Floor Statements

Mr. President, I come to the floor today to speak about ObamaCare and what I have long believed is a march to rationing of health care.

The ObamaCare bill and the accompanying regulations now tower over 7 feet--1 foot above where I stand--when stacked together, and they have provision after provision that will deny patients the care they want, the care they need to ensure they get the life-sustaining and lifesaving treatments that are best for them.

These rationing elements in ObamaCare have been documented by a recent report of the National Right to Life Committee's Powell Center for Medical Ethics. This study is entitled ``The Affordable Health Care Act and Health Care Access in the United States.''

Perhaps most egregious about ObamaCare is that it directly inserts the Federal Government into the personal lives of Americans, their families, and their doctors.

We all know about the individual mandate that coerces people into purchasing a product they may not want by threatening to tax them. And I have often spoken about my personal nemesis in the rationing board that I am going to bring up--the Independent Payment Advisory Board, IPAB. This is a board made up of 18--15 voting and 3 nonvoting--all unelected bureaucrats who will decide what gets to stay and what must go in Medicare coverage. They will decide which treatments and services will be covered and which will not. And there is no accountability whatsoever. It would, in fact, take a two-thirds majority of the U.S. Senate to undo any of their actions. As a result, this board diminishes our constitutional responsibility.

This President has already raided half a trillion dollars from Medicare to pay for ObamaCare, and then he gave himself the ability to go after even more Medicare dollars without any accountability. This, my friends, is frightening. It is irresponsible. But there is more.

It is conceivable that the Independent Payment Advisory Board won't just limit Medicare access; it will also propose ways for the Federal Government to limit what Americans of all ages are allowed to spend out of their own private money--not taxpayer funds--to save the lives and health of their families.

Shocking but true: ObamaCare tells bureaucrats on the board to make sure we are not even allowed to keep up with medical inflation. Further, it is conceivable that the board will suggest ways for the Federal Government to impose so-called quality and efficiency standards on doctors and hospitals with the purpose of limiting the health care we can get.

So here is the deal: If a doctor dares to give her patient treatment beyond what those standards allow, the doctor will be punished. That doctor will be excluded from all of the health insurance plans qualified under ObamaCare. Unbelievably, under ObamaCare, Washington bureaucrats can dictate one uniform standard of health care that is designed to limit what private citizens are allowed to spend out of their own money to save their own lives.

But the Independent Payment Advisory Board isn't the only rationing provision in the ObamaCare or Affordable Healthcare Act. If only. ObamaCare also has a Cadillac tax for having too much health care coverage. Patients all across America need to know there is a provision of ObamaCare that punishes them and their employer if they provide coverage that is above the arbitrary limits imposed by the Federal Government. This is an additional 40-percent tax on individuals who need more expensive treatments and coverage oftentimes essential to battle life-threatening illnesses. Even worse, these ObamaCare limits were drafted in a way they will never be able to keep up with medical inflation. This means insurance companies will have to cut back even more on patient treatments and services or people will be forced to pay an incredibly higher tax.

What about those individuals who are already suffering from life- threatening illnesses who really need the care? This is why we should pass the legislation I am offering.

Do Americans know that there is a provision in ObamaCare that lets the Federal Government--not them and not their employer--decide if coverage is ``excessive or unjustified''? This isn't government- subsidized coverage in the exchanges, nor is it the federally funded Medicare and Medicaid coverage. This is their own and their employees' private money--their money. The Federal Government is given the authority to decide if the way it is being spent is excessive or unjustified, and they are going to do it through the provision of ObamaCare that allows the Obama administration to review premiums by pressuring private insurance companies to stop offering coverage or face adverse government consequences.

So far we have talked about the private coverage, but there are also similar provisions for seniors' coverage. It wasn't bad enough that the President diverted one-half trillion dollars from Medicare to pay for ObamaCare to begin with, he also granted the Department of Health and Human Services the authority to deny private market-offered coverage for services and treatments that could save your life. Before ObamaCare these private market programs such as the prescription drug program and Medicare Advantage could allow seniors to add their own money to purchase coverage they want and need beyond what the government will pay. ObamaCare allows Washington bureaucrats to deny that choice.

Folks, this isn't how we should be treating our seniors. It isn't how we should be treating people who need access to life-saving treatment and services. This isn't how we should be treating anybody.

That is why today I come to the floor to introduce the Repeal Rationing in Support of Life Act of 2014. My legislation repeals these provisions that allow the Federal Government to intercede on very personal decisions. It repeals the provisions that authorize rationing boards to deny patients the ability to access the care that may save their lives.

This legislation is relatively simple and should be supported by all of my colleagues to address some of the egregious changes from the Affordable Care Act that patients should be aware of but that many don't even know exist. This is down the road. We are trying to stay ahead of the curve. That is why I am introducing this legislation.

This legislation builds upon my Restoring Access to Medication Act. This bill repeals the provision of ObamaCare limiting a patient's right to purchase over-the-counter products with their own money. It is also a continuation of my efforts that I discussed when introducing the Four Rationers Repeal Act many times on this floor. It repeals the Independent Payment Advisory Board. It repeals the euphemistically but misleadingly named Innovation Center. It repeals the changes made to the Preventive Services Task Force and makes sure any comparative effectiveness research is used by the doctor and the patient, not coverage providers or CMS, to determine the best care for patients, not simply try to lower costs.

I really believe that in order to protect this all-important doctor- patient relationship we need to repeal and most importantly to replace ObamaCare with the real reforms that work for Kansans and all Americans. However, until we can accomplish full repeal we at least need to ensure we are protecting the life-saving care and treatment that Americans need by attacking the elements of ObamaCare that ration care, and passing the Repeal Rationing and Support of Life Act of 2014. I urge my colleagues to support this proposal and take the steps necessary to protect the lives of their constituents.

Thank you, Mr. President. I come to the floor today to also speak about ObamaCare. But before I do so, I feel the need to address some comments made on the floor of the Senate yesterday that, sadly, I find to be extremely distasteful.

Yesterday, two prominent citizens were called unpatriotic merely because they have engaged--legally, I must say--in their First Amendment right to participate in the political process. I was saddened, I was dismayed, and I was discouraged to see the floor of the Senate used as a venue for such campaign-related attacks.

In order to further their own agenda, it has become commonplace for my colleagues--especially across the aisle--to suppress the free speech and rights of certain people and organizations. These are simply people with whom they do not agree and who have had the audacity to hold views different from this administration.

Make no mistake, this is all part of a coordinated plan. I call it shaping the battlefield to tamp down--maybe that is not the right word; make that suppress--political opponents in the runup to the general election as of this fall.

We have seen repeatedly since the Citizens United decision of 2010 Members of this body trying to rein in conservative groups' ability to participate in the political process. This campaign is a direct attack, I believe, on the rights of these organizations. This campaign created an environment in which the Internal Revenue Service found it necessary and possible to single out conservative organizations for extra scrutiny. And this has made it impossible for conservative groups to participate in the last two elections, and now they are at it again in 2014. There is a short phrase which describes this, and I think it is ``abuse of power.''

This is all troubling and shocking enough, but now we have a very direct personal attack against a Kansas company whose political views some find very objectionable. What I find even more offensive is declaring on the floor the opposing views make them ``liars.'' Our Constitution grants every American the fundamental right to engage in the political process, and these folks have done so, fully within the bounds of the law.

Nothing Charles and David Koch have done or are doing is illegal. Their participation, their statements, their work is very far from un- American. Quite the opposite. It is the essence of what it means to be an American. Nothing is more fundamental to our Constitution, our way of governing, than the freedom of speech.

We should be focused on our role and responsibility of governing to make things better for the American people and not using the Senate floor to further any political agenda by making personal attacks on private citizens.

That brings me to what I came here to discuss today.

(The remarks of Mr. Roberts pertaining to the introduction of S. 2064 are printed in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. President, I yield back the remainder of my time.

Mr. President, I come to the floor today to discuss ObamaCare provisions that should be keeping my colleagues and all Americans up at night. Obviously, my views are very different from my colleagues who have just propounded their views on the same subject.

Unfortunately, since the implementation of ObamaCare began, the stories and reports have only confirmed the many warnings that I and many of my colleagues made during the debate. Most of the stories Kansans tell me now involve many hundreds of dollars in increases in monthly premiums or people simply losing their coverage. These are real stories from real Kansans, and they are not lies.

Compounding the problem, this administration has made it a routine practice to do what we call a regulations dump on Friday. This is a deliberate posting of sometimes thousands of pages of regulations during the time when the American public and the press is least likely to be paying attention.

Most recent reports from the Centers for Medicare and Medicaid Services--what we call CMS--are that millions of small businesses will face increased premium rates under ObamaCare. The President promised to make it easier for small businesses to offer coverage and, lo and behold, it may even become impossible for them to do so.

Then there are the cuts our seniors are about to face to their Medicare plans. We can't forget that the President pilfered--that is a good word, pilfered--$1 trillion from Medicare to pay for ObamaCare. These cuts have been delayed, but the most recent regulation on Part D and Medicare Advantage will be extremely detrimental to seniors' access to the availability of Medicare plans. And because of this, for once-- for once--I wish to speak about a subject where we get ahead of the curve, get in front of the next disaster, and repeal specific provisions of this law that I think will be most harmful to patients.

I have talked before about how this law comes between patients and doctors, but I think we need to bring more attention to the specter of what I call rationing--yes, rationing. In the absence of complete repeal, I urge my colleagues that these provisions must be repealed.

During the health care reform debate, and many times since then, I have spoken at length about rationing. Specifically, I want people to know about what I refer to as the four rations that are included in ObamaCare. Yes, this is a very real threat. And, yes, they will ration care.

Let me start with something called the Centers for Medicare and Medicaid Services Innovation Center. That is a pretty big, fancy government name. The Center has an enormous budget to match, aimed at finding innovative ways to reform payment and the delivery of health care. That sounds very good, but what this means is that the ``innovation center'' can now use taxpayer dollars to invest in ways to reduce patient access to care.

Let me say that again. The government can now use taxpayer dollars to invest in ways to reduce patient access to care. It gives the government new powers to cut payments to Medicare beneficiaries with the goal to reduce program expenditures. The reality is they are going to reduce patients' ability to access the care they want and need--all hidden under the cloak of innovation. And that isn't innovation at all. Even if they did give it a fancy title, folks, it is smoke and mirrors. This outfit is already pushing out all of the regulations to implement ObamaCare that are now hurting patients--all the regulations we hear about from our health care providers.

Let me move to the second ration. It grants new authorities to the U.S. Preventive Services Task Force--that is another nice-sounding entity with a long title. This Preventive Services Task Force used to be a body that was scientific and academic, that reviewed treatment, testing, and prevention information, and made recommendations for primary doctors. Nothing is wrong with that. It used to be an academic body that made recommendations, not a body pushing through mandates and regulations. Many would argue that is still what they do today. However, the effect of their recommendations is they are significantly more costly and burdensome. Because of ObamaCare, the task force can now decide what should and, more importantly, should not be covered by health plans. That is not prevention, that is rationing. If the task force doesn't recommend it, then it won't be covered by health plans and patients bear the cost of the procedure. We are seeing this already with things such as prostate exams and mammograms for breast cancer which have been so helpful to so many people--saved their lives.

The third rationer is the Patient Centered Outcomes Research Institute. Yes, that is another mouthful. This is the outfit that was given millions and millions of dollars to do comparative effectiveness research. I am not opposed to research. I don't know anyone in this body who is opposed to research, especially when it is used to inform the conversation between doctors

and their patients. But there is a reason this was formerly called cost-effective research. There is a very fine line between providing information to doctors and patients to determine the best course of care and using that information to decide whether the care or treatment is worth paying for. I have long been concerned that instead this research will be abused to arbitrarily deny patients access to potentially lifesaving treatments or services. That simply should not happen. The research should only be used for the doctor and the patient to make the best health care decision.

Finally, the fourth rationer--my personal nemesis--the Independent Payment Advisory Board--IPAD. This is a board made up of 15 unelected bureaucrats who will decide what gets to stay and what gets to go in Medicare coverage. They will decide which treatments and services will be covered and which will not, with no accountability whatsoever.

When proposed, supporters of the health care law told me: We are too close to our constituents. It is too difficult to make the hard decisions.

Then they said: Let's have somebody else do it.

That was during the debate with regard to IPAD.

I couldn't believe it. I believe we are elected to make the hard decisions and take care of the hard votes, and I believe that is the way Kansans want it, and I think that is the way virtually everybody in every other State wants it. This board diminishes our constitutional responsibility.

Even worse is the fine print of the Independent Payment Advisory Board, or IPAD. If Kansans or any Americans determine they do not like the direction the board is taking and they call my office and, down the road, any other office of any other distinguished Senator to ask me to do something about it--which is what you get when you go back home on any regulation today: what are you going to do about it?--it will take 60 votes in the Senate to overturn their decision--60.

On the surface this sounds OK until you realize that the President doubtless will never support Congress overturning the recommendation of this board made up of his bureaucrats. So he will veto it, and overriding a veto, obviously, takes a two-thirds vote. That is 66 votes to overturn a decision by the payment board.

My colleagues have been changing the rules around here because they think 60 votes is too high a threshold. What are the chances of reaching 66? But wait. There is even more. If the Secretary appoints a board unable to make recommendations for cuts to Medicare--tough decisions, albeit--then she gets the authority to make the decision of what to cut, one person.

This President has already cut $\1/2\ trillion from Medicare to pay for ObamaCare and gave himself the ability to go after even more Medicare dollars and have no accountability. This, my friends, is frightening; it is ridiculous; it is irresponsible; but it is not new.

I have been talking about the four rationers for a long time and what it means to patients, especially senior patients.

What upsets me, scares me, as I watch all the other warnings and broken promises come true, is what is going to happen to Kansans and all the folks back home when the warnings about the four rationers come true.

We need to protect the all-important doctor-patient relationship, which the four rationers put at risk. That is why today I come to the floor to introduce the Four Rationers Repeal Act of 2014.

For once, look beyond the current troubles we are experiencing. We have to get ahead of the curve. This legislation repeals the Independent Payment Advisory Board; it repeals the euphemistically but misleadingly named Innovation Center; it repeals the changes made to the Preventive Services Task Force; and it makes sure any--any-- comparative effectiveness research, called CER, is used by the doctor and patient, not coverage providers or CMS, to determine the best care for patients.

This legislation is relatively simple. It should be supported by all of my colleagues to address some of the egregious changes from ObamaCare that are about to happen just around the bend. It is time to get ahead of the curve this time, prevent it.

I really believe that in order to protect this all-important doctor- patient relationship, we need to repeal and, most importantly, replace ObamaCare with the real reforms that work for Kansans and all Americans.

However, in the meantime we can also start taking it down, piece by piece, which is what my Four Rationers Repeal Act does. I urge my colleagues to support this proposal. For once, let's get ahead of the curve.

Mr. President, I come to the floor today to discuss ObamaCare provisions that should be keeping my colleagues and all Americans up at night. Obviously, my views are very different from my colleagues who have just propounded their views on the same subject.

Unfortunately, since the implementation of ObamaCare began, the stories and reports have only confirmed the many warnings that I and many of my colleagues made during the debate. Most of the stories Kansans tell me now involve many hundreds of dollars in increases in monthly premiums or people simply losing their coverage. These are real stories from real Kansans, and they are not lies.

Compounding the problem, this administration has made it a routine practice to do what we call a regulations dump on Friday. This is a deliberate posting of sometimes thousands of pages of regulations during the time when the American public and the press is least likely to be paying attention.

Most recent reports from the Centers for Medicare and Medicaid Services--what we call CMS--are that millions of small businesses will face increased premium rates under ObamaCare. The President promised to make it easier for small businesses to offer coverage and, lo and behold, it may even become impossible for them to do so.

Then there are the cuts our seniors are about to face to their Medicare plans. We can't forget that the President pilfered--that is a good word, pilfered--$1 trillion from Medicare to pay for ObamaCare. These cuts have been delayed, but the most recent regulation on Part D and Medicare Advantage will be extremely detrimental to seniors' access to the availability of Medicare plans. And because of this, for once-- for once--I wish to speak about a subject where we get ahead of the curve, get in front of the next disaster, and repeal specific provisions of this law that I think will be most harmful to patients.

I have talked before about how this law comes between patients and doctors, but I think we need to bring more attention to the specter of what I call rationing--yes, rationing. In the absence of complete repeal, I urge my colleagues that these provisions must be repealed.

During the health care reform debate, and many times since then, I have spoken at length about rationing. Specifically, I want people to know about what I refer to as the four rations that are included in ObamaCare. Yes, this is a very real threat. And, yes, they will ration care.

Let me start with something called the Centers for Medicare and Medicaid Services Innovation Center. That is a pretty big, fancy government name. The Center has an enormous budget to match, aimed at finding innovative ways to reform payment and the delivery of health care. That sounds very good, but what this means is that the ``innovation center'' can now use taxpayer dollars to invest in ways to reduce patient access to care.

Let me say that again. The government can now use taxpayer dollars to invest in ways to reduce patient access to care. It gives the government new powers to cut payments to Medicare beneficiaries with the goal to reduce program expenditures. The reality is they are going to reduce patients' ability to access the care they want and need--all hidden under the cloak of innovation. And that isn't innovation at all. Even if they did give it a fancy title, folks, it is smoke and mirrors. This outfit is already pushing out all of the regulations to implement ObamaCare that are now hurting patients--all the regulations we hear about from our health care providers.

Let me move to the second ration. It grants new authorities to the U.S. Preventive Services Task Force--that is another nice-sounding entity with a long title. This Preventive Services Task Force used to be a body that was scientific and academic, that reviewed treatment, testing, and prevention information, and made recommendations for primary doctors. Nothing is wrong with that. It used to be an academic body that made recommendations, not a body pushing through mandates and regulations. Many would argue that is still what they do today. However, the effect of their recommendations is they are significantly more costly and burdensome. Because of ObamaCare, the task force can now decide what should and, more importantly, should not be covered by health plans. That is not prevention, that is rationing. If the task force doesn't recommend it, then it won't be covered by health plans and patients bear the cost of the procedure. We are seeing this already with things such as prostate exams and mammograms for breast cancer which have been so helpful to so many people--saved their lives.

The third rationer is the Patient Centered Outcomes Research Institute. Yes, that is another mouthful. This is the outfit that was given millions and millions of dollars to do comparative effectiveness research. I am not opposed to research. I don't know anyone in this body who is opposed to research, especially when it is used to inform the conversation between doctors

and their patients. But there is a reason this was formerly called cost-effective research. There is a very fine line between providing information to doctors and patients to determine the best course of care and using that information to decide whether the care or treatment is worth paying for. I have long been concerned that instead this research will be abused to arbitrarily deny patients access to potentially lifesaving treatments or services. That simply should not happen. The research should only be used for the doctor and the patient to make the best health care decision.

Finally, the fourth rationer--my personal nemesis--the Independent Payment Advisory Board--IPAD. This is a board made up of 15 unelected bureaucrats who will decide what gets to stay and what gets to go in Medicare coverage. They will decide which treatments and services will be covered and which will not, with no accountability whatsoever.

When proposed, supporters of the health care law told me: We are too close to our constituents. It is too difficult to make the hard decisions.

Then they said: Let's have somebody else do it.

That was during the debate with regard to IPAD.

I couldn't believe it. I believe we are elected to make the hard decisions and take care of the hard votes, and I believe that is the way Kansans want it, and I think that is the way virtually everybody in every other State wants it. This board diminishes our constitutional responsibility.

Even worse is the fine print of the Independent Payment Advisory Board, or IPAD. If Kansans or any Americans determine they do not like the direction the board is taking and they call my office and, down the road, any other office of any other distinguished Senator to ask me to do something about it--which is what you get when you go back home on any regulation today: what are you going to do about it?--it will take 60 votes in the Senate to overturn their decision--60.

On the surface this sounds OK until you realize that the President doubtless will never support Congress overturning the recommendation of this board made up of his bureaucrats. So he will veto it, and overriding a veto, obviously, takes a two-thirds vote. That is 66 votes to overturn a decision by the payment board.

My colleagues have been changing the rules around here because they think 60 votes is too high a threshold. What are the chances of reaching 66? But wait. There is even more. If the Secretary appoints a board unable to make recommendations for cuts to Medicare--tough decisions, albeit--then she gets the authority to make the decision of what to cut, one person.

This President has already cut $\1/2\ trillion from Medicare to pay for ObamaCare and gave himself the ability to go after even more Medicare dollars and have no accountability. This, my friends, is frightening; it is ridiculous; it is irresponsible; but it is not new.

I have been talking about the four rationers for a long time and what it means to patients, especially senior patients.

What upsets me, scares me, as I watch all the other warnings and broken promises come true, is what is going to happen to Kansans and all the folks back home when the warnings about the four rationers come true.

We need to protect the all-important doctor-patient relationship, which the four rationers put at risk. That is why today I come to the floor to introduce the Four Rationers Repeal Act of 2014.

For once, look beyond the current troubles we are experiencing. We have to get ahead of the curve. This legislation repeals the Independent Payment Advisory Board; it repeals the euphemistically but misleadingly named Innovation Center; it repeals the changes made to the Preventive Services Task Force; and it makes sure any--any-- comparative effectiveness research, called CER, is used by the doctor and patient, not coverage providers or CMS, to determine the best care for patients.

This legislation is relatively simple. It should be supported by all of my colleagues to address some of the egregious changes from ObamaCare that are about to happen just around the bend. It is time to get ahead of the curve this time, prevent it.

I really believe that in order to protect this all-important doctor- patient relationship, we need to repeal and, most importantly, replace ObamaCare with the real reforms that work for Kansans and all Americans.

However, in the meantime we can also start taking it down, piece by piece, which is what my Four Rationers Repeal Act does. I urge my colleagues to support this proposal. For once, let's get ahead of the curve.

Mr. President, I started my public service career fighting for rural health. In a State that has many rural hospitals, the rural health care delivery system is especially important to Kansas. One of my first speeches was to rural hospitals. Since that time, I have been beating the drum, so to speak, for our rural areas about how important it is to focus on rural health.

I have always said that people in rural towns deserve the same access to care and level of treatment as their urban counterparts. I have made it my mission to protect our rural health system and patient access to the best possible care. I am honored to serve as the cochair of the Senate Rural Health Caucus where I work with my colleagues to fight for our rural health care system every day.

Unfortunately, these days it feels as though rural health care, and all of those involved in it, face an uphill battle. Over the past few years, the rural health system has continued to face even more challenges.

Funding for rural health care programs has been targeted again and again. This year the Senate Finance Committee held a markup with regular order where we considered some of the rural extenders that are absolutely vital to our rural communities. Regrettably, we have more work to do. We have to convince and educate our colleagues, this administration, and everyone else about the importance of rural health care. We have been successful in protecting some of the ideas I have championed, especially on the rural extenders side, but we have more work to do. As this process moves forward, we need to ensure we follow regular order on the floor of the Senate and for any pay-fors for the doc fix package. While I was pleased with some of the additions that addressed rural health care in the package passed out of committee, I have concerns that these issues were not included or addressed in the most recent package introduced in the House and in the Senate.

In addition to ensuring rural health is part of any moving legislation, I wish to ensure it is a package that is offset and paid for, and this has to be done before I can support it. But the bottom line is that we, the Senate, need to return to regular order and ensure that practice does continue.

As will many of my colleagues in the Senate, I will continue to vigorously fight to rein in Federal spending and to

reduce the deficit. In order to address this fiscal crisis, I think Congress must enact basic structural changes to entitlement programs that will strengthen and preserve these programs for future generations while protecting current participants. Without real tangible reform and cuts in Federal spending, we will bankrupt the country. At the same time, we need to ensure that any of those policies we put in place do not result in a disproportionate impact on our rural health care system or restrict patients' access to the care they need. As I started saying today, this is going to be an uphill battle. But I, for one, am ready to lead the charge.

As a member of both the Finance and HELP Committees, as well as the cochair of the Rural Health Caucus, I have tried to be a leader in the discussion about the need to address the entire health system.

I have made it a point that within our health care system discussions, we need to talk about the differences between our rural areas and the care and treatment provided in those rural settings and their urban counterparts. We need to address common misconceptions about funding challenges in rural communities before taking a Lizzie Borden ax to the funding streams.

Throughout my career in public office, I have made it a point to always fight for Kansas and rural health care providers. This has been one of my top priorities in Congress. I understand the important role of rural health in America and continue to advocate for policies that protect and preserve these benefits.

Most recently, the Centers for Medicare and Medicaid Services--CMS-- have made some changes that will be particularly harmful to rural health. More specifically, their changes will force doctors into a guessing game about their patients. The condition of payment changes CMS is making would require the physician, and no other level provider, to not only predict at the time of admission to the critical access hospital that the patient will require hospital care for more than two midnights, but also that the patient can be cared for and discharged in less than 96 hours. This is an extremely narrow CMS window for the physician to make a determination about that patient's future needs-- extremely difficult, if not impossible. A physician may certify that they expect the patient to be treated and discharged within 96 hours, but, unfortunately, the patient's situation may change and they may need to be kept longer. The physician's concern will be that they have failed to meet the terms of their certification according to CMS. This is likely to lead to premature discharges and readmissions, both of which CMS has taken actions to minimize.

A CEO for one of our critical access hospitals in Council Grove, KS, writes:

This new ``condition of payment'' rule causes potential

conflicts with what is best for the patient, causes issues

for the physician in having to predict outcomes at admission

in complex cases, and may cause increased expense for

medically unnecessary transfers to more costly care centers.

Today I am introducing the Critical Access Hospital Relief Act of 2014. My bipartisan legislation would remove the condition of payment for critical access hospitals that requires a physician to certify that each patient will be discharged or transferred in less than 96 hours. This is another example of having to tell CMS, ``If it isn't broken, then there is no need to fix it.'' We need to focus on ensuring rural patients have access to their health system, not coming up with bureaucratic ways to make it harder for patients in rural areas to get quality care from their doctors.

I urge my colleagues to cosponsor the Critical Access Hospital Relief Act of 2014.

Mr. President, I started my public service career fighting for rural health. In a State that has many rural hospitals, the rural health care delivery system is especially important to Kansas. One of my first speeches was to rural hospitals. Since that time, I have been beating the drum, so to speak, for our rural areas about how important it is to focus on rural health.

I have always said that people in rural towns deserve the same access to care and level of treatment as their urban counterparts. I have made it my mission to protect our rural health system and patient access to the best possible care. I am honored to serve as the cochair of the Senate Rural Health Caucus where I work with my colleagues to fight for our rural health care system every day.

Unfortunately, these days it feels as though rural health care, and all of those involved in it, face an uphill battle. Over the past few years, the rural health system has continued to face even more challenges.

Funding for rural health care programs has been targeted again and again. This year the Senate Finance Committee held a markup with regular order where we considered some of the rural extenders that are absolutely vital to our rural communities. Regrettably, we have more work to do. We have to convince and educate our colleagues, this administration, and everyone else about the importance of rural health care. We have been successful in protecting some of the ideas I have championed, especially on the rural extenders side, but we have more work to do. As this process moves forward, we need to ensure we follow regular order on the floor of the Senate and for any pay-fors for the doc fix package. While I was pleased with some of the additions that addressed rural health care in the package passed out of committee, I have concerns that these issues were not included or addressed in the most recent package introduced in the House and in the Senate.

In addition to ensuring rural health is part of any moving legislation, I wish to ensure it is a package that is offset and paid for, and this has to be done before I can support it. But the bottom line is that we, the Senate, need to return to regular order and ensure that practice does continue.

As will many of my colleagues in the Senate, I will continue to vigorously fight to rein in Federal spending and to

reduce the deficit. In order to address this fiscal crisis, I think Congress must enact basic structural changes to entitlement programs that will strengthen and preserve these programs for future generations while protecting current participants. Without real tangible reform and cuts in Federal spending, we will bankrupt the country. At the same time, we need to ensure that any of those policies we put in place do not result in a disproportionate impact on our rural health care system or restrict patients' access to the care they need. As I started saying today, this is going to be an uphill battle. But I, for one, am ready to lead the charge.

As a member of both the Finance and HELP Committees, as well as the cochair of the Rural Health Caucus, I have tried to be a leader in the discussion about the need to address the entire health system.

I have made it a point that within our health care system discussions, we need to talk about the differences between our rural areas and the care and treatment provided in those rural settings and their urban counterparts. We need to address common misconceptions about funding challenges in rural communities before taking a Lizzie Borden ax to the funding streams.

Throughout my career in public office, I have made it a point to always fight for Kansas and rural health care providers. This has been one of my top priorities in Congress. I understand the important role of rural health in America and continue to advocate for policies that protect and preserve these benefits.

Most recently, the Centers for Medicare and Medicaid Services--CMS-- have made some changes that will be particularly harmful to rural health. More specifically, their changes will force doctors into a guessing game about their patients. The condition of payment changes CMS is making would require the physician, and no other level provider, to not only predict at the time of admission to the critical access hospital that the patient will require hospital care for more than two midnights, but also that the patient can be cared for and discharged in less than 96 hours. This is an extremely narrow CMS window for the physician to make a determination about that patient's future needs-- extremely difficult, if not impossible. A physician may certify that they expect the patient to be treated and discharged within 96 hours, but, unfortunately, the patient's situation may change and they may need to be kept longer. The physician's concern will be that they have failed to meet the terms of their certification according to CMS. This is likely to lead to premature discharges and readmissions, both of which CMS has taken actions to minimize.

A CEO for one of our critical access hospitals in Council Grove, KS, writes:

This new ``condition of payment'' rule causes potential

conflicts with what is best for the patient, causes issues

for the physician in having to predict outcomes at admission

in complex cases, and may cause increased expense for

medically unnecessary transfers to more costly care centers.

Today I am introducing the Critical Access Hospital Relief Act of 2014. My bipartisan legislation would remove the condition of payment for critical access hospitals that requires a physician to certify that each patient will be discharged or transferred in less than 96 hours. This is another example of having to tell CMS, ``If it isn't broken, then there is no need to fix it.'' We need to focus on ensuring rural patients have access to their health system, not coming up with bureaucratic ways to make it harder for patients in rural areas to get quality care from their doctors.

I urge my colleagues to cosponsor the Critical Access Hospital Relief Act of 2014.

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

Mr. President, I yield the floor. It would appear we do not have a quorum.

Mr. President, I would like first to thank my colleagues for working with Senator Flake and myself to bring this proposal forward. This is a critical issue, one that really gets straight to the heart of our American democracy.

The current investigations of the IRS clearly show it is not an overreaction to say that the Internal Revenue Service did suppress political opposition. Now, to Kansans, to Arizonans, to Texans, to Utahns all across the country, and to my colleagues, this is not only a scandal but one that is egregious.

There is a great deal more than a ``smidgen'' at stake here. It gets right to the heart of our system of government. The government must be held accountable for its actions and must

never be permitted to trample on the constitutional rights of our citizens. The behavior of the IRS in singling out select groups at their discretion for extra scrutiny and harassment just because they hold views that differ from the administration is simply outrageous.

Worse, the IRS continues to target groups whose politics it does not like even as we speak on the floor of the Senate. In fact, the proposed IRS 501(c)(4) regulations will even more directly prevent groups the IRS does not favor from really participating in the political process.

The proposed regulations would place much tougher controls on what would be considered political activity, effectively blocking the normal practice of a wide range of not-for-profit organizations, not only conservatives. Under the proposed rules, healthy debate and discussion of political issues, political candidates, and Congressional actions would be prohibited.

This is, in effect, suppression of free speech for these Americans. The proposed regulations would result in continued sanction, intimidation and harassment to these groups, and permit the Federal Government to be used as a partisan tool. We recently learned that the proposed regulations have been under development for some time. Senator Flake has just mentioned this. This is nothing new, and perhaps it is as far back as 2011. Some say even 2010.

These proposed regulations until recently have been considered off- line--my colleagues, pay attention to this--off-line. Off-line means that the regs are being considered outside the normal regulatory process, which, in my view, has been done in order to circumvent the Administrative Procedures Act. There is no transparency here.

I cannot help but think that all of this, the targeting, the slow walking of exemption applications, and the proposed regulations are part of a calculated plan to deny unfavored groups their First Amendment rights to participate in the political process of the Nation.

My colleagues, this is simple. What we are seeing is a deliberate effort to infringe the peoples' First Amendment rights. It is incredible. I never thought I would live to see the day that this would happen in the United States and we would have to be debating this. This is a copy of the Constitution of the United States--the First Amendment by James Madison. This was given to me by Robert C. Byrd, the institutional flame of the Senate, who sat right over there to the left of the distinguished ranking member from Utah, and I know who is our Republican lead in regards to the investigation of all of this in the Finance Committee.

Congress shall make no law respecting an establishment of

religion or prohibiting the free exercise thereof or

abridging the freedom of speech.

The freedom of speech, my colleagues, or the press or the right of the people peaceably to assemble and/or to petition the government for a redress of grievances.

As former chair of the Intelligence Committee, I can say that the arrogant response of the administration to the IRS actions, the denials, the evasions, the attempts to downgrade the implications of the IRS efforts, and now counteraccusations--they look like they came from some counterespionage handbook.

The real problem is that the IRS has proposed these regulations before Congress has even completed, as the Senator from Arizona pointed out, its investigation of the agency's actions in these matters. The manner in which these regulations have come up raises questions about the integrity of the rulemaking process--the exact opposite direction the agency should be taking.

Even worse, the IRS proceeds with these rules when they have done as much as possible to slow down the Finance Committee's investigation--I am a member of that committee; Senator Hatch is leading the effort on the Republican side--by responding to document requests at a glacial pace at best and redacting large amounts of critical information.

Senator Flake and I have proposed a very straightforward, very commonsense approach to this entire mess. We simply halt further action on the proposed regulations until the Justice Department and the congressional investigations by the House Ways and Means Committee and the Senate Finance Committee into the IRS actions are completed. The bill freezes further IRS action for 1 year and would make it clear that the IRS could only enforce the regulations that were in place before all this mess began.

It is no wonder, given the IRS's behavior, that Kansans and virtually every American--with very good reason--doubt that the agency can in good faith administer the Tax Code. Clearly, the IRS has no capacity to regulate any political activity without running roughshod over the people's fundamental constitutional rights.

I have said this many times, but the scandal also shows that the IRS is too big, too intrusive, and too involved in taxpayers' business. The time for us to scale it back is now. In fact, it is easily the most distrusted agency in the Federal Government. That is a shame. The IRS has become a four-letter word.

This growing lack of faith in the IRS is a very strong reason why Congress should consider a wholesale rewrite of the tax system by simplifying tax collection and reducing the government's intrusion into economic and other affairs of the public. This is the main reason I am supporting legislation to scrap the Tax Code and move to a simplified, single-rate tax system. We do not need the IRS regulating constitutionally guaranteed free speech and muzzling lawful activity in regard to politics and taking part as a partner in government.

Will Rogers once said, ``The difference between death and taxes is death doesn't get worse every time Congress meets.'' Today, Will Rogers is wrong. It is not Congress that is making things worse, it is the

Madam President, I come to the floor to discuss the recent report by the Congressional Budget Office, the CBO, which contains updated estimates of the insurance coverage provisions of the Affordable Care Act, also known as ObamaCare.

It was just on Sunday the President told Bill O'Reilly of Fox News-- in front of all America on Super Bowl Sunday--that his health care bill is working. Today, the Congressional Budget Office has changed that tune. We learned from the report that ObamaCare will now cost us $2 trillion. People may recall President Obama told the country his bill would cost less than $1 trillion. We also learned that we are expected to lose--expected to lose--2.5 million full-time jobs over the next 10 years. Finally, the CBO says exchange subsidies under the ACA will reduce incentives to work.

Let me go over that again. President Obama told the country his bill would cost less than $1 trillion. Now the CBO says it will be $2 trillion. We are expected to lose 2.5 million full-time jobs over next 10 years. Finally, CBO says exchange subsidies under the ACA will reduce incentives to work.

If this is working, what does ``broken'' mean to this President?

As I am reading this report and accompanying reaction, the most recent updates sound hauntingly familiar. In fact, I believe this is something that I and my colleagues spoke about every day during the debate on health care reform. We questioned at that time whether the CBO estimates accurately reflected the impact of ObamaCare on the American people, which leads to why I am on the floor as of this evening. This is about accountability, folks.

During the debate, we questioned whether the scoring done by the CBO was fraught with gimmicks or an unrealistic belief that Medicare would achieve significant savings in the future.

I have serious concerns with the accuracy of the scoring done on ObamaCare and its portrayal of the impact of this legislation versus the stated benefits for the American people.

We cannot keep doing this. There are people's lives at stake, people's lives that we are dealing with. The CBO projections during the health care reform debate seemed to significantly underestimate the negative impact of ObamaCare. Because of those projections, supporters were able to jam it through--one vote, everybody knows about that vote--and now the American people have to pick up the tab on the CBO's errors.

I am calling for hearings in the Finance Committee, upon which I sit, to demand CBO come before the committee and explain to the Congress and the American people why and how its scores, which led to the passage of ObamaCare, did not tell the whole story. This is about accountability for past actions, and we must ask the question, the difficult question, an unfortunate question: Was this political? Were the books cooked?

CBO needs to take the responsibility for the differences between their projections and the most recent updates just released as of this morning. We must have accurate estimates on the costs and benefits of the legislation so we can do our jobs. This shouldn't be about politics or gaming the system. This is about people's lives, and it is our responsibility to get that right. Let the hearings begin. Let the CBO provide answers. The CBO must answer this Congress and America.

I yield back the remainder of my time, and I suggest the absence of a quorum.

Mr. President, I rise this evening to discuss the Agricultural Act of 2014--the farm bill conference report.

This legislation has been delayed over 2\1/2\ years, weighing the entire time on the minds of farmers and ranchers all across the country.

Last Tuesday I came to the floor to explain why I was the only Senator on the farm bill conference not to sign the conference report and why I cannot in good conscience support this legislation. I am here today to go beyond my philosophical concerns with the direction of the legislation, and I will instead focus on how the farm bill will negatively impact agriculture in my home State of Kansas, as well as other States.

The farm bill is not a simple reauthorization or continuation of our Nation's farm and food programs. We have already done that once with the 1-year extension of the 2008 bill. Instead, the legislation before us should be a wholesale rewrite of the programs and policies at the Department of Agriculture.

When this bill is signed into law by the President and fully implemented, our producers will have to make choices among new safety net programs, new regulations, and new rules. Some of these choices will happen only once and will be irrevocable. They cannot be changed for the next 5 years. This is a 5-year bill. We owe it to these farmers, ranchers, small business owners, as well as to the next generation of producers to get this legislation right. Unfortunately, I believe the Congress has missed the mark in that the conference report goes backwards toward protectionist subsidy programs instead of forward with innovative and responsible solutions.

I am not alone in that assessment. As reported by the Kansas City Star last Friday, January 31, all four Kansas House members voted ``no'' on what is arguably the single most important piece of Federal legislation in Kansas. Now, that should grab everybody in America's attention. The entire House delegation from the wheat State was united in opposing this version of the farm bill.

It is not that we do not appreciate agriculture or the producers and their families in our State. It is entirely the opposite. We care so much that after 3 years of work, we will not settle for supporting backwards legislation just to get something done. I call it a look in the rearview mirror.

I understand compromises were made. But I cannot support a bill which marches backwards toward producers making bad decisions based off of government subsidies, retaliation against our livestock producers, and, once again, agriculture taking a disproportionate cut in spending compared--yes--to Federal nutrition programs.

When Chairperson Stabenow and I started the process of rewriting the farm bill, Kansas producers, regardless of what they planted, over and over again said their number one priority and concern was the availability of crop insurance which protects in case of disaster. They were also fully aware that direct payments would no longer be available to them, and most were OK with that direction. Kansas producers did not ask for a continuation of a target-priced subsidy program and they certainly did not want Congress to raise the target prices of all commodities.

Two years ago, in 2012, the Senate Agriculture Committee and the full Senate passed a farm bill that ended the countercyclical and commodity subsidy programs. If signed into law, the 2012 Senate farm bill would have taken the Federal Government and the Department of Agriculture out of the business of sending signals to producers, essentially telling them what crops to plant. Unfortunately, that reform was never fully realized.

We have something called the new Price Loss Coverage Program that is contained in this conference report. It

sets high fixed target prices and subsidies for all commodities and regions of the country.

Last week, after the final details of the bill were released, I talked with a young producer near Dodge City, my hometown, who is a member of my volunteer agriculture advisory council. I fondly refer to them as my ``ag posse.''

With the current cash price for wheat at the Dodge City grain elevator around $6 and a target price guaranteed for wheat set at $5.50 a bushel for the next 5 years, I asked this young, successful, and informed producer: What are you going to plant? What he told me should not surprise anyone in this body--or anyone. He said: Pat, I am going to plant wheat for the government subsidy.

His answer only reinforces one of my biggest concerns with this conference report. When the Federal Government guarantees producers a subsidy triggered off a target price, reference price, a countercylical price--whatever you want to call it--it always has and always will lead to planting and marketing distortions.

Today many producers have a college or advanced degree, often in business. They are going to evaluate the programs at the Department of Agriculture and make decisions that benefit their business's bottom line.

Instead of planting grain sorghum or corn or soybeans, my friend in western Kansas already knows he is going to plant the crop he is guaranteed to receive the highest subsidy payment from the government, not from the market. In this case, he plans to plant wheat at $5.50 per bushel over corn which has a target price of $3.70 a bushel.

I have yet to hear one explanation for why Congress is not only including target prices for corn, wheat, sorghum, soybeans, rice, peanuts, and barley but raising and fixing their prices regardless of movements in the market.

Kansas is the breadbasket of the world. So you might think Kansas producers planting more wheat would be a good thing; however, simple economics and history demonstrate why this is such a dangerous road for the Federal Government to take.

When all producers in Kansas and the rest of America have the same price guarantees and signals to plant wheat--no matter where you are-- and the majority makes the business decision to follow subsidy signals instead of the market, over time there will undoubtedly be more production than global demand or otherwise.

We will have a surplus of wheat leading to lower wheat prices. That could normally be corrected by market signals, but with the fixed target price, farmers will continue to plant wheat for the subsidy-- that subsidy guarantee--leading to further overproduction and even lower crop prices. We have been there before, and that is why we tried to reform the program several farm bills back.

This cycle of overproduction, low grain prices, and expensive support payments could eventually lead back to the days of mandatory quotas and acreage allotments--it has happened before--known as set-asides, paying farmers not to grow anything. We don't need to go back to those days. Our producers in Kansas want none of that from their Federal Government.

Besides having high fixed target prices, the new Price Loss Coverage Program sets the price guarantees so high that some are at or above the producer's cost of production. This would mean the government is essentially subsidizing a producer so much that they are guaranteed to make a profit if they have a normal or average year.

It gets worse. The early analysis I have seen shows that the target prices are high enough that rice, peanuts, and barley growers will receive a subsidy payment at least 75 percent of any given year, likely triggering a payment 4 out of the next 5 years.

Other commodities are not treated as favorably. Wheat prices are likely to trigger a payment, on average, only 35 percent of the time and soybeans less than 15 percent.

What that tells me is that the new target price guarantees are set high enough for a few commodities to trigger subsidy payments with a high frequency.

Folks, this is no longer a risk-management tool or part of a responsible safety net. Make no mistake, the Price Loss Coverage Program is nothing more than a profit protection program from some of our commodity growers.

The lone commodity that has moved out of the price supports entirely was forced to after learning the lesson the hard way.

In 2002, the World Trade Organization ruled against the United States for cotton programs, including a decoupled target price subsidy. In a settlement with Brazil, we have been paying their producers $147 million a year for damages. We are still paying them.

As much as I disagree with the backward direction of the commodity title, Kansas livestock producers may have more beef with this conference report. Kansas is in the heart of cattle country. After 3 years of drought, livestock producers in my home State are waiting for disaster assistance that has been unnecessarily delayed for over 3 years.

Yet when taking the full conference report under consideration, both the Kansas Livestock Association and the Kansas Pork Association strongly oppose this bill. Why?

In a letter sent to me by Jeff Sternberger, president of the Kansas Livestock Association, he says:

We are deeply disappointed the report does not address our

two priority issues, mandatory country-of-origin labeling

(COOL) and the Grain Inspection, Packers and Stockyards

Administration, GIPSA, rule on cattle marketing.

Mandatory country-of-origin labeling, or COOL, is a marketing program; however, our closest trading partners have found the practice anything but cool. Canada and Mexico are two of our biggest and historically strong markets for U.S. beef, pork, and chicken exports. In 2012 alone, Canada imported over $1 billion worth of U.S. beef and Mexico imported over $800 million.

If we do not come into compliance, as required by the World Trade Organization, Canada and Mexico will retaliate against the United States.

Without these markets, Kansas livestock producers will lose value on their products, negatively impacting one of the biggest drivers of our State's economy. Unfortunately, our efforts to fix COOL in the farm bill conference committee fell short--to the displeasure of our livestock producers and trading partners.

The GIPSA rule on livestock marketing should have been addressed in the final farm bill conference report as well. The House version of the farm bill had strong provisions that would have let our livestock producers make their own marketing decisions instead of GIPSA. Yet the provisions were left entirely out of the conference report with no explanation or transparency--behind closed doors.

Finally, I have to address a major inequality in the final conference report; that is, nutrition spending. When the Congressional Budget Office released their official estimate of the budgetary effects of this agriculture act, I was more than disappointed.

According to their letter:

CBO estimates that direct spending stemming from the

programs authorized by the conference agreement would total

$956 billion over the 2014 to 2023 period, of which $756

billion would be for nutrition programs.

That is almost $800 billion. By the way, that lower figure is a bet on the economy improving and people getting off the SNAP program, which would certainly be good but is not certain.

When you do the math, that means 79 percent--almost 80 percent--of the total spending in the farm bill will go to nutrition programs, including SNAP, the Supplemental Nutrition Assistance Program.

The final compromise includes $8 billion in food stamp savings mainly from tightening the Low-Income Heating and Assistance Program, the infamous LIHEAP loophole, and that is a good thing. States were gaming the system. I am all for that, but that amounts to a 1-percent reduction to the nutrition spending out of a $750 billion program if you believe the projections. I think it is probably more toward $800 billion.

The Senate Committee on Agriculture, Nutrition and Forestry recently released a statement with the headline ``Deficit Reduction: The 2014 Farm Bill,'' showcasing the savings in this legislation. The release highlights the inequality between farm and food programs:

Farm subsidy programs were cut far more significantly than

any other area of the budget under the Agriculture

Committee's

jurisdiction. By comparison, farm subsidy programs were cut

by 31 percent, while nutrition programs were reduced 1

percent.

You heard that right. Farmers, ranchers, farm broadcasters listening in, you heard that right. The farm bill once again prioritizes spending for food stamps over all other Department of Agriculture programs, including important conservation programs, research programs, and rural development programs.

I am fine with reducing farm subsidies such as the target price program, but we should have included additional reforms to the nutritional programs, which we tried to do--in several votes--in a reasonable and responsible manner. We were not touching anybody's benefits; we were just looking at the eligibility requirements. But the conference principals decided on the final compromise--again behind closed doors.

While we all want to provide much needed certainty to producers-- goodness knows it is been a long time since we had a farm bill in place--the conference missed an opportunity for greater and necessary reforms to our Nation's farm programs, burdensome regulations on livestock producers, and Federal nutrition programs.

After over 3 years of deliberation and disputes over the farm bill, our producers, consumers, taxpayers, and global trading partners expect and deserve more than what is found in this conference report.

As a conferee, I did not sign the conference report last week. That didn't give me any pleasure. As a Kansan and a Senator from a large agriculture State, I am going to vote against this rearview mirror legislation for all the reasons I have itemized.

Having said that, I do wish to take a moment to personally thank Chairperson Stabenow and Chairman Lucas, over in the House, for their unwavering drive and perseverance to finalize a farm bill. It is one thing for me to stand and criticize it and find in my heart and my mind and on behalf of my Kansas producers to vote no because I think that is the right vote, but I also know they have endeavored--Chairman Stabenow and Chairman Lucas--to at least get a bill. It is a tall task to get a majority of the Members of Congress to understand that the farm bill is not simply a bill that you pay off.

I can remember when I was chairman of the committee over in the House and I asked a colleague to help me on the farm bill. He said: Why don't you just pay it? That indicated his broad knowledge of the farm bill at that particular time.

The farm bill is not simply a bill you just pay off. It instead represents important legislation for both urban, rural States and districts and the stability of the world, if you will, knowing we have to feed 9 billion people in the next several decades. At last, the Chairs have beaten all the odds and are on the verge of completing a very complicated and time-consuming undertaking, to say the least.

I must also thank my colleagues and friends on the House and Senate agriculture committees for their knowledge, their expertise, and their diverse perspectives on agriculture. It is going to be really hard to imagine that many of the faces in the Senate agriculture committee room will not be there in person for the next farm bill 5 years down the road--Senator Tom Harkin, Senator Saxby Chambliss, both of whom will be sorely missed as they have both led the committee in their respective caucuses through previous farms bills. However, they will literally ``watch over'' the committee for years to come, because their portraits are on the wall, hanging just above us. I think their eyes move when we consider amendments.

Senator Max Baucus will continue his service to the country as the next Ambassador to China, but we will miss his advice and counsel in the committee.

Finally, it is hard to describe the void that will be created with the departure of Senator Mike Johanns of Nebraska. As the Secretary of the Department of Agriculture, he has seen both sides of the farm bill, implementing one and writing another. Even though Nebraska left the Big 12 for the Big 10, this K-State fan can admit we will all miss having this champion from the Cornhusker State around.

So although I will not vote for the farm bill conference report, I promise to all of Kansas agriculture that I fully appreciate the need for a farm bill, especially one that has been delayed for years. But while we need a farm bill, we do not need this farm bill.

I truly respect the farmers and ranchers and everybody connected with agriculture for what they do as a profession for our economy and for global stability in a troubled and angry world. I just wish the rest of this Senate would do the same thing. I will continue to work and to advocate and to champion agriculture on their behalf every single day.

Mr. President, I yield the floor.

Mr. President, I ask unanimous consent that detailees Nona McCoy and Kevin Batteh be granted floor privileges for the duration of the consideration of the conference report to accompany H.R. 2642, the farm bill.

Mr. President, I rise today to discuss the Agriculture Act of 2014. That is the new name of the farm bill.

After over 3 years of hard work by the House and Senate Agriculture Committees and other interested Members, we are finally nearing the finish line for this version of the Nation's farm and food policy.

As all Kansans and all farmers and ranchers from every State know, the farm bill impacts not only our farmers and ranchers but also businesses up and down Main Street, as well as families in our rural towns and urban cities.

Everyone in Kansas, people who work in agriculture or are impacted by its success--which, by the way, is every single American--and my colleagues in the Congress deserve to know why I was the only Senator on the conference committee not to sign the conference report as of last night. I am here today to fully explain my reasoning and why I cannot and will not vote for this legislation.

It all comes down to this simple question: Does the new farm bill improve agriculture in America? I believe the answer is, unfortunately, no.

While we all want to provide long-overdue certainty to producers-- something lacking for over 400 days, for 2 years; a record--the conference missed an opportunity for greater and necessary reforms to our Nation's farm programs, Federal nutrition programs, and burdensome regulations.

We should not march backward and pass a farm bill with more government subsidies, more regulations, and more waste.

How on Earth did we get to this point today?

Back in 2011 Chairperson Stabenow and I started the process of writing a new farm bill with a field hearing in her home State of Michigan. Later that year we held another successful hearing in Wichita, KS. After more formal hearings in the Senate and conversations with Kansas producers, Michigan producers, producers all over this country, it was clear to me that this farm bill would have to be reform-oriented, reduce the deficit, and be responsible--not only to farmers and ranchers but also to consumers and taxpayers. Unfortunately, as I stand here today, this farm bill does not meet those standards, and, taken as a whole, the conference report fails to move both Federal farm and food programs forward.

I previously voted against the Senate bill, which looked too much in the rearview mirror for outdated programs, but this report is even worse. Just listen to this: Last year's House bill was officially called the Federal Agriculture Reform and Risk Management Act-- ``reform,'' ``risk management''--and here in the Senate we passed the Agriculture Reform, Food, and Jobs Act. The final report now is reduced to the Agriculture Act, the farm bill.

Today I will focus my comments on my three biggest concerns: commodity subsidy programs, nutrition program spending, and the lack of regulatory reforms so sorely needed.

Considering we all commonly refer to the legislation as the farm bill, my first concern and criticism is the new price loss coverage program. The acronym for that is PLC. It is a subsidy program.

Back in 2012, 2 years ago, I was pleased that the Senate Agriculture Committee and the full Senate passed a bipartisan commodity title that contained real reform. We ended the current countercyclical commodity subsidy program and got the government out of the business of sending signals to producers essentially telling them which crops to plant by setting target price guarantees for producers--farming for the government, not farming for the market. Unfortunately, that reform was replaced in the latest Senate bill with a new target price subsidy program, doubled down in the House version with even higher target prices, and manipulated even more in the conference report to suit the desire of specific crops over the objections of others in different regions.

The new Price Loss Coverage Program repeats a classic government subsidy mistake: setting high fixed target prices or subsidies, which only guarantees overproduction, with long periods of low crop prices, leading to more expensive farm programs funded directly by taxpayers.

Why do we have to go down that road again? I have yet to hear one legitimate explanation for why Congress is about to tell all producers across this country that the Federal Government will guarantee the price of your wheat at $5.50 per bushel--by the way, it is a little over $6 right now at the country elevator in Dodge City--and rice at $14 per hundredweight for the next 5 years regardless of what happens in the market. We have done this before, and we know it creates planting and marketing distortions instead of letting our producers respond to market conditions.

After the World Trade Organization--the WTO--ruled against the United States for our cotton programs, I thought we had learned a lesson. I have

said it before and will say it again: The WTO stove is hot. Why would we reach out and touch it again? Remember that we are still required to pay Brazil millions of dollars a year under that decision.

The Amber Box subsidy programs in this bill will open American agriculture to global trade disputes--which we have already lost and will likely lose again if challenged.

To date, objections and solutions from me and my colleagues--ranging from South Dakota, Senator Thune; Nebraska, Senator Johanns; Iowa, Senator Grassley; and even Ohio, Representative Bob Gibbs--have all fallen on deaf and stubborn ears. Our efforts to add market orientation to the price loss coverage subsidy program, as well as attempts to end it outright, have all been blocked and are certainly not reflected in the final report.

I am equally unhappy with the final outcome of the nutrition title of the farm bill.

Partisan politics has unnecessarily infiltrated this debate, with many Members on the other side of the aisle drawing a line in the sand at zero savings or real reform to the expensive and unrestricted Supplemental Nutrition Assistance Program. That is called SNAP. It is really the food stamp program. Facts are stubborn things. Despite good intentions, SNAP--food stamps--now makes up more than 80 percent of the Department of Agriculture's budget and was previously exempted from across-the-board sequestration cuts.

What we have here today is a ballooning and expensive set of Federal nutrition programs, with a patchwork of eligibility standards, loopholes, and, frankly, unneeded bonuses to State governments for simply administering the program. If you administer the program right, you get a bonus.

I understand and sympathize with the need for nutrition assistance for hard-working families. I have championed their efforts. However, we cannot and simply should not box off SNAP from unnecessary and timely reforms.

While the Senate version of the bill in 2012 and 2013 did tighten the Low Income Home Energy Assistance Program--LIHEAP--loophole to save roughly $4 billion over 10 years, there have always been additional needed reforms to the program.

At the end of the 2012 Senate bill, I included my personal views in the report. I identified eight additional ways to rein in the out-of- control spending and reinstitute program integrity for the SNAP program.

Last year, in 2013, I introduced a stand-alone piece of legislation that would have saved a total of $36 billion in SNAP without ever touching individual monthly benefits, and it failed on a party-line vote.

Eventually, the House of Representatives passed nearly $40 billion in savings--after intense debate over there--within the SNAP program. That is a 5-percent reduction over a 10-year period. I do not see how the final legislation, amounting to a 1-percent reduction in SNAP spending, is a fair compromise between both versions of the legislation. This just does not add up.

In every single one of my townhall meetings in Kansas--and I know the Presiding Officer from West Virginia finds the same thing true in his home State--the first question fed-up producers and business owners ask is, How can we stop or even slow down the onslaught--the onslaught--of regulations?

This farm bill had great potential to help producers and ranchers and all of agriculture with reducing the crushing regulatory burden from the government's rules and requirements. They just want relief.

Despite years of work in both committees and strong provisions in the House-passed farm bill, the final legislation lacks key, commonsense, and sound science regulatory reforms.

I am more than disappointed that a WTO-compliant resolution to mandatory country-of-origin labeling--it is called COOL--was not reached. As a result, our livestock producers who were already facing drought and high feed prices, now are going to have to worry about retaliatory actions by the Governments of Canada and Mexico.

Our ranchers are equally troubled that provisions in the House bill directing the USDA to refocus their efforts on the Grain Inspection Packers and Stockyards Act, the acronym for that is GIPSA, they were excluded. Another regulatory relief provision was already cleared by the full House and the Senate ag committee would have ended the duplicative National Pollutant Discharge Elimination System. I will not try the acronym for that.

These are pesticide permits required by the Environmental Protection Agency. We had an opportunity to protect human health and eliminate duplicative, unnecessary regulatory actions, and instead, despite all of our commitments to work together to resolve the issue, we were all blocked from including the simple and necessary regulatory relief.

Each of these regulatory reforms had bipartisan support. But now producers across the country are left without an explanation and, much worse, no needed relief. I am shocked at how far some Members will go to protect this administration's regulatory agenda instead of protecting real hard-working Americans.

After all of that, let me point out that with any large piece of legislation one can usually find some positives to point to and today's farm bill is no different. While I support many of the programs in the less talked about titles of the farm bill, I am especially appreciative of the inclusion of strong crop insurance provisions and livestock disaster programs. The No. 1 issue we heard over and over again from our producers across the country and in every corner of Kansas was that crop insurance was their No. 1 one priority for the farm bill; secondly, they said get the regulations off our backs.

The policies in the final bill protect the commitment to producers by strengthening crop insurance as the cornerstone of our farm safety net, regardless of the size of their farm or the commodity they grow. As this bill moves forward, the Risk Management Agency, RMA, will be busy offering expanded coverage for commodities such as cotton that have not traditionally participated in the program as much as other crops.

However, I am concerned that the conservation compliance requirement included in the legislation on crop insurance, not on cropping operations, not on being a farmer but on crop insurance, will unnecessarily burden producers who are already good stewards of their land and already subjected to conservation requirements in the commodity programs. This is a duplication--more paperwork.

As the western half of Kansas continues to linger in a historic drought, the lack of livestock disaster programs that expired in 2011 is truly upsetting. We should have never let the programs expire in the first place. We had an opportunity in 2012 to reauthorize them, but the Senate failed to act, over my calls of action.

All of the livestock disaster programs are finally retroactively authorized. But the assistance will be too little and too late in many parts of cattle country. Some have lost part of their herds and even strains of cattle genetics.

Unfortunately, as a Kansan, as well as a member of the Senate Agriculture Committee and the farm bill conference committee, I am disappointed to say that the final policies of this farm bill do not outweigh the positives. While we all want to provide certainty to producers, the conference has missed an opportunity for greater and necessary reforms to our Nation's farm programs, Federal nutrition programs, and burdensome regulations.

After over 3 years of debate, the challenges that agriculture faces at home and across the world have only continued to grow. We need 21st century policies and innovative solutions. Instead, this bill misses the mark and goes backward to protectionist programs.

The issues I raise deserve to be debated fully and publicly. I know time is of the essence. Yet the full conference committee met only once for opening statements last October. With all of the ramifications of the farm bill, we met once last October--for 3 minutes apiece.

In truth, the majority of this bill was negotiated behind closed doors without the opportunity for votes, amendments or discussion. There is too much of that around here. Producers, consumers, and our global trading partners expected more. Unfortunately, the

U.S. taxpayers deserve better than this conference report. I did not sign this conference report last night and cannot in good conscience vote for this legislation.

But I will promise this to all of the Members who worked so hard to at least get a bill. I will continue to work and advocate on behalf of advancing agriculture.

I yield the floor.

Earlier today Senator Graham and Senator McCain spoke to this issue. I could not speak at that time as I had a conflict, but my remarks are pertinent to the issue they spoke about.

It has been an agonizing 16 months. But this week, through the investigation efforts of the House Armed Services Committee and the Senate Intelligence Committee, we have learned that circumstances surrounding the terrorist attacks on our U.S. consulate in Benghazi and the murder of four Americans, as told by this investigation, simply are not factual.

A year of news reporting and these congressional findings confirms an egregious disconnect between what the administration has alleged and the facts of what happened. As we say in Kansas, simply put: It just doesn't add up.

We now know this tragedy did not have to happen and, most certainly, the hard-to-understand actions and behaviors of those involved have added unneeded hubris, scandal, and conduct difficult to comprehend. This is a mess that still has to be cleaned up. It demands clarity, honesty, and simply owning up to the truth.

I come to the floor to discuss this tragedy not so much as a Republican Senator from Kansas, but always a Marine. I fear our lack of truth and understanding has broken a bond that those who risked their lives for our Nation all share and believe in--the bond that if they come in harm's way, we have their backs, and we will be there for them. This is a speech I wish I never had to make. But I feel compelled to make my plea to this administration yet again--specifically to President Obama--to give the American people and the families whose lives were lost in Benghazi a full accounting. It is long overdue.

A month after the attacks I wrote the President, as a Marine, with the deepest concern regarding his personal handling, and that of his administration, of the Benghazi attacks and the damage it continues to do to that sacred bond our men and women in uniform have of sacrifice for each other. That extends to those who serve our country overseas in a civilian capacity as well.

I am once again asking this President, our Commander in Chief, to actively restore the trust and sincerity once made with that promise never to leave anybody behind. If he and others responsible for this tragedy do not restore this trust, I truly believe the future morale and effectiveness of our military services are at stake.

As I travel through Kansas and speak with my constituents, regardless of their background, they want to know what really happened in Benghazi and why. Why has it taken so long to get the answers?

Many asked me directly, when will the President be forthright with the families of those killed and injured in the attacks? When will the President stop covering up the bad decisions made on September 11, 2012? Most emphatically they say, please, please, do not forget about Benghazi.

However, the response has been a dogged all too familiar tactic of delay, nonresponse, and the hope that somehow tomorrow it will all go away. Well, this is not going away.

I applaud my colleagues on the House Armed Services Committee for the recent release of 450 pages documenting these classified hearings held over the

past year. I applaud my colleagues on the Senate Select Committee on Intelligence for their report released yesterday detailing the events surrounding the attacks. The headlines from this report now read: ``Benghazi could have been prevented.''

While the results of these investigations have brought more truth to light, they have also brought more questions to mind. As a Marine, I know there is no mission our Marines cannot accomplish or complete. If press reports are accurate, I do not understand why our Marine rapid response unit was delayed by an hour--required to change out of their uniforms into plain civilian clothing--and then, ultimately, simply turned away.

Our commanders have testified it was the State Department that declined the Marines in Benghazi, yet they have been reluctant to point the finger at the State Department. Somebody made this call. Someone gave this order. Facts are stubborn things, and as more relevant facts are now becoming public, the obvious questions increase.

In the Senate Intelligence Committee's report--and I urge every Member to read this report because it is a good report--it is made clear that individuals within the administration have continued to stonewall Congress from the truth. I am not going to go into every detail here on the floor--it is all here in this report--but enough is enough.

Congress has the constitutional duty to ensure the Executive Branch does not abuse its power. That power has been abused. No one who has played a role in this debacle has been held accountable--no one--let alone brought to justice, as promised by the President. In fact, just the opposite. We have released individuals who have returned to start working on the next terrorist attack.

Likewise, this report makes it clear U.S. personnel raised alarms for months before the attacks. Requests for additional security were made by the previous Ambassador as early as February 2012. Yet, the State Department's Deputy Assistant Secretary for International Programs, Charlene Lamb, rejected the request because Libya was a ``political game,'' and the administration did not want to ``look bad,'' according to the Senate Intelligence Committee's report.

The absurdity and egregious behavior of putting politics before security is overwhelming. Lives were at stake. It has been confirmed that our top military leaders, General Ham, General Dempsey, and Secretary Panetta, knew immediately--immediately--this was a terrorist attack and not a protest. And so did the President.

We knew AQIM, AQAP, the Muhammad Jamal Network, and Ansar al- Shariah--founded by Sufian bin Qumu, a former detainee--were all involved. This just raises more questions. Why were there no contingency plans in place? We had actionable intelligence. The British left. The Red Cross left. There certainly were no flags flying in Benghazi by any western nation, and the consulate had already been attacked.

Why didn't we deploy immediately, with the assumption there would be follow-on attacks? Why were those who paid the ultimate sacrifice left to their own devices that day--on September 11--that anyone could anticipate would bring trouble?

Our generals have testified the United States was not even looking at Libya, but rather Tunisia, Egypt, and Sudan. Less than 1 year after Qadhafi, and no one was concerned about safety in Libya? Does anyone believe this assessment? Given the turmoil and danger, did the State Department really believe that we could normalize Libya? That the country was stable?

This has been an incredible example of condescending arrogance and elitism, putting politics and personal agenda ahead of protecting the lives of Americans. The insult is that 16 months later we still can't get the truth. We now know, without a shadow of doubt, there was actionable intelligence. Yet no action was taken. I personally, as a Senator and, yes, as a Marine, am fed up with the lack of accountability this administration has taken in response.

I am fed up with the stonewalling by several of those in the State Department who have ignored a request from the Intelligence Committee for testimony.

When then Secretary Clinton came before Congress to testify, she replied: ``What difference does it make?'' The difference is our Ambassador and three other patriots did not have to die. The families of Ambassador Stevens, Sean Smith, Tyrone Woods, and Glen Doherty deserve better from this country. They deserve more from this President.

With that in mind, I want to make a simple and very respectful request of the President. I simply ask that he take the opportunity during his State of the Union speech on Tuesday, January 28, to give those families and all Americans the whole story.

Mr. President, I simply ask that you be forthright with the American people. Help us get beyond this tragedy. Help us restore confidence and faith for our personnel serving overseas and in harm's way, that the sacred bond of always having their back is not gone.

Yesterday I had the opportunity to speak with 40 young Marines, all second lieutenants, who are just about to finish The Basic School at Quantico, VA. They are going to be great officers. I hope someday some of them will be Senators and Congressmen. I looked each one of them in their eyes and let them know, because they needed to know, that a bipartisan majority in this Senate has not forgotten about that promise--the same promise that was made to me when I joined the Corps. I say to President Obama: I hope you can make that promise again soon, too.

I yield the floor.

Mr. President, today I wish to stress the problems and impact the President's legacy program, the Affordable Care Act--known as ObamaCare--is having on Kansans and, for that matter, patients and people all over the country.

I know some of this has been repeated over and over. The problem is, it seems the administration continues to turn a blind eye, unfortunately, to some very egregious problems which plague the President's legacy program. Perhaps the title of my remarks should be ``Promises Made and Promises Not Kept.''

When I travel home to Kansas and talk to people involved in the rural and urban health care delivery system, folks who came to the townhall meetings because they were worried and concerned about ObamaCare to begin with, that concern turned to frustration, then it turned to fear, and now it switched back into anger. They have said: What on Earth can we do to solve some of these problems and these challenges which are directly affecting people in such an egregious way?

I think everybody now understands the rollout of the health care exchanges was a debacle. I think that is the favorite word of the people writing and providing news about this. But the point is the administration has failed to hold anyone at the Department of Health and Human Services accountable for the complete failure of the exchange, the waste of taxpayer dollars, and the confusion and headaches this has caused. I know the only one who has been held accountable--or terminated, if you will, fired--was the current contractor and they have hired a new contractor. There is news--which we would have to confirm--that the new contractor was recently fired by the National Health Service in Great Britain for being $2 billion over on the contract. That doesn't bode well if we are going to actually fix this Web site.

At the time of the rollout, the refrain was that ObamaCare is certainly more than a Web site. Similar to Nancy Pelosi's words prior to passage, we were all told: Just wait and see. That is still what the refrain is, with the presumption that things are going to work

out, it will just take time, for the American people.

Unfortunately, what I and many of my colleagues have said is coming true and a lot of people back in Kansas have told me is coming true in what they are going through, and it is the polar opposite of what was promised by this President. Again, promises made, promises not kept.

Estimates are that over 5 million people have received cancellation of their health care policies and that is just in the 35 States for which we have estimates. So much for the promise, ``if you like your plan, you can keep it,'' which has been highly publicized.

The President proposed a so-called fix to this problem, which caused insurance companies to scramble to delay things until after the midterm election, and the only person in America for whom this was convenient was the President. It is still not working.

What about the promise of less cost? A specific promise made by the President, of those people forced into the exchanges we continue to get reports--firsthand reports, I know, to everybody in the Senate and the House as well--reports that have received a lot of coverage with regard to the news media that the premiums are going up, not down, as promised by the President. There are reports of ObamaCare more than doubling people's costs and increasing deductibles by sevenfold. I am not sure that is the average, but that at least is a high one with regard to some of the reports that are still coming in, obviously becoming then more than people can afford.

It is no surprise that only 2.2 million have signed up, and 2 to 1 on that goes to Medicaid as opposed to the new program, so one can see where we are headed with regard to Medicaid and some of the challenges there. That is according to the recent estimates of the Department of Health and Human Services. That is far below what was expected.

Of those enrollees, only one-quarter of them are young and healthy individuals, and that is a problem. Without younger and healthier people in the exchanges to offset costs, we can only expect premiums to rise even higher. Once people are enrolled that is not the end of their problems, however. Some folks in Kansas are reporting that when they go to the doctor, they only then discover they do not have the insurance they thought they purchased. Some have had to cancel planned appointments with their doctors because their exchange coverage was not in order or could not be confirmed. In some of the worst cases, patients in the emergency room were forced between getting care they desperately needed or leaving to avoid high costs when their coverage could not be verified. That is exactly opposite of what the President promised--again, promises made and promises not kept.

Emergency rooms will face more problems in the future. Recent studies have shown that instead of reducing emergency room utilization as the President promised, which has been identified as a crowning achievement, people with coverage are actually accessing the emergency room more than their uninsured counterparts.

Some weeks ago I spoke about one of my favorite topics, in that as a member of the HELP Committee and the Finance Committee, the amendments that I had dealt with rationing and the worry of rationing with regard to the Affordable Health Care Act or at that time what was called PPACA, now referred to as ObamaCare or the Affordable Care Act, depending on which side you are on.

These rationing boards represent some of the more frightening aspects of the law. I have always referred to them as the four rationers. I think a colleague of mine, who is an expert on health care, actually said they are the ``Four Horsemen of the ObamaCare Apocalypse.''

Let me go down these four rationers. It gets involved, but patients and people worried about their health care coverage have every reason to worry about them.

First is the CMS Innovation Center. We know what that stands for, the CMS Innovation Center. That allows CMS to use taxpayer dollars to invest in ways to reduce patient access to care that they may want. What this means for patients is the CMS has a new and expanded power over and above what they are already doing to cut payments to Medicare beneficiaries, with the goal to reduce program expenditures but the reality being they will reduce patient access to health care, to their doctor.

Second, rationing. The new authorities granted to the U.S. Preventive Services Task Force--that is a mouthful, USPSTF--I don't know how on Earth one would pronounce that acronym, but it is the U.S. Preventive Services Task Force. These folks are to determine what should and should not be covered by health insurance. It is some unelected group of bureaucrats deciding what should and should not be covered by health insurance. What this means for patients is that if the USPSTF, the mouthful acronym doesn't recommend it, then it will not be covered by your health care plan and you will bear the cost of the procedure.

Here is the third rationing. The Patient-Centered Outcomes Research Institute, that is the PCORI, if you are discussing health care policy with CMS or the Department of Health and Human Services, does comparative effective research--comparative, effective research, CER.

To me, that is a slippery slope--that I tried to amend back during consideration within the HELP Committee and the Finance Committee, unsuccessfully on a party-line vote--that will lead to the government deciding whether the care or a treatment a patient wants is worth paying for. What this means for patients is that research could be abused to arbitrarily deny patients access to treatments or--and treatments by age or by gender or by race--services to save the government money.

If that was not enough, finally, the fourth horseman, there is everyone's nemesis, IPAB, the Independent Payment Advisory Board. We don't want to saddle up on this horse. This is a board made up of 15 unelected bureaucrats who will decide what gets to stay, what gets to go into Medicare coverage. We used to do that in this body and over in the House. It was alleged during debate that we could not make those decisions because we were too close to the people involved.

What is that all about? Isn't that what we are supposed to be doing in terms of representing the folks we represent? No, it has to go to this 15-member unelected board that will decide what gets to stay and what gets to go in Medicare coverage.

They will decide what treatments and services will be covered and which will not. The primary reason is to save money. Goodness knows we are all for saving money in the health care system--or saving money period, given our national debt and all that involves. This Board has no accountability. There is no confirmation process; they are appointed. There is no real transparency and we cannot do anything about it. I think the provision of the bill is we can say, wait a minute, they made the wrong decision on Medicare payments to hospitals or to any part of our health care delivery system, that we could by a supermajority, 67 votes, maybe change it, maybe not.

I have been talking about the four rationers for a long time and what it means to patients. I will continue to talk about that. I will come to the floor after next week and see if we can't put this together in a little bit better way so people are alert to what is going on and people are alert to what dangers lurk for them in regard to the availability of their doctor and their current way of treating themselves and their family.

What is scary about this, as I watched all the other warnings and broken promises come true, is what is going to happen to Kansas constituents and those across the country when these new warnings about ObamaCare continue to come true. The bottom line? We need to protect, we truly need to protect the all-important relationship between the doctor and the patient, which now is at risk.

In order to do that, it seems to me that small fixes are not going to do this. We need to repeal and, most importantly, replace ObamaCare with real reforms that work, not only for Kansans but everybody across the country. The whole program needs to be repealed, replaced, defunded, delayed, not just the parts that are politically convenient for the President or the parts that have yet to be decided

by the President as the Lizzy Borden ax falls in regard to those decisions. I know Kansans and the American people certainly deserve better.

I am going to talk and talk about the four rationers again in more detail. This only serves as a warning and an alert about promises made, promises not kept, but people have to understand who these four rationers are, what they intended to do, and what the dangers are and why amendments to prevent rationing were not successful in the beginning when this bill was passed.

I yield the floor and it appears to me we do not have a quorum.

Madam President, I rise to address the nomination of Cornelia Pillard for the DC Circuit. It appears to me the environment in which we are discussing these nominations is a good example of the new rules of the Senate. We are already getting a taste of the new world order around here. It did not take long. It has only been a few weeks but we are already experiencing life in the new Senate. Those in the majority who wanted to change the rules are now certainly getting their wish.

It should have been obvious that the rule change would impact the Senate in many unforeseen ways. We in the minority have had to find other ways to make our voices heard. As we watch the majority use its new power to move whomever it wants through this body, we should realize that we have started down a course from which we will never return. Indeed, we should expect more changes in the future. The majority changed the rules because it did not like how they were operating to frustrate their ambitions and agenda. If other things come about that frustrate the majority, we may have new changes to get rid of those frustrations too. The invocation of the nuclear option has set us on an irreversible course.

A few weeks ago I came to this floor and quoted our former Parliamentarian Bob Dove. He and Richard Arenberg, one-time aide to former majority leader George Mitchell, wrote a book called ``Defending the Filibuster.'' This is what they said, and it bears repeating:

If a 51-vote majority is empowered to rewrite the Senate's

rules, the day will come, as it did in the House of

Representatives, when a majority will construct rules that

give it near absolute control over amendments and debate. And

there is no going back from that. No majority in the House of

Representatives has or ever will voluntarily relinquish that

power in order to give the minority greater voice in crafting

legislation.

Unfortunately, the majority didn't seem to care about the concern these wise men raised and went ahead with their rule change anyway. Now we are feeling the effect.

This power grab is having other consequences too. Today I attended a hearing in the rules committee as the ranking member, for nominees to an agency called the Election Assistance Commission. You probably never heard of it. Madam President, I doubt if you have ever heard of it. It is a small agency with 4 commissioners--2 Democrats and 2 Republicans. Nominations to bipartisan commissions have traditionally been paired and moved jointly. This practice ensured each party has a voice in such bodies.

Before the rules were changed, the minority could be assured that their consent would be needed for appointments. That assurance is now gone. Will the majority just make its own appointments to commissions such as this now? I hope not. That is under discussion in the rules committee. But what motivation do they have to ever confirm any Republican nominee, if they so choose to even consider minority views in this regard? We are going down a dangerous path, and no one knows where it will lead.

The same is true in regard to the atmosphere that we find with the affordable health care act. For some reason, the executive has decided to make any changes to the law without really considering coming back to the Senate or the House or the Congress to make these changes. So in part I come to the floor to speak about an issue that continues to keep me up every night--and every Kansan as well--that is the implementation of this affordable health care act, the health reform law.

This is, indeed, the President's legacy legislation. Based on what I am hearing from Kansans at home, I would think the President would want to be remembered for something else entirely. Unfortunately, since the implementation of ObamaCare began, the stories and reports have only confirmed the many warnings that I and my colleagues have made during the debate for the last 3 years.

People cannot keep their coverage. Despite the many, even hundreds of promises made by this President and the supporters of this law, people are losing their coverage. Premiums are increasing, even though the President and supporters of this law said premiums would decrease by $2,500 for all Americans. Most of the stories I hear, and especially from Kansans, involve many hundreds of dollars in increases in monthly premiums.

Even more recently, folks are realizing that what they had to pay in out-of-pocket costs are going to skyrocket. Deductibles are higher and the products, drugs, and services Kansans have to pay to reach their deductible has virtually exploded. This doesn't even count the increases to copays and other costs that patients are seeing, especially with regard to prescription drugs.

This is being done in a way so that patients are getting the full information they need. So much for being the most transparent government in history.

Along these lines I believe it is my responsibility to come to the floor and remind Kansans about several other provisions of ObamaCare that patients may not be aware will put the government between the patient and the doctor--their doctor. During the health care reform debate, I spoke at length in the Health, Education, Labor, and Pensions Committee and in the Finance Committee, and on the Senate floor about something called rationing, a subject that is very controversial. Specifically, I want people to know about the four rationers--boards, commissions, whatever you want to talk about--the four rationers included in ObamaCare.

First is the CMS Innovation Center, the Center for Medicaid Services Innovation Center, which was given an enormous budget to find a way to reform payments and delivery models. What this really means is CMS can now use taxpayer dollars in ways to reduce patient access to care. It gives CMS new powers to cut payments to Medicare beneficiaries with a goal to reduce program expenditures, but the reality being that they will reduce patient access.

There are new authorities also granted to the U.S. Preventive Services Task Force. The USPSTF used to be a body that was scientific and academic, that reviewed treatment, testing, and preventive health data and made recommendations for primary care practitioners and health care systems.

I guess many would agree that is still what they do today. However, the weight of their recommendations holds significantly more weight as of today, due to the Affordable Care Act or ObamaCare. Because of this law, the health care law, the USPSTF, can now decide what should and, more importantly, should not be covered by health care plans. If the USPSTF doesn't recommend it, then it will not be covered by your health plan and you will bear the cost of the procedure. We are already seeing this with prostate exams, mammograms for breast cancer, which many people say have saved their lives. You reach a certain age and they will not do a PSA test. The same kind of criteria--with some degree--to mammograms.

Rationale No. 3, the Patient Centered Outcomes Research Institute or PCORI. This outfit was given millions and millions of dollars to do comparative effectiveness research, also known as CER. I am not opposed--I don't know of any Member in this body who is opposed--to research, especially when it is used to inform the conversation between a doctor and their patients.

But there is a reason this was formerly called cost-effective research. There is a very fine line between providing information to doctors and patients to help them make the right decision that works the best for them and then using that information to decide whether the care or treatment is worth paying for. I have long been concerned that this research will be abused to arbitrarily deny access to treatments or services in order to save the government money by Federal Government decree.

Finally, there is my personal nemesis IPAB, which stands for the Independent Payment Advisory Board, and is just now making news as various people within the media are finally recognizing IPAB. This is a board made up of 15 unelected bureaucrats who will decide what gets to stay and what gets to go in Medicare coverage. They will decide what treatments and services will be covered and which will not, all to allegedly save money with no accountability. There is no accountability whatsoever.

When proposed--I remember it well both in the HELP Committee and the Finance Committee--supporters of the health care law told me we are too close to our constituents. Really? We are too close to our constituents. It makes it too difficult to make the hard decisions. Let's have somebody else do it. It will be more fair. We know them too much. We trust them too much.

I could not believe it. I believe I am elected to make the hard decisions--I and others in this body--and take the hard votes. I believe that is the way Kansans and every other State constituency also wants it.

Even worse is the fine print of IPAB. Get this. If Kansans determine they do not like the direction the IPAB is taking and call my office, and every other office in the Senate, to ask us to do something about it--to ask me to do something about it--we in Congress can overturn their decision, but it has to be by a certain margin. On the surface this sounds OK until you realize the President will never support Congress overturning the recommendation of this Board, so he will veto it. Overriding a veto takes a two-thirds vote, which is 66 votes to overturn a decision by IPAB.

My colleagues have been changing the rules around here because they think 60 votes is too high a threshold. What are the chances of reaching 66 if a decision is made by IPAB with regard to Medicare?

But wait. There is more. If the Secretary appoints a board unable to make recommendations for cuts to Medicare, then she gets the authority to make the decision of what to cut. This President has already cut one-half trillion dollars from Medicare to pay for ObamaCare, and he gave himself the ability to go after even more Medicare dollars and have no accountability with IPAB. This is egregious, if not ridiculous, but it is not new.

I have been talking about the four rationers for a long time and what it means to patients. I will have more to say about it when the opportunity presents itself.

What scares me, as I watch all the other warnings and broken promises

come true, is what is going to happen to Kansans--and I know other Senators have this same fear--when the warnings about the four rationers do come true.

We need to protect the all-important relationship between the doctor and the patient, which I believe the four rationers put at risk. In order to do that, we need to repeal--and most important--and replace ObamaCare with real reforms that work for Kansans.