine, this level of cut will destroy many small business nursing homes and force the closure of the facilities that currently provide nursing home care to hundreds of Medicare patients.

Connie Jenkins, the executive director of the Star Valley Senior Center, south of Jackson, WY--a lot of people know where Jackson is, over on the western side of the State; it is the home of the Grand Teton National Park, below Yellowstone National Park. The director recently wrote to me about the important role nursing homes play in rural small towns in Wyoming. She noted that many small communities depend on nursing facilities to provide a large portion of the available jobs. She wrote that ``in a rural State, such as ours, closing of nursing homes would mean families traveling further to visit loved ones and, in some cases, loss of access altogether.'' It is important to be near the people who are in a nursing home. We have great distances and very small towns.

The Reid bill would also cut more than $40 billion in Medicare payments to home health agencies. According to the analysis done by one industry association, this level of cuts could put

nearly 70 percent of all home health agencies at risk of having to close their doors.

Home health agencies provide valuable assistance to disabled individuals, allowing them to receive their care in their home. It is a lot cheaper than a nursing home. If these cuts are enacted and these agencies are forced to close, the patients will have to go back into institutional facilities to receive their care. In addition to devastating these small businesses, this proposal would clearly break the President's promise to protect Medicare beneficiaries and not reduce their benefits.

Many doctors, such as my colleague, John Barrasso, who has been on the Senate floor all day, have also been small business owners. Doctors are currently facing a 21-percent reduction in Medicare payments that is slated to go into effect in January. Despite cutting $460 billion from the Medicare Program, the Reid bill does nothing to fix the Medicare payment formula for physicians. Since 40 percent of doctors will not take Medicaid patients, that is now moved into Medicare, and I think 20 percent will not take Medicare patients. How would you like asking for an appointment and they say: Are you Medicare? And if you are, we are not taking you.

It can happen. That is not health insurance at all. Also, it is fascinating that Medicare doesn't have catastrophic coverage. We will talk about that. Unlike the Federal Government, small business owners cannot lose money on every Medicare patient and then hope to make it up on volume. A 21-percent payment cut is not sustainable, and it highlights why we need to fix the broken Medicare physician payment formula. Rather than stealing $460 billion from Medicare to create a new entitlement program for the uninsured, we should use those moneys to strengthen and improve Medicare.

Medicare is going broke. You saw the charts over there earlier. It is going broke. We are going to take $460 billion from it. Oh, but don't worry. The bill has a little provision in there where we are going to form a commission that, every year, will give us suggestions on how we ought to cut Medicare so that it stays solvent.

I don't know any other way you can put that: Cut Medicare to stay solvent. We had to form a commission to do that after we steal $460 billion from the program. It cannot afford to have that taken out.

Another interesting thing on that commission is they already made a deal with the hospitals, and they cannot cut them, and the doctors were supposed to have a deal, although I think the deal has been broken because the low payments did not get fixed and the medical malpractice did not get included as they were promised. So I don't know if they are still in there. In exchange, they were supposed to not get any cuts.

The pharmaceutical companies were not supposed to get any cuts. I would love to have the time to explain the deal they have. Do you know whom that leaves? That leaves the nursing homes, the home health, and the Medicare patients themselves. They are going to pick up those costs that are each year prescribed to us to pass to save Medicare. Medicare money should go to Medicare.

The Reid bill also drives up health care costs for small businesses by its massive expansion of Medicaid. This bill includes the largest expansion of the Medicaid Program since it was created in 1965. In addition to trapping 15 million low-income Americans in the worst health care program in America, this Medicaid expansion will also increase costs for many small businesses.

Medicaid uses government price controls to set private rates far below what private insurers pay, often below the cost of what it costs to provide the care. According to one estimate, Medicaid pays only 60 percent of the rates paid by private insurers. This forces doctors to make up for their losses on Medicaid patients by increasing their costs to other purchasers. According to a recent estimate by the accounting firm Milliman, inadequate Medicaid payment rates resulted in physicians shifting $23.7 billion in costs onto private sector purchasers.

Enrolling 15 million more Americans into the broken Medicaid Program will only worsen this cost shift. That means if this bill is enacted, small business owners will see their health care costs increase as physicians and hospitals struggle to make up for inadequate payments for many more Medicaid patients.

In addition to doctors and hospitals, States also cannot afford to pay for this expansion of the Medicaid Program. The Reid bill imposes approximately $25 billion in new unfunded Medicaid costs on State budgets at a time when the States are facing a worse economic crisis in general than perhaps our economic crisis because they cannot just print the money.

When we were working with the Gang of 6, we had a table that showed how the $25 billion was distributed among the different States. The CBO estimate of the $25 billion never changed. But every day, we got a new sheet and the different States paid different amounts. Did you know that finally New York and Nevada got theirs down to what they thought was a workable level? I don't know if that is actually the way it will come out if people are just jimmying the numbers.

What this will mean for small businesses will be even higher taxes and fees, as States struggle to close the estimated $22 billion budget shortfall they will face in fiscal year 2011. According to the National Association of State Budget Officers, States have already enacted $23.8 billion in new taxes and fees in the current fiscal year. These numbers are only expected to increase as States see no end in sight to their current fiscal crisis.

Increased State and Federal taxes, higher health care costs, and Medicare payment cuts are the results small businesses are most likely to see if the Senate passes the Reid health care reform bill. While these would never be welcome changes, the Senate will be debating these policies at a time when small businesses face their most severe economic challenges since the Great Depression.

As I mentioned, unemployment is already at 10.2 percent. Even that number, which is the worst we have seen in 26 years, may actually understate the severity of the situation. The government estimates that up to 17.5 percent of the population may be entirely without a job or underemployed.

Other economic indicators paint a grim picture for a potentially jobless recovery. In October, new housing starts fell 10.6 percent, which is 30 percent lower than 1 year ago. Federal Reserve Chairman Ben Bernanke recently noted that the ongoing financial crisis has led to the reduction or elimination of bank credit lines for many small businesses. He also noted that the fraction of small businesses reporting difficulty in obtaining credit is near a record high, and these conditions are expected to tighten further.

Small businesses are the engine of economic growth that can lead this Nation out of its current economic crisis. Unfortunately, the Reid bill will have the effect of sand being poured into the gears of that engine.

The recent statement of the National Federation of Retail Businesses does the best job of summarizing the impact of the Reid bill on small businesses. They said:

We oppose the Patient Protection and Affordable Care Act

due to the amount of new taxes, the creation of new mandates,

and the establishment of new entitlement programs. There is

no doubt all these burdens will be paid for on the backs of

small business. It's clear to us that at the end of the day,

the costs to small business more than outweigh the benefits

they may have realized.

I see I have run a few minutes over. I apologize to the Chair.

Mr. President, I am very pleased to have this opportunity to acknowledge one of our great success stories--the Congressional Awards--on the occasion of their 30th anniversary. This is a great milestone in the history of a program that has served to inspire and encourage countless young people across the country since it was first signed into law in 1979.

Thirty years ago, Senator Malcolm Wallop of Wyoming and Congressman James Howard of New Jersey joined forces to establish and promote the Congressional Awards and provide this great opportunity to young people all across the Nation. Today this program is achieving results throughout the United States far beyond what anyone could have ever expected. One by one, students are rolling up their sleeves and getting to work, establishing personal goals as well as goals for community service. Their dedication has made it possible for them to make a great difference in the world right where it should always start--in their own backyard.

The Congressional Awards program has deep Wyoming roots because Malcolm Wallop helped to provide the leadership that led to its creation. It has deep roots in Wyoming because it has inspired our young people to a truly remarkable degree. The popularity of this program extends from one corner of my home State to the other and it continues to spark the imagination and encourage the enthusiastic participation of another group of participants every year.

Because of the great work this program makes possible, I try to attend as many award ceremonies as I possibly

can. I enjoy having the opportunity to recognize the achievements of those who have earned these awards almost as much as the award winners enjoy receiving the recognition of the Congress for their efforts. Every time I take part in one of these special ceremonies, I can see the excitement and sense of satisfaction that the award represents to each recipient because they have earned it by accomplishing what they set out to do.

The Congressional Awards are open and available to young people from about age 14 to 23. They honor those who have done something to improve themselves by expanding their horizons as to what they believe is possible for them to achieve. Working with adult mentors, they dedicate themselves to achieving a set of goals in four areas--public service, personal development, physical fitness, and the exploration of the world around them. Because of their enthusiasm, it is no surprise that they have been able to achieve such great results in their lives.

There are three levels of awards offered by the program--Bronze, Silver and Gold. The Gold Award is the most difficult of the three to earn because it requires the most in terms of both time and effort.

Over the years, the number of Wyoming Congressional Award winners at each level has been impressive. However, because of the good example Malcolm Wallop worked so hard to provide, we have had a remarkable number of Gold Medal award winners in my State. That is a remarkable achievement for a State with a comparatively small population. It underscores the determination of Wyoming's young people to always finish what they set out to do.

That is why our award winners have been getting noticed and the word has been getting around about how much it means to each award winner to have earned such a special prize. That has inspired others to try to do the same and it has kept the line of program participants going strong.

Malcolm Wallop understood the importance of that message and the need for our young people to hear it--and hear it clearly. Thanks to him and his efforts, kids in Wyoming and throughout the nation understand that there is something better for them to do than to complain about what's wrong with the world. They now know that if there is a problem in the community or down the street you can do something about it. It's more than positive thinking; it's a call to action. It's a lesson learned that will then encourage our young people to apply the same determination that helped them to earn their Congressional Award to the other goals they have set for themselves so they can achieve the same kind of success in every area of their lives.

Although Malcolm accomplished a great deal during his three terms of service in the United States Senate, I have always believed the Congressional Awards had to be one of his favorite achievements, something special that will continue to last as part of his Senate legacy that will serve to inspire present and future generations to continue to work to make great changes in the world around them.

That will mean, in the years to come, when we look to the young people of Wyoming, the West and the United States to take their place as our leaders on the local, State and national level, thanks in part to the experience of the Congressional Awards program, they will be ready.

Mr. President, I rise today to introduce legislation to extend for 1 year the Ensuring Continued Access to Student Loans Act of 2008, ECASLA. Without this extension, hundreds of thousands of students may not have access to student loans for the 2010-2011 academic year.

Since 1965, the Federal Family Education Loan, FFEL, program has successfully helped millions of Americans realize the dream of a college education. Today, it continues to provide student loans for nearly 70 percent of America's college students at over 3,400 schools. However, during the credit crisis of 2008 many private, non-profit FFEL lenders encountered difficulty raising the necessary capital to make student loans, and others left the FFEL program. Congress responded by passing the bipartisan, cost-neutral Ensuring Continued Access to Student Loans Act of 2008. ECASLA preserved liquidity in the student loan market by giving the Secretary of Education temporary authority to purchase student loans made under the FFEL program. It has been a resounding success--it has preserved liquidity in the student loan market, it has been cost neutral, in fact it has generated revenue and, most importantly, it has maintained student access to FFEL loans.

However, while it was meant to be temporary, serious problems persist in the financial markets and many private, non-profit FFEL lenders are again considering leaving the FFEL program when ECASLA expires on July 1, 2010. The potential consequences could be catastrophic for America's college students, many of whom will be unable to secure student loans for 2010-2011 academic year without a functioning FFEL program.

Given this predicament, the solution is simple--extend ECASLA for an additional year. Unfortunately, instead of working with Congress to pass a clean, bipartisan, one-year extension of ECASLA, the Department of Education is pursuing yet another government takeover and placing undue pressure on FFEL-participating schools to switch to the government-run Direct Loan, DL, program. Some schools will make this choice, but most do not want to because the FFEL program provides a product and services that meet individual student needs rather than the one-size-fits-all approach of the government-run DL program.

Moreover, schools begin making financial aid determinations in January--just seven weeks from now. Given that it can take 4 months to make the switch to the government-run DL program, most schools do not have the time, staff, resources or capacity to make the switch while at the same time attending to the financial aid needs of current and enrolling students. Furthermore, making the switch is not simply a matter of ``flipping a switch,'' as the Department of Education asserts. Among other things, schools must install new computer software, hire and train financial aid personnel, and receive substantial technical assistance from the Department of Education. While the Department has been able to successfully assist the several hundred schools that have made the switch over the past year, thousands will need assistance over the next 7 months. The Department simply does not have the resources to devote the necessary time and attention to all of these schools, which will frantically be trying to switch before ECASLA expires on July 1, 2010.

At this point, the only responsible course of action for Congress is to pass a clean, one-year extension of ECASLA. This will ensure that students have access to student loans, and will give Congress the time needed to have a serious and well thought discussion about the future of the Federal student loan program.

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

Mr. President, I rise today to introduce legislation to extend for 1 year the Ensuring Continued Access to Student Loans Act of 2008, ECASLA. Without this extension, hundreds of thousands of students may not have access to student loans for the 2010-2011 academic year.

Since 1965, the Federal Family Education Loan, FFEL, program has successfully helped millions of Americans realize the dream of a college education. Today, it continues to provide student loans for nearly 70 percent of America's college students at over 3,400 schools. However, during the credit crisis of 2008 many private, non-profit FFEL lenders encountered difficulty raising the necessary capital to make student loans, and others left the FFEL program. Congress responded by passing the bipartisan, cost-neutral Ensuring Continued Access to Student Loans Act of 2008. ECASLA preserved liquidity in the student loan market by giving the Secretary of Education temporary authority to purchase student loans made under the FFEL program. It has been a resounding success--it has preserved liquidity in the student loan market, it has been cost neutral, in fact it has generated revenue and, most importantly, it has maintained student access to FFEL loans.

However, while it was meant to be temporary, serious problems persist in the financial markets and many private, non-profit FFEL lenders are again considering leaving the FFEL program when ECASLA expires on July 1, 2010. The potential consequences could be catastrophic for America's college students, many of whom will be unable to secure student loans for 2010-2011 academic year without a functioning FFEL program.

Given this predicament, the solution is simple--extend ECASLA for an additional year. Unfortunately, instead of working with Congress to pass a clean, bipartisan, one-year extension of ECASLA, the Department of Education is pursuing yet another government takeover and placing undue pressure on FFEL-participating schools to switch to the government-run Direct Loan, DL, program. Some schools will make this choice, but most do not want to because the FFEL program provides a product and services that meet individual student needs rather than the one-size-fits-all approach of the government-run DL program.

Moreover, schools begin making financial aid determinations in January--just seven weeks from now. Given that it can take 4 months to make the switch to the government-run DL program, most schools do not have the time, staff, resources or capacity to make the switch while at the same time attending to the financial aid needs of current and enrolling students. Furthermore, making the switch is not simply a matter of ``flipping a switch,'' as the Department of Education asserts. Among other things, schools must install new computer software, hire and train financial aid personnel, and receive substantial technical assistance from the Department of Education. While the Department has been able to successfully assist the several hundred schools that have made the switch over the past year, thousands will need assistance over the next 7 months. The Department simply does not have the resources to devote the necessary time and attention to all of these schools, which will frantically be trying to switch before ECASLA expires on July 1, 2010.

At this point, the only responsible course of action for Congress is to pass a clean, one-year extension of ECASLA. This will ensure that students have access to student loans, and will give Congress the time needed to have a serious and well thought discussion about the future of the Federal student loan program.

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

Mr. President, I am pleased to have this opportunity to join my colleague from Maryland, Senator Mikulski, in introducing Rosa's law. I would like to thank her for her leadership and her commitment on this issue. Simply put, this legislation will make an important change in the words we use to refer to those with intellectual disabilities. It is a much needed change in the law that is fully deserving of our support.

For far too long we have used words like ``mental retardation'' in our Federal statutes to refer to those with intellectual disabilities. This has been unfortunate because when we use such a term we send a message throughout our society that someone ``is'' their disability, instead of someone like us who is facing a challenge in their life. Such a term creates the unwanted impression that growth is impossible and their disability will lock them into a certain lifestyle forever.

As an example, imagine a friend with cancer. When you refer to him or her you would probably say they have cancer, or are going through cancer treatment. You wouldn't say they ``are'' cancer like this term says that someone ``is'' their disability. It's a distinction that makes a big difference for anyone facing such a difficult period of their lives.

This is not a unique situation. Historically, this and other unfortunate terms have been used to refer to people with disabilities of all kinds for many years.

Prior to the 1960's, people who were viewed as having intellectual limitations were shunned from society and placed in institutions. The American dream of self-determination, independent living, and the pursuit of freedom and happiness was thought to be impossible for them to achieve. We let the limitations we helped to create with our words and our attitudes slowly take away their hopes and dreams for a better life and a brighter future.

We know now that words have meaning, sometimes far beyond what we intend. Therefore, we must be very careful about the way we describe the people we see every day, including those with disabilities, or those who are undergoing treatment for a variety of health issues. Unfortunately, the Federal Government has not dropped this term from our laws and it still appears in the regulations and statutes that come before our legislative bodies and our courts.

With this legislation we are taking a giant step forward, as we acknowledge that times have changed and we live in a much different world. Clearly this term was not developed from malice. It came from a lack of understanding of what it was like to be labeled with such a term and then left virtually alone in the effort to overcome it.

Over the years, Congress has made it known that community living, educational opportunities that lead to success in the workplace, and equal opportunity without discrimination will be available to people who are living with intellectual limitations under appropriate Federal statutes.

That was a good start. Unfortunately, several key Federal disability statutes, including the Individuals

with Disabilities Education Act, the Rehabilitation Act, the Developmental Disabilities Act, and the Genetic Information Nondiscrimination Act, still use the outmoded term. It is time for Congress to be proactive and join the States of New Hampshire, Maryland, and my home State of Wyoming by ending the use of this pejorative term and replacing it with a more carefully chosen word.

To paraphrase a quote I have heard about cancer, a disability is a word, not a sentence. We have put that philosophy into practice over the years for other disabilities. It is time we adapted it to provide support to those living with intellectual disabilities as well.

Some will ask if we are being overly sensitive, or if we are just trying to make a change to be politically correct. The answer to that question is clearly ``no.''

It is no secret. When we put a ``label'' like that on someone we often find ourselves dealing with the label as if it is not a description of the challenges someone faces in their lives but a reflection of who that person really is. That puts them in a group with a label for a name and tells them that they are not worthy of being treated as an individual, with individual needs and interests.

I have heard from people with intellectual disabilities over the years. They have asked us to put an end to the use of that outdated term. Self-advocacy groups such as Self-Advocates Becoming Empowered and local People First Organizations as well as organizations such as the Arc of the United States, Special Olympics International, and others have already stopped using this archaic terminology and dropped the term from their agency names. The American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders, has already voted to use the term ``Intellectual Disability'' in the next publication of their manual.

I have always believed that the law is a great teacher. That is why we need to join in this effort and express our support for the efforts of those with disabilities of all kinds to live to their full potential. We can do that by eliminating the use of negative archaic terms to refer to those with intellectual limitations. Such an action on our part starts with this bill that uses the term intellectual disability in laws that are in the jurisdiction of the Senate Committee on Health, Education, Labor and Pensions. This bill makes our intent clear throughout our Nation that this term will never again be used in Congress or in any Federal office.

When I came to the Senate 13 years ago, my staff and I met almost immediately to work on our mission statement. When it was completed, one of the most important clauses we had written was our commitment that we would treat others not as we would wish to be treated, but as they would wish to be treated. There is a difference.

Today, with the passage of this important legislation, we are reaching out to those with intellectual disabilities to assure them that their government will treat them as they would wish to be treated. By so doing, we will also be directing our staffs and the staffs of federal offices throughout the U.S. that the best way for them to refer to those with disabilities or to anyone who comes into their office is by the term they have carried with them throughout their lives--their name.