Floor Statements

Madam President, I ask unanimous consent that the order for the quorum call be rescinded.

Madam President, at 2 o'clock, I believe we are going to have a series of votes, roughly somewhere around 2 o'clock. One of them is going to be on amendment No. 3389, an amendment that I offered yesterday but chose not to speak on yesterday. I would like to take about 5 minutes just to share with my colleagues what the content of this amendment is.

In simple terms, it is a sales tax holiday amendment. I think we all agree, there is no partisan difference, that our economy is shut down; that we are in a period of anemic growth; and that with anemic growth there is no hope of reinflating employment. We are almost at a point where we need a shock and awe in our economy, something that gives confidence back to consumers, and, more importantly, to manufacturers of goods.

We have experienced, over the last several months, a replenishment of inventory of purchases that were made in the fourth quarter, predominantly because of the holidays. What we have seen since then is a decline in, or a stagnation of, retail sales. Once we get past this replenishment period, we are going to see manufacturers who look at their workforce, not with the intention of growing it but potentially of possibly shrinking it if things do not grow with the outlook.

I think we are at a point that there is not one silver bullet. I think it takes things such as tax credits to employers that help provide an avenue to bring on somebody new, but it requires something to go out the door.

So I think we have neglected in many ways two areas: one, the access to credit--and there are some bright minds in a bipartisan way working on that here--but also what do we do to stimulate economic activity.

Practically every State in the country, one time a year, at back-to- school time, announces they are going to have a sales tax holiday for the weekend limited to those items that are back-to-school items. Forget the fact that the week before there were probably 50 percent off signs, and nobody went to the store and took advantage of the 50 percent off for backpacks and pencils and paper.

All of a sudden, the no sales tax sign goes up for 2 days, and it is a mass consumer frenzy to try to buy those products while there is no sales tax. I cannot explain why. I can tell you it works.

In 2001, when we were in an economic downturn, we introduced something similar.

So what does my amendment No. 3389 do? It establishes a national tax holiday to provide a needed economic boost for small businesses and for consumers. The legislation would allow States to voluntarily choose to participate and suspend collection of sales taxes for a 10-day period to encourage greater sales.

The Federal Government, unlike in 2001, would share with States the economic cost that would be incurred in lost tax revenue during the tax suspension. The Federal share would be 75 percent of the taxes lost at the State and local level. This is cost sharing. We are going to ask the States to share at 25 percent in hopes that the increase in sales will more than make up for the 25-percent cost that States have incurred in the program.

This sales tax holiday would run for 10 days beginning the first Friday 30 days past enactment of the legislation. Now, why is that important? It is important because starting on the first Friday we get two weekend cycles in the 10-day sales tax holiday.

In my household it does not matter what day of the week it is, we will buy regardless. But there are many Americans who, because of their work schedules, because of their family schedules, the weekend is the only time they have access to do it. This legislation, I believe, would provide increased consumer confidence but, more importantly, stimulate economic activity, stimulate economic activity with tax credits for employers that begin to hire back, and match that with the capital that is needed by small businesses in the way of loans. I think all of a sudden we have a formula that we can turn this economy in the right direction. It may not be a plan to sustain it, but I think what we have to overcome is the lack of confidence of the American consumer right now.

The legislation would require the States to notify the Secretary of the Treasury within 30 days of enactment. Let me say for States, no later than 45 days after the end of the holiday, the Secretary of the Treasury would pay the participating States their 75 percent. Actually in the law it would say: You have 45 days to pay back. Hopefully, it would not be another Cash for Clunkers disaster that we had where the dealers were not reimbursed for the money they had out.

Again, let me just say, tax holidays have a successful track record at the State level. They have provoked strong retail consumer reaction. While they are still somewhat of a new phenomena, surveys and case studies are showing, and have shown, most shoppers view the sales tax holiday favorably. It is an important motivation to them to shop.

What do I have to go on to offer this legislation? I have actually talked to retailers. I have listened to them. I have asked them what would change this overnight. Without exception, they all point to one thing: Do a tax holiday and you will drastically change the number of people coming in our stores. You will drastically change how much they purchase.

This is not a tool where I am trying to create grotesque purchasing in this country. But I am trying to say to the American people, if we want to turn the economy around, if we want to start reinflating employment, it all starts with creating retail activity. We have an opportunity through this legislation to begin to create the retail activity that puts on a path to recovery.

I hope my colleagues in the next hour or so will consider this piece of legislation. I pay for it with unobligated stimulus money. Therefore, I readily expect a point of order on the Budget Act. So the likelihood is, we will not vote on this amendment, but we will vote on waiving the Budget Act. If we waive the Budget Act, that will tell you that we would then agree to this language, and then it would be up to the House to determine whether we have come up with a successful way to stimulate retail activities.

I thank my colleagues for their consideration.

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

Mr. President, I will be very brief, and we can get on with this.

My amendment is very simple. In the spirit of trying to restart this economy, get Americans back to work, what this amendment does is create a 10-day tax holiday. It is voluntary for any State that wants to participate. It would start 30 days after enactment on the first Friday so that we incorporate two weekends of sales.

We introduced this in 2001 to handle the economic downturn. States do it every year for back-to-school time. It is proven to generate retail activity. Right now we need a shock and awe to this economy if we want to get Americans back to work.

I urge my colleagues to support this amendment.

I yield the floor.

Mr. President, pursuant to section 904 of the Congressional Budget Act of 1974 and section 4(G)(3) of the statutory Pay-As-You-Go Act of 2010, I move to waive all applicable sections of those acts and applicable budget resolutions for purposes of my amendment, and I ask for the yeas and nays.

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

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

Mr. President, I ask unanimous consent to set the pending amendment aside and to call up amendment No. 3389.

Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. President, I am going to set this amendment aside and talk on it later.

I ask unanimous consent to set the pending amendment aside.

Mr. President, I call up amendment No. 3390.

Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Mr. President, there is an amendment pending by Senator Sanders to offer a $250 stipend to seniors, veterans, and those disabled to replace the lack of a cost-of-living increase, a COLA increase. As we are all aware, the formulas that drive the cost-of- living increase are predominantly affected by inflation. With the lack of inflation, seniors, veterans, and the disabled did not receive a cost-of-living increase for this year.

Senator Sanders' amendment is very clear. He wants to provide a $250 stipend. That has broad-based support within the Senate body, but I think it is responsible to say that to do this, we should pay for it. To do this, we should not print more money, borrow that money just to provide a $250 check. I think most of our Nation's seniors, veterans, and disabled would agree with that statement.

To ignore the fact that we are not paying for it would be to say that we are going to pass this stipend on to our children and our grandchildren; that we are going to take the money we are going to borrow and the debt and the obligation for that debt and we are going to pass it generationally down. As a parent of a 25-year-old and a 24- year-old, I do not think they deserve it. At some point, I hope they are both going to have children, and I do not think their children deserve for me to shove this down. And I think most Members of the Senate probably agree that it is time we start paying for it.

How does this get back? Senator Sanders makes this an emergency declaration to spend. We have a lot of priorities, and there is probably not a priority that does not deserve us to pay for it, to find somewhere where we have prioritized and decided, here is how we are going to pay for it, versus to continue to go out and borrow.

Let me remind my colleagues, we have the largest debt we have ever had. It continues to climb every day. Of every dollar we spend, we borrow 43 cents. Over the next 10 years, right now our country is obligated at $5 trillion in interest payments. That is trillion with a ``t.'' I am reminded that the most popular bumper sticker in Washington today is ``Don't tell Congress what comes after a trillion.'' I am not sure we know yet. At the rate we are going, we are going to find out. Do you know who is going to be saddled with that debt? It is going to be our children and our grandchildren. Nobody wants to leave our seniors, our veterans, and the disabled without the means they need to live. But I think even the people who are the recipients of these checks would look at us and say: Pay for it; don't put it on my grandchildren or my great grandchildren.

My amendment No. 3390 is very simple. It says this: Pay for the $250 stipend and use the unobligated stimulus money, the money we have already appropriated. We cannot borrow it twice; we can only borrow it once. Use the unobligated stimulus money, a little over $14 billion--I think it is about $14.4 billion--to pay for the stipend. Let's do the COLA, but let's, in fact, make sure that COLA is paid for. The amendment is almost identical to Senator Sanders' amendment which provides the emergency benefit; it just pays for it. I don't think there is anything unreasonable on that. The Congressional Budget Office estimates the cost of the Sanders amendment to be at 12.7 billion. I understand the Sanders amendment was modified, so that might be slightly higher. Millions of seniors and veterans are struggling on fixed incomes in this troubled economy. This amendment also provides them the ability to get through those tough times but it also gives them the comfort of looking at their grandchildren and their great- grandchildren and saying: I am not a burden on you because this was paid for. We accounted for it.

Senator Bunning came to the floor yesterday--I think we were talking about $10 billion yesterday--and he said: How can a country this great not find a way to pay for $10 billion? Well, we didn't. And as that makes its way through, we are going to borrow that $10 billion, and that $10 billion is going to equate to $10 billion of interest payments over the next 10 years. Let me say that again. What we did yesterday is going to compute to $10 billion worth of interest payments over the next 10 years. No payment down of principal, just an obligation of interest on the debt.

Maybe some are smart enough here to tell me exactly what the interest rates are going to be in the open marketplace as we finance our debt 3 years, 5 years, 10 years down the road. I don't think it is going to be where it is today. There is every indication it is going higher. So when I state the number $5 trillion over the next 10 years, you have to understand that is a static interest rate that we have applied to it. It is 3.45, is the projection of the Congressional Budget Office. And they

have said if it averages at this point, then we are going to, as a nation, owe $5 trillion, if we didn't borrow another dime. Well, not only do we continue to borrow money, but the likelihood is, with the economic conditions and with the fragile nature of the international economy, anybody who buys our debt, anybody who loans us their money is probably going to want to require more than 3.45 percent to take the risk. When countries such as Greece are on the precipice of default, it drives the international market up. It drives the cost of risk up. It will drive the cost of our risk up. What is $5 trillion today--we might not borrow another dime--may end up being next week, next month, next year $10 trillion over 5 years, just with the change in interest rate; just with what it costs us to go out and attract somebody to loan us this money.

I think I have given us a best-case scenario of saying we owe $5 trillion in the next 10 years. Excuse me, $5 trillion plus 10 more billion that we spent last night. The question is: Today, are we going to add another $14 billion to it? That is the decision in front of the Congress. My amendment, No. 3390, provides a $250 stipend. What it does that the Sanders amendment doesn't do, is it pays for it. It assures every recipient--senior, veteran, disabled person--that they are not putting the obligation of their check on their grandchildren and their great grandchildren; that we are taking the responsibility now to fund that.

I thank the Chair, and I yield the floor.

Mr. President, I will take my minute to simply say my amendment does exactly what the Sanders amendment does. It provides a $250 stipend to seniors, veterans, the disabled who did not receive a cost-of-living increase because the inflation formula did not provide one this year. The difference between mine and Sanders is novel--I actually pay for the $14 billion we are paying out to seniors, veterans, and the disabled. I am saying to every recipient of a check, we are not going to bill this to your children and grandchildren, we are going to pay for it now with money that is unobligated but already appropriated by the Congress. I think this is a reasonable approach. I think every Member should support it. We should be pleased we are doing a stipend to seniors, but we should sleep well tonight because we paid for it.

I yield the floor.

I move to waive the appropriate provisions in the Budget Act and ask for the yeas and nays.

Madam President, will my colleague yield for a question?

If, in fact, the Congress did reverse the decision of an advisory board, what does that do to the budget deficit? And what does it do to the claims that this current bill being considered is paid for?

So if the authors of this bill never intended to make cuts, then it blows the budget neutrality that is portrayed in this bill. But if they use all the mechanisms that are in place to make sure reimbursements are cut or the scope of coverage is affected by a decision to limit one's care, then we could see prevention cut, wellness programs cut, or even the preventive diagnosis such as for breast cancer limited to a much smaller group.

May I ask a question of my colleague? Listening to this list of products that have been denied people in Great Britain, and certainly this is true in some other countries, makes me look at the Medicare population in this country with the realization that the way Medicare was constructed, a senior can't pay out of pocket because no provider can receive a payment from a senior. If for some reason this bill were passed and you took part of the arsenal of drugs away from seniors or procedures away from seniors, how can a senior get a benefit if no provider can receive an out-of-pocket payment from a senior?

Madam President, I am going to be joined by a number of my colleagues, so I ask unanimous consent that we be able to have a colloquy during the remainder of our time.

Madam President, I think many Members have to ask: Why are we here? We are here because at 1 a.m. this morning, there was a cloture vote

on the consideration of the Reid managers' amendment. I think it is important that we discuss what that means. It means there are going to be no more amendments, no opportunity for any Senator from any State to propose a change to the bill. At some point, we will have an up-or-down vote on exactly what Senator Reid has presented to us.

But here is what we do know. We are going to steal $466 billion from Medicare. We are going to take that $466 billion away from hospitals, from hospice, from nursing homes, from home care, and, yes, a popular target up here--the insurance product many Americans have chosen, 20 percent of the seniors, Medicare Advantage. We are going to eliminate that option. So this is one case where if you like your health care, you are going to lose it.

The bill that we are considering and that will be voted on later this week raises $519 billion in new taxes and fees--$519 billion in new taxes. I might add for my colleagues, we are taxing tanning salons at 10 percent. What in the hell does that have to do with health care? Well, the reason it is in there is because we dropped taxing Botox. Hollywood saw this was not advantageous to have Botox taxed, so when they dropped that, they had to find something else: poor tanning salons, small businesses in every community across this country. We are going to actually tax the majority of Americans the President said he would never tax: those under $200,000, the ones who can't afford to go to the beach every weekend; the ones who don't have a beach house. They are going to pay a 10-percent tax when they go to get a little bit of a tan. Well, when they do that, how far off are we from fining parents because we don't put a high enough SPF on our children, or are we going to start charging when we go to the beach because we get exposure to the Sun? That is what happens when the government becomes a more dominant role in health care.

I might add: No doctor fix, something many of us have highlighted. In the bill, there was a 1-year fix. Doctors are going to be faced with a 21-percent cut in their reimbursements after this next 2 months. There was a 1-year fix to it. It didn't do away with the problem. It didn't fix the whole problem. But now there is no 1-year fix. We have said in 60 days doctors will be on their own.

Yes, there were some special deals--the cornhusker kickback, the windfall for Nebraska. I have to admit that I was proud of my colleague, Senator Johanns, who came to the floor and said: Let me assure you, the people in Nebraska have never asked for something different than everybody else. They are willing to pay their share of the way there. They haven't asked for it to be free for them and cost everybody else.

Yes, it will cost my constituents in North Carolina, and it will cost the constituents in Nevada--well, it won't in Nevada. I think maybe there is even a deal that affects them to some degree.

Is it fair? No, it is not fair. The fact that it wasn't fair was called: ``That is compromise.''

That is not compromise. We are here under an obligation to make this fair to all of the American people. But in this case, it is not.

Yes, there are 31 million Americans who are going to have health insurance, 15 million of whom are delegated into Medicaid, the most dysfunctional delivery system that exists in the American health care system.

Yes, there is, for many States, an unfunded mandate to those States because after 5 years, for most States, except for those who got these special deals, the States are going to be responsible for some portion, an average of 10 percent of the cost of Medicaid.

Let me tell you what my Governor, Governor Bev Perdue of North Carolina, said earlier:

The absolute dealbreaker for me as governor is a Federal

plan that shifts costs to the States.

Well, we are shifting costs to the States, and she is nowhere to be found now. But the people in North Carolina, the taxpayers of North Carolina are going to continue to be charged for this expansion of Medicaid when that is the most inefficient place for us to have put these 15 million Americans who were promised health care.

While we do all this, according to the Chief Actuary of the Centers for Medicare and Medicaid Services, CMS, 20 percent of our hospitals and nursing homes are going to go bankrupt. They are going to go out of business because as the Chief Actuary said:

They would be unprofitable within the next 10 years as a

result of these cuts.

Hospitals, nursing homes, at a time that our senior population is getting ready to explode as the baby boomers hit it, we are cutting $466 billion from Medicare, and we are starving the infrastructure of hospitals and nursing homes and hospice and home care.

What is going to happen to the providers? The Chief Actuary, again, said if we pass this plan, the result is providers will be unwilling to see Medicare and Medicaid patients.

Today, 40 percent of providers don't see Medicaid patients. Does that mean it is going to be 50 percent or 60 percent or 70 percent? We are ballooning a system that today is having a hard time finding providers. To most of us that doesn't make sense, but that is what the Senate is going to do.

I might also add that the attempt was to expand coverage; and, yes, sure, in numbers, we are expanding coverage. But, if passed, the Congressional Budget Office says 8 million to 9 million individuals who currently have employer-based health care will lose that health care. Eight million to nine million who currently have their health care will lose their health care with the passage of this bill. The net-net is not real pretty, and when you look at the $2.3 trillion that health care costs, you have to ask yourself, where is the beef? Where is the value in this?

As hospitals close, as nursing homes close, as providers don't see Medicare and Medicaid, ask yourself, have we really done something good? Chances are, you will find out if we do nothing, if we do nothing, we will actually save money in the health care system.

The last fact: The Chief Actuary of Medicare said: If you pass this bill, the cost of health care will be $\1/4\ trillion more than if we did nothing.

The President talked about bending the cost curve down. We are bending that cost curve up in this bill. We are bankrupting hospitals and nursing homes. We are chasing providers from seeing Medicare and Medicaid patients.

There are not too many things we can point to that are great about this bill. That is every reason we should start over.

I know my colleagues are here to join in and to offer some perspectives, and I would ask them to chime in.

If I can comment to my good friend, who started on a quest with me several years ago to try to put together a health care reform bill, I might say it was the first one introduced in the Congress in May of this year on comprehensive health care reform--not that it is better than anybody else's, but I can honestly say today it was true reform. I think that is what Dr. Coburn is trying to say.

In this bill, it lacks reform. What do I mean by that? Their reform is to set up an advisory panel that if we exceed the costs we have designated for health care, they are going to cut the scope of coverage or the reimbursement. So either the array of coverage for a senior or for an American is ``skinnied down'' or we cut the reimbursement to the doctor or the hospital, and they call that reform.

What Dr. Coburn and I found out, as many other Members have, is if you look at the successful companies across this country that have held down their health care costs through doing real reform--paying for prevention and wellness in work, changing the lifestyles of the employees--we saw companies that, for 4 years, had a 45-percent increase in their health care. Where is any of that in this bill? Out of 2,700-plus pages, there is no attempt to do that. There is no attempt to try to affect the lifestyles through supporting chronic disease management, prevention, and wellness, but we set up a lot of independent advisory boards.

As a matter of fact, they were so scared that in the managers' amendment, it is no longer called the Medicare independent advisory board. It is called the independent advisory board. So the word ``Medicare'' was dropped, not to signify that they are going to cut Medicare, but that is exactly what CBO and CMS have said. These will kick in. The question is, Are they sustainable or will Congress legislatively override their authority to cut the spending?

I thank our colleague from South Carolina. I know we are about to run out of time, but I wanted to go back to the Chief Actuary at Medicare because I think the way they analyzed the bill is absolutely essential for the American people to understand what is in it.

The Chief Actuary, the President's Actuary, said:

The Reid bill funds $930 billion in new spending by relying

on Medicare payment cuts which are unlikely to be sustainable

on a permanent basis.

It gets to what Dr. Coburn said. By design, maybe this could work, but there is not a will because there is not reform. We have spent a lot of money, and at the end of the day, it looks as if the only thing we have done is tried to address waste, fraud, and abuse. For $2.3 trillion, it seems as if you could bring more bacon to the table. It seems as if there would be a little more meat.

It seems as if there would be some substance there we could look at and say: Look at the improvements our health care system makes.

I know Dr. Coburn has said many times: If we do this wrong, what we do is we chase innovation out of this country, out of our system, the breakthroughs that go from maintenance to cure, the research on a bench that finds us new ways to address diabetes where amputation and blindness are not in somebody's future. If we go backward, if we chase that innovation out, we lock ourselves into not only the most costly health care but health care that achieves the least amount of quality for future generations.

I thank the good doctor, and I thank the Presiding Officer, and I yield the floor.

I do, Mr. President.

Mr. President, I look around this Chamber, and I see the busts of many Vice Presidents who have served as the leaders of this Chamber. It makes me wonder what would they think of the process in which we are currently engaged, individuals who, in a time of history of our country, took so seriously what went on in this Chamber and the effects it had on the American people.

I look at the process we are going through right now and see the way we have trivialized this process--votes in the middle of the night. Twenty-four hours ago, there was not a managers' amendment. There was not a score. Then yesterday morning we got a managers' amendment, 380- some pages, and we got a score. Today we get a notice from the Congressional Budget Office saying that in their score, they made a $\1/2\ trillion error, a $500 billion, $\1/2\ trillion error in the projection they sent to Congress. In 24 hours, $\1/2\ trillion.

Why doesn't this seem to bother those who are the authors of the bill? It is because it is not their money. It is the American people's money. That is the only way you could rationalize how you could be in Washington talking about spending $2.5 trillion at best to stop waste, fraud, and abuse, because, let's face it, Republicans and Democrats agree: There is no health care reform in here. There is a coverage expansion, but there is no health care reform.

Democrats have walked to the floor and said that we lie. I am not lying. Show me the health care reform. Show me where you have drastically changed, transformed health care. If you transform health care, then you wouldn't have to steal $464 billion from Medicare.

Regular order, Mr. President.

I appreciate that, Mr. President.

We have gone through this, and we are refused the ability to offer amendments. We are refused the opportunity to sit in the back room where the legislation was constructed. It is shared with us when they are ready. But they use everybody's money. Tell me how it is fair to the American people.

When Nebraska gets a sweetheart deal under Medicaid, and Massachusetts and Vermont, in the managers' amendment, when Nebraska is told: We are going to expand Medicaid and we are going to hold you harmless in perpetuity, you will not have to pay, tell me how that is fair to the taxpayers of Virginia, tell me how it is fair to the taxpayers of Ohio, tell me how it is fair to the taxpayers of North Carolina that they are going to pay for what Nebraskans should be obligated to pay. I believe, knowing Nebraska, that the people of Nebraska would want to pay their fair share. But, no, to buy a vote, they have been given a deal.

This bill is still $2.5 trillion. It still steals $464 billion from Medicare. It still puts a tremendous unfunded mandate on every State in this country with the exception of the State of Nebraska. There are a number of States that have a grace period for some period of time, whatever it took to get their comfort level of their vote, but for every other State, at some point they are going to be obligated to pick up that difference.

We cover 3l million Americans who were not covered--that is a wonderful thing--and 15 million of them are dumped into Medicaid, the worst health care delivery system that exists in this country, a health care system that only has the opportunity today to see 60 percent of the available doctors because the other 40 percent will not see them.

Oh, by the way, what did the Chief Actuary of the Centers for Medicare and Medicaid Services say?

The Reid bill is especially likely to result in providers

being unwilling--

Unwilling--

to treat Medicare and Medicaid patients, meaning that a

significant portion of the increased demand for Medicaid

services would be difficult to meet.

The Chief Actuary went on to say:

The CMS actuary noted that the Medicare cuts in the bill

could jeopardize Medicare beneficiaries' access to care.

I just heard the Senator from Rhode Island basically come out and say that was a fabricated thing on the part of somebody on this side of the aisle. I am quoting the Chief Actuary, the President's chief health care budgetary person. The Actuary said it ``could jeopardize Medicare beneficiaries' access to care.'' He goes on to say that he finds that roughly 20 percent of all Part A providers--hospitals, nursing homes, et cetera--would become unprofitable within the next 10 years as a result of these cuts. Hospitals will close, nursing homes will close. This isn't fabrication. This is the Chief Actuary of the Centers for Medicare & Medicaid Services, who is part of this administration. The CMS's Actuary found that further reductions in Medicare growth, through the actions of the independent Medicare advisory board--this is the advisory board that is being set up to make determinations about coverage in the future--which advocates have pointed to as a central linchpin to reducing health care spending, may be difficult to achieve in practice.

In other words, we are making claims that aren't right, it is the authors of the bill who are making claims that are not accurate, according to the Chief Actuary.

I yield to the minority leader.

The minority leader makes a great point. If we waited another day to vote, we might save another $\1/2\ trillion. That is probably in the best interest of the American taxpayer.

I will wrap up, Mr. President, because I know Dr. Coburn wants to speak. Let me say this. I said earlier this still steals $464 billion from Medicare. It also still raises taxes and fees to the tune of $519 billion. Many of those taxes and fees, by the way, are going to impact people well below the $200,000 threshold the President promised he would never touch.

We have just learned in the managers' amendment that we have dropped the doctor fix. They should be comforted in knowing that they have a 2- month extension, but the 1-year extension was dropped in the managers' amendment. Dropped. Why? Because they had to pay for what they were doling out to get extra votes.

I ask unanimous consent at this time, Mr. President, to set aside the pending amendment, and I wish to call up amendment 3134, which is a 3- year doctor fix of the SGR and ask for its immediate consideration.

Well, Mr. President, my hope is no other Member from the other side will come to the floor and say that Republicans haven't come up with substantive amendments to this bill.

Dr. Coburn and I participated in 56\1/2\ hours in the HELP Committee. We offered numerous amendments. Some technical amendments were accepted. The amendments that meant anything were rejected along party lines. We have filed a comprehensive health care reform bill--the first one introduced in Congress--in May of this year, I believe. Still, Members from the other side come to the floor and say Republicans haven't offered anything. We were the first. They may not have liked it, but we were the first.

You know what, it doesn't cost this much and it doesn't raise taxes. I think Dr. Coburn will later talk about that bill a little.

I was glad to see that politics comes from all sides. In the managers' amendment we dropped the tax on botox. Hollywood spoke out about this tax on one of their health care tools. And what did we replace it with? We have now put a 10-percent tax on tanning salons. How in the hell does that affect health care? Explain that to me. Are we going to tax everything in this country? I can make a tremendous case that the 10-percent tanning salon tax gets exactly the person that the President said he wasn't going to affect, people who make under $200,000--or are we income testing the tanning tax, too?

I yield to the Senator from Oklahoma.

The Senator makes a great point, and I am sure we have loaded the chairman of the Finance Committee with additional good ideas he can go back and think on. I am sure before it is over, we will fine parents who don't put suntan lotion on their children--especially if it doesn't meet high enough SPF to block everything the Sun might produce.

This is out of control. This is not the way to write a bill that affects one-sixth of the U.S. economy. I mean it is bad enough it is done behind closed doors, in a back room, with only a few people there, but when the No. 2 Democrat can walk on the floor and say: I haven't seen it, either--well, if the No. 2 Democrat hasn't seen it, how many people were there? How many people had input into this? Was it just Leader Reid and Senator Nelson? Was it the Presiding Officer from Minnesota? Nobody knows. Nobody knows. The truth is, and what we do know is that the American people don't like the process, and more importantly the American people don't like the bill.

The chairman of the Finance Committee and others have said: But once it is out there and they get a taste of this, they are going to like it then. Well, let me remind my colleagues: It is too late. The Chief Actuary already told us: Hospitals are going to close, nursing homes are going to close, doctors are going to quit practicing medicine. They will quit seeing Medicare and Medicaid beneficiaries. How do you repair that after you have done the damage? Are we willing to risk that for the future of this country and generations yet to come?

Boy, we have a few hours--8 or 10 hours--before we vote. I hope people get some sense. I hope they pull back from this. Let's leave for Christmas. Let's think about this. Let's go home and talk to people. Let's listen to people in this country. If we do, we might come back, get a new piece of paper, take some of the things in this bill and take some of the things we have talked about on this side of the aisle, take some of the things the American people have talked about, and find a way for 100 percent of the doctors, nurses, and hospitals to survive; find a way for 100 percent of the American people to have coverage, and not the 31 million covered in this bill, leaving 24 million outside the scope of coverage.

You see, when we set out we had three objectives: One was to cover all the American people. We flunked. Another was to invest in prevention, wellness, and chronic disease management. The doctor and I both say we haven't come anywhere close to doing that. The third and most important was to make sure it is fiscally sustainable. CBO, CMS, wherever you want to go, the only way this is fiscally sustainable is if the independent Medicare advisory board continues to cut reimbursements, the scope of coverage, to meet how much we are willing to spend on health care to say it is affordable.

I don't believe that is reform. I believe that is legislation that picks winners and losers, and that is not the role of the Senate of the United States.

I yield to the good doctor.

Mr. President, I ask unanimous consent to speak for 20 minutes.

Mr. President, as my colleague finished, he made the statement, ``when the other side comes to the table.'' Let me just say at the beginning, we have been asking to be invited to the table since the beginning of this debate. Unfortunately, we don't know where the table is. We have never been invited, and we hope before this is over we will have an opportunity to provide input into a health care bill that affects 300 million Americans.

But on this rare session, as I have heard it described, of a Sunday session of the Senate where I know the Presiding Officer of the Senate has sat in the chair for quite a while now, I am reminded of one of our colleagues, the Senator from Oklahoma, the doctor, Tom Coburn, whose mother passed away on Sunday. Sometime this weekend there is a service.

I know my colleagues join me in saying to Tom that our hearts and our prayers go out to him and to his family. My mother died in between the time I was elected to the Senate but before I was actually sworn in. She was able to see me win, but she didn't live to see me sworn in to the Senate.

I know how traumatic the loss of a parent can be. I remember, in my case, how quickly you focus on the fact that mothers have an incredible gift given to them by God--the gift of birthing children, of replenishing the next generation. I remember my focus shifted from the loss of my mother to the responsibility of my children. I think as parents we had undervalued that. That was a shock to me to make me wake up and say: I have a responsibility now to make sure that I nurture, to make sure that I raise, to make sure that I educate. It fell on my wife's and my shoulders because that is the next generation of business. That is and will be the next generation of leaders locally, at the State level, and at the national level.

Parents are invaluable but so are the kids they produce and the opportunity from there on generationally to experience what is great about this country, and that is unlimited opportunity. My responsibility is not just to nurture and to raise two sons, in my case, or in Tom's case great daughters, and one is a tremendous opera singer--probably one of the most sought after in the world--but it is also to make sure we protect the opportunities we were given, to make sure that what people have fought for in wars before are recognized to preserve the opportunity of success.

I feel as though, in our position today, that is part of our responsibility. We are here to preserve the opportunity for generations--for pages, for children, for our own kids.

So it does hurt on a rare Sunday session to have come in during one of the most difficult economic crisis periods in our country's history and watch without much thought as the Senate passed a spending bill that had a 12-percent increase from last year, something no family can do right now, something that no individual can do.

We will borrow 43 cents of every dollar that we just spent in that bill. There is no family in the world who can go into a bank today and say: I would like to borrow 43 cents on every dollar. I would like to go out and buy this big-screen TV. I don't need it, but I want it.

There are some things in this bill we need. But there is a lot in this bill we just want--over 5,000 earmarks. Members of Congress actually, at a time that we should be prioritizing our spending in this country, not only did we raise it 12 percent over last year, but we had the audacity to stick 5,244 earmarks in this bill because we can do that, because somebody asked us.

The truth is, families cannot, communities cannot, most States cannot. They have laws against it. They have to balance their budgets. Families have to balance their budgets or they file for bankruptcy. Communities have to balance their budgets and try to meet the core responsibilities of providing services to their communities. There is a choice when they do it: Do we overtax a community through property taxes or do we prioritize on what we spend our money?

We never prioritize in this institution anymore. We believe we can spend

as much as we possibly want to, and that is evidenced by 5,244 earmarks. The fact is, we just spent $3.9 billion that was not even in the bill originally when the appropriators received their caps.

I am sure the community needed their park, and I am sure that the community needed the study or the service that each one of those 5,244 earmarks represent. But let me ask this: If they need it that badly, couldn't they fund it themselves? Let me say it again.

If they need it that badly, couldn't they fund it themselves?

Why were earmarks created? It is a way to get somebody else to pay for something you want, not necessarily what you need.

Let me say to you, Mr. President, and my colleagues, to everybody listening: We are broke. We borrow 43 cents of every dollar we spend in the Federal Government right now. The 10-year projection says we are going to increase the debt in the next 10 years more than we did under the previous 43 Presidents.

What else do we need to hear to stop spending? It just continues to roll on and on.

You know what. We are going to get another opportunity next week to spend money we don't have. We are going to get an opportunity to raise the debt ceiling, something that for the 15 years I have been here was a big debate: How much do we need? When do we do it? It was a tool that we used to force us to prioritize. We are going to stick a $1.8 trillion debt ceiling increase into a Defense appropriations bill so that everybody feels guilty about voting against it if they do--and I will, for the first time, because I believe it is wrong. I believe it is wrong, and it should not be done.

Let me just say this: Sometimes you have to say no. As my children grew up, the toughest thing was to look at those kids and say no. I want this. What do you want for Christmas? I want this. No.

When I started work, I was always told in sales: The toughest thing you are ever going to have to do is say no.

I will buy it from you, but I will only pay this much. No.

We are at that point where the American people have said prioritize. We have to look at communities, we have to look at States, and we have to have guts enough to say no.

Wealth is not created by government. Wealth is not created by States. But government steals wealth when the opportunity is available.

Communities will grow, and they will be healthy, and States will grow and they will be healthy but only through local success. It does not come through handouts from the Federal Government. All that does is give us a false sense of security and a false sense of a bank account.

In the midst of all this, as we passed this huge spending bill, a 12- percent increase, we are debating health care. We are debating a $2.5 trillion health care bill that steals $464 billion from Medicare.

I talked about the transition I went through from the loss of a parent to the focus of children, and now all of a sudden I am back to stealing from my parents. As an institution, we are getting ready to steal $464 billion from Medicare, and people up here don't seem worried about it. My dad and possibly your dad and your mother have been paying into it their entire lives and were promised it would always be there.

I am going to tell you a little secret today: Medicare is underfunded by $34 trillion. That is trillion, with a ``t.'' You know the most popular bumper sticker around today is: Don't tell Congress what comes after a trillion. So Medicare is underfunded by $34 trillion. That is not a guess by an actuary, that is a real number. The Medicare board says it is insolvent in 2017--8 years from now. What are we doing? We are stealing $464 billion out of it.

I have heard people come to the floor and say they will never miss it. It would not affect a benefit. It would not affect a service. It would not affect a facility, a hospital. Now, all of a sudden over this weekend, we have been presented with news stories that suggest--because nobody has seen a bill, including many Democrats--there may be a deal that expands Medicare to include the 55-to-64-year-old age group-- potentially, 20-plus million people. I have heard other people say it is only going to be 2 million or so. I guess it will be crafted in a way that it will leave some out and put some in. I am not sure how you do that. I thought the purpose of the Federal Government was to be fair and equitable to all. But maybe this will be crafted in a way that we let 2 million 55-to-64-year-olds in and we leave the other 18 million- plus out.

Anyway, my good friend from Rhode Island talked about the CMS Actuary and what he had to say. I wasn't prepared to come today and read every editorial out of the Wall Street Journal, but had I done so, I think they would have rebutted most of what my colleague said. But let me just read a couple quotes from the Actuary--the same one Senator Whitehouse talked about.

This report says:

The Reid bill is especially likely to result in providers

being unwilling to treat Medicare and Medicaid patients.

`` . . . unwilling to treat Medicare and Medicaid patients.'' In other words, not stealing the $464 billion--well, yes, stealing the $464 billion is going to generate less interest by providers to see patients. There is only 60 percent of the doctors today seeing Medicaid patients. There is about 74 percent seeing Medicare patients.

So if you like your health insurance, you can keep your doctor, you can keep your plan. Well, that is out the window basically, based upon what the CMS Actuary said. The Actuary noted:

The Medicare cuts in the bill could jeopardize Medicare

beneficiaries' access to care.

Keep in mind, this is the President's person. Medicare cuts in the bill could jeopardize Medicare beneficiaries' access to care. He also found that roughly 20 percent of all Part A providers, which are hospitals and nursing homes--two things additionally that we specifically cut, hospitals and nursing homes--would become unprofitable within the next 10 years as a result of these cuts.

Well, my take as a businessman, not a lawyer, is that when an entity is unprofitable, they go out of business. When there is not enough revenue to meet your expenses, you close your door. So in essence, what the CMS Actuary noted in this was that hospitals and nursing homes would shut their doors. They would close. That is why Senator Conrad and others and me, who represent rural parts of the country, have tried to say to my colleagues: Pass that bill, and you eliminate rural hospitals. You eliminate the ability to provide preventative care in rural America.

When a woman in rural America gets pregnant, there will not be prenatal care there. She will have to drive 60 miles to get the prenatal care she needs, and she will never do that. But she will drive 60 miles to deliver that baby who will end up in the NIC unit, probably for weeks, because she didn't have the proper prenatal care. We will spend hundreds of thousands of dollars to treat that baby when we could have kept that local facility open to provide the level of preventative care she needed. But, no, in this it says 20 percent--20 percent--of our country's hospitals and nursing homes will close if we pass the Reid bill.

The Actuary also found that further reductions in Medicare growth rates through the actions of the Independent Medicare Advisory Board-- now, this is important, because this is what they always point to, that the Medicare Advisory Board is going to do this. The Independent Medicare Advisory Board, which advocates have pointed to as an essential linchpin in reducing health care spending--may be difficult to achieve, in practice.

In laymen's terms: They ain't gonna do it. So the independent Medicare advisory board, the CMS Actuary says it is not going to happen. Gees, how can we take the same Actuary's report and get such a different view of what the results of this bill are between me and the last speaker?

The Actuary says:

The Reid bill would cut payments to Medicare Advantage

plans by approximately $110 billion over 10 years, resulting

in less generous benefit packages and decreasing enrollment

in Medicare Advantage plans by 33 percent.

Like your insurance? You get to keep it. No. Like your doctor? You get to keep him. No. Like your hospital? You get to keep it. Not if it closes. Like your nursing home? You get to keep it.

No. The Actuary says 20 percent of them are going to go out of business. They would not be in business.

As a matter of fact, the Reid bill funds $903 billion in new Federal spending by relying on Medicare cuts. As a result, the actuary says:

Providers could find it difficult to remain profitable, and

absent legislative intervention might end their participation

in the Medicare program, possibly jeopardizing access to care

for beneficiaries.

Well, now we have eliminated the hospital, we have eliminated the nursing home, we have eliminated Medicare Advantage, and now the Actuary says the doctors, because of what we are doing, may opt out of the system.

The majority whip came to the floor earlier, and he said the Republicans will not offer a plan. For the record, and for the 100th time, Tom Coburn and I introduced comprehensive health care legislation in May. We were the first Members of Congress, House or Senate, to introduce comprehensive health care legislation. I am not sure how many times I can come to the floor and say that. Tom and I have come down and spoken hour after hour and given descriptions of what our plan does.

We don't expect it to be adopted. It has some good things in it. We would love to have some input into whatever the legislation is going to do. But make no mistake about it, just because you stick your head in a hole and do not see anything else out there doesn't mean it is not there. To come to the floor and claim that no Republicans have offered a legislative remedy to health care is to stick your head in a hole and say: I am not going to look; therefore, nothing exists.

I know I am coming to the end, and I see the ranking member of the Finance Committee wants to speak.

My good friend from Rhode Island said--I wrote it-- ``Actuaries can't cost it out.'' He said before he left the floor: ``Actuaries can't cost it out.'' Well, he may or may not be right. I can tell you this: The American people can cost it out, and the American people have said no--no to passage of this Reid health care bill. We should listen to the American people.

I yield the floor.

Madam President, I rise to reiterate exactly what my colleague just said, that transparency with the American people on the cost of this plan is absolutely essential. If you are going to tax the American people, tell them what you are going to tax. If you are going to cut their benefits, tell them what you are going to cut. Do not use smoke and mirrors to create a panacea for the people down the road to find out they have been sold a pig in a poke.

I want to talk about not what has been introduced but what has been reported in the press as to where we may go on this bill.

As many know, the bill that is under consideration that is supposed to reform health care is a bill that was crafted in a back office in the Capitol where very few people participated, and those who did participate were only Democrats. It was not until it was rolled out on the Senate floor that many of us had an opportunity to read the 2,074 pages. If the American people are like I am, we are still working our way through section by section trying to figure out exactly what it says and, more importantly, exactly what it means and, even more important than that, how does it affect me? How does it affect my family?

You see, health care is a very personal issue for everybody in this country. It is important that we display the honesty they expect from us. If, in fact, we are going to reform health care, then let's reform it. If we are going to do what we have done over the past several weeks, which is have a debate about coverage expansion, then let's be honest with the American people. Who is going to pay for it?

We know how CBO looked at the bill and how it was designed by the majority leader. They are going to steal $464 billion from Medicare. That is a fact. Nobody disagrees with that. Madam President, $464 billion would be stolen from Medicare which the Medicare trustees say will be insolvent in 2017, a mere 8 years from now. I am not sure that is fiscal responsibility, but it is in the bill.

In the last 24 hours, the press reports the majority leader has sent a new proposal to CBO, the Congressional Budget Office, because he is seeking to find out what that new proposal will cost. If the reports are correct, he has decided to drop the public option and to craft a new coverage plan for some segment of

the American people. Again, by news accounts only, that would be an expansion of coverage for individuals in this country 55 to 64. I do not know whether that is the entirety of the group. That is 24 million to 30 million people. The likelihood is if it were opened to any segment, it would be like a magnet to those who probably had some type of health condition because if you do not have a health condition, the likelihood is, in the open marketplace through your employer, if you are employed, you can find a reasonably priced plan. Automatically, the way we have designed it is we are going to attract the sickest of that population.

In the process of doing that, we have to pause for a moment and realize that we have over 40 million seniors and disabled already in Medicare. It is a system that does not reimburse for 100 percent of the services provided. In other words, for Medicare, we reimburse a doctor and a hospital less than it costs them to deliver the service. Nationally, we have accepted that because in that system, when a senior goes in under Medicare and gets a service, what is not reimbursed is then shifted over to the private sector side. It is shifted over to people who pay out of pocket. It is shifted over to people who have private insurance.

Doctors and hospitals have been successful at managing their payer mix. A lot of doctors have X amount of Medicare, X amount of Medicaid, and X amount of private pay. When they put them all together, they find a way to stay in business.

I think it is safe to say if you change the doctors' payer mix or you change the hospitals' payer mix, you could take a provider and move them from slightly profitable, enabling them to practice, over to losing money based upon how the payer mix reimburses them.

My point is, as you take people out of private pay, which is coverage by their employer under a health care plan, payment out of pocket or purchase of health insurance, where that health insurance pays at 100- plus percent of the cost of a service provided, we are basically putting 24 million possibly new additional covered lives into Medicare under Medicare reimbursements. Through that, we automatically change the payer mix of every potential provider in America. We put in jeopardy the doctor. We put in jeopardy the hospital. We put in jeopardy anybody who provides a service under Medicare.

What is the doctor going to do? The doctor can look at it and say: I can absorb the reduction and the change in the payer mix or the doctor may look at it and say: I cannot add any more Medicare beneficiaries. I am sorry, I saw you before when you were on private insurance, but I cannot continue to see you because now I do not get reimbursed sufficiently. So you are going to have to find another doctor.

Now we have gotten into the core pledges of the President where he said: If you like your plan, you get to keep it; if you like your doctor, you can continue with him. We are putting a burden on the doctor or the hospital to make a determination as to how they monitor and control their payer mix by one simple change: by increasing the opportunity for people to participate in a program that up to this time has been sacred and, I might also add, is a program that every participant has paid in their lifetime to be enrolled in.

Medicare is a trust fund. I think we forgot that, when we arbitrarily said we can take $464 billion and steal it out of Medicare and use it to fund this new entitlement. This is not our money to steal. This is the beneficiaries' money that they have paid taxes on their entire life to fund their Medicare benefits.

I am not sure why we believe we have the right to go in and move that money from one account to another, where, in essence, we are moving it from one account and using it for somebody totally different. It is unfair to those who planned a lifetime for this.

Let me go back to the payer mix. As you increase the rolls of Medicare beneficiaries, you affect the viability of every outlet of medical services--hospitals, doctors, this could also affect pharmacists. It is important that we realize we have already increased in this bill the number of individuals who will be covered under Medicaid. The majority leader's original bill mandates that every State will now raise their limit on Medicaid participation from 100 percent of poverty to 133 percent of poverty. Medicaid reimburses at about 72 cents of every dollar of service provided. When you do that, you have now enrolled between 11 million and 15 million new covered lives under Medicaid.

So every provider in the system is already looking at what has been proposed--until the press accounts of the last 24 hours--and said: I am going to have 11 million to 15 million more people. I am being reimbursed 72 cents of every dollar provided. It is hard to stay in business when it costs you a dollar to deliver a service and you get 72 cents back as payment.

They are already trying to figure out how they are going to adjust their payer mix to meet the demands when all of a sudden we come out with a new proposal that the press accounts say we could enroll 24 million people in, that further contributes to cost shift.

Let me say to my colleagues, I was in full agreement with the President when he came out and said: Here are our goals. We have to reform health care. We have to focus on making sure every American has access and affordable options to health care. We have to make sure it is fiscally sustainable.

Why, in the 21st century, would we design a health care system that we could not be certain was financially sound for generations to come?

The truth is, by every account, in a real 10-year period, 10 years of taxes and 10 years of benefits going out, this bill before the revision yesterday is a $2.5 trillion bill. It will contribute to the debt. It will borrow money that our children will be obligated to pay interest on and pay back.

This just compounds the problem, a breakthrough. This is not about policy; this is about in a back room in Washington in the U.S. Capitol, where the majority leader was trying to get to 60 votes. It is real simple.

Listen to the American people and we would start over and we would start over with the principles of the President: Make sure what you do reforms health care, attracts 100 percent of the American people because of access and affordability, and it is fiscally sustainable for generations to come.

The truth is, we have been on the Senate floor for 2 weeks. We have debated a bill that does coverage expansion. I admit openly, it covers 3l million more Americans. But it misses the mark of doing any health care reform because, you see, the bill, before the press accounts of the last 24 hours, assured every American that if they had private insurance or they paid out of pocket, their health care costs were going up. There is no way they could not.

Now what we have done is we have shifted and said we are going to increase the amount of the cost shift. Let me explain for just a minute what a cost shift is. Cost shift is when somebody goes in and is provided a medical service, and if they do not pay for that service or they do not pay the entire cost of that service, what is left over is shifted somewhere in the system. Well, somewhere in the system is the next person who walks in with insurance or who pays out of pocket. Because of the blend they have to meet, they pick up the difference.

Why has health care had such a phenomenal increase in cost? It is because as we increased the rolls of Medicaid, as we had more seniors go into Medicare, we had more costs that were shifted. Up to this point, the President, the Congress, and others were only focused on the uninsured and the underinsured. Well, they are a contributor to the cost shift, there is no question. But let me suggest to you that if we provide insurance--and we should provide access and affordability for every American. By putting people into Medicaid, all you are doing is exacerbating the cost shift. If, in fact, you create a health care system that has an incentive for an individual not to purchase their own health care because it is cheaper to pay the fine, all you are doing is exacerbating the problem of cost shift.

Health care reform is about changing the health system so that cost shift is eliminated. Quite frankly, it starts with making sure we pay 100 percent of what the cost of the services are. But we are not having that debate. This debate on the Senate floor right now, 2 weeks before Christmas, is about coverage expansion. It is not about health

care reform. If it were about health care reform, we would be talking about how we create an incentive for private companies to create products that allow an individual to construct their health insurance so that it matches their age, their income, and their health condition. That is not what we are doing. We are sitting in Washington, creating a one-size-fits-all program and saying: You know what, if this doesn't fit, well, we are going to create a government option for you, and we will subsidize you and put you in the government option. Where is that fair to the American taxpayer?

That is why Senator Crapo's motion is so important. Refer it back to committee. Start over. We have our priorities wrong as it relates to our ability to dip into the American people's pockets and use their money to fund something that is not going to benefit them one bit. This would be a different debate if we could look at the people who are not covered and say: We have fiscally maximized our ability to provide you health care but not necessarily abused the American people's pockets to do it.

America is the most compassionate country in the world. But when we debate things such as this, we are also the most foolish country in the world because it is irresponsible on our part to abuse the power of this government to spend money like this without the benefits that we set out to achieve.

So it is my hope that as we go through the weekend, we will have an opportunity to see what the new proposal is that is laid down on the table. Again, I have to go by what I read, and that is not always accurate in this town.

The CBO has stated that a similar proposal, which was a proposal for a buy-in at the age of 62, would result in an adverse selection in the Medicare Program and would drive up premiums. Let me quote CBO because I don't want it just to be me. This is what the CBO said:

A potential problem with this option is that the amount of

adverse selection that the program experienced could be

greater than anticipated, which would put upward pressure on

premiums.

CBO is the entity that is evaluating the cost of the current proposal, which nobody knows what is in it. But this was a proposal that was sent to them some time ago that had the buy-in starting at 62, not 55, and their assessment of it, with a buy-in of 62, is that the adverse selection--meaning more sick people were going to migrate to this new option--would cause upward pressure on Medicare premiums and upward pressure on premiums across the board.

So it is my hope that we will have an opportunity very soon to know what is in the proposal and to be able to debate the facts versus just trying to educate ourselves based on the leaks from the media. But there is one thing for certain: The American people have voiced their position on health care reform. They do not see it as reform. They do not see it as positively affecting themselves. They see it as too expensive, they see it as a breach of trust on a plan that seniors have become 100 percent reliant on because they paid into it.

This path has a lot of problems. It is not just the new proposals, it is the proposal that has been on the table for some time. It is my hope that we will continue this debate as long as it takes to make sure that at the end of the day we do what is right for the American people and not necessarily what is expeditious for Members who would like to be home for the holidays.

I thank the Chair, and I yield the floor.

I will make this point and ask this question: The President set out in this debate and targeted two things--quality and savings. He assured the American people that we were going to save health care and we were going to maintain quality.

Would it not be accurate to say that, as you take money away from home health, one, you remove from that population that tool that maintains disease, that keeps that from getting worse, and you chase seniors back to the hospitals for the services. So, one, the acuity of the senior patient is much worse and, two, the cost of the delivery of the service because by the time they hit the hospital, it has deteriorated. So we flunk on both points. We don't decrease cost by cutting home health, we increase it. From the standpoint of the quality, the outcome of the patient is worse because we put them into a hospital setting. Is that not what we are trying to eliminate?

The Washington Post in October of this year, talking about the story on AARP, said:

The group and its subsidiaries collected more than $650

million in royalties and other fees last year from the sale

of insurance policies, credit cards and other products that

carry the AARP name . . .

Absolutely, because it says ``the majority of its $1.14 billion in revenue'' that AARP collected, according to the tax records, were made up of sale of these insurance products.

The Senator from Arizona has stated this case very well over a number of days, and it will continue to be stated--they are cutting Medicare to fund a new government program. They are taxing the American people through drugs and devices and more money for their own insurance policies so that government can have a larger hand in health care.

You know what. At the end of the day, the American people realize now that they are going to pay more and the quality of their health care is going to go down. It is no more obvious than the current amendment on slashing the reimbursements to nursing homes or to hospice or to any other area under Medicare.

This is wrong, it should be stopped, and the American people's voices should be heard in this debate.

I thank the Senator.

Will the Senator yield for a question?

I would ask the Senator from Massachusetts, relating to the quote from Senator McCain that he showed, is the Senator aware that the day after that, factcheck.com said that was false?

Madam President, this debate to date has not been about health care reform. It has been about coverage expansion. We are learning how expensive it is not to do reform. In fact, incorporated in this bill, just short of $900 billion, we are required to offset 100 percent of it because you don't receive savings unless you reform.

When Dr. Coburn and I started work over 3\1/2\ years ago to try to figure out how you change the health care system to the most efficient, yet maintaining the same quality of care and innovation and breakthrough, we went on a search. We went to States to look at creative things that States had done. I daresay everybody trumpeted the reforms in Massachusetts. What we learned very early on was Massachusetts didn't have any reforms. They did coverage expansion. Where they used to pay for it out of the right pocket, now they paid for it out of the left pocket. They promised that coverage would be extensive and include everyone.

Where are we today, just a few years later? The companies they said they would never send bills to, they are sending an additional surcharge to the Massachusetts people, and they said everybody would be covered. This year they are throwing people off the Massachusetts plan because they don't have enough money to cover them.

Real health care reform means we are going to make sure every American has the resources to be covered or to be able to pay out of pocket because the real boogeyman of health care today is the cost shift. It is cost that is incurred when a service is delivered to you that the person or the institution delivering the service isn't reimbursed for. If they receive no payment for the service they provide, then they have to shift the cost of delivery of that service over to somebody else. The somebody else is people who privately pay. They either pay out of their pocket or they walk in with insurance, and the cost of those services is shifted to everybody who falls into that category.

Up until this debate, most Americans had thought cost shift was only generated by people who had no insurance. What we have learned in this debate is it doesn't stop there, that the cost shift is also initiated from somebody who is underinsured, meaning they haven't got enough insurance to take care of the services they need. But it doesn't stop there. For every beneficiary that Medicaid covers, we reimburse at an average rate of 72 cents of every dollar of service provided, meaning for the millions of Americans who are covered under every State Medicaid plan, we automatically cost shift 28 cents of every dollar of service they get to the private side.

As a matter of fact, for the 35 to 40 million seniors under Medicare, we reimburse at 91 cents for every dollar of service provided. Therefore, 9 cents is shifted in some fashion to the private pay side. No wonder health insurance and the cost of health care has continued to rise at an unsustainable rate. It is because we keep growing the pool of people who don't provide 100 percent of the cost of the service provided.

We are here debating a plan that they say is a reform. Well, I will give them credit for this: They do cover 31 million Americans who are not covered today. It still leaves 24 million Americans uninsured, uncovered, but they do cover 31 million. Fifty percent of that number, 15 million Americans, are going to be thrown into Medicaid in the States they live in. If the attempt is to reform health care, the first place you start is with eliminating cost shift. The first place they have started is to take the least-efficient medical delivery system in the country, Medicaid, and jam 15 million Americans into it. Forget the fact that it is an unfunded mandate to the States at some point, after the Federal Government pays 100 percent of the initial charge. We are exacerbating the problem that exists in health care today because we are putting 15 million new covered lives into Medicaid, and we know for every dollar of services they get, we are going to cost shift 28 cents of that over to people who pay out of pocket or have insurance.

The direction we have started in is flawed because we haven't tried to address the cost shift that exists in our health care system. Senator Coburn and I attacked that. After we got past Massachusetts, we looked at innovative plans such as North Carolina's for Medicaid, where they were making progress reaching new efficiencies and last year saved $200 million in their health care plan.

Most people don't know it, but Medicaid is an opt-out program. States can choose to opt out.

That word has been used a lot as we talk about health care reform in the United States, and that as long as you do an opt-out, we will be fine for a public option for the government-run system. Well, we have one of those. It is called Medicaid. It is an opt-out government health care program. How many States opt out? None. Why? Because the subsidy is so big they cannot do it.

But what happens when they want to change their plans? Let's go back to North Carolina. North Carolina would like to change their plan further, now that they have learned things they can do. They asked the Centers for Medicare and Medicaid Services for a waiver. Religiously, what happens? They are denied the waiver to change their health care plan to raise the quality and to reduce the cost.

Sound eerily similar to what we are talking about, potentially, in a health care plan we are going to roll out for the rest of the country? Maybe an opt-out plan where States could opt out, where they say it is not a government takeover. Well, if you have to go to the government and ask their permission to change it, to increase the quality of the care and to decrease the cost because of the efficiencies you get through how you design it, I will tell you that is a government-run plan, plain and simple.

We talked to self-insured companies. There was a gold mine of great ideas from companies such as Dell, SAS, Safeway, and Pitney Bowes, companies that had frozen their health care costs year after year after year. We had one simple question. How did you do it?

They looked at us and said: We invested in prevention, wellness, and chronic disease management--even to the degree that one company offered the employees who had chronic disease the ability to have a program specifically designed for them for free, if they would enter into the program. Employees in some cases chose not to go into it. The company turned around and financially rewarded them by writing them a check to get into the program.

At one company, when they wrote them a check, they had 80 percent enrollment, and in the first 18 months they saved $1,782 per employee. That is real savings. That is bending the cost curve of health care down. That is not what we are doing in this debate. Even the CBO says you are going to spend almost $900 billion and you have to raise $900 billion to do it because there is no savings because there is no reform.

So Senator Coburn and I went through that process, and we began to construct a bill. He did a majority of the work. What did we find? We found that we needed massive insurance reform in this country. As he said earlier, you cannot be excluded if you have a preexisting condition. You cannot be excluded because you get sick. What you have to have is competition.

Well, I will tell you, in this plan, where they say there is choice and competition and innovation, they actually mention choice 40 times, they mention innovation 25 times, and, believe it or not, they mention competition 13 times. Yet when they talk about taxes, fees, and revenues, they mention it 899 times. That gives the American people some insight as to where the focus of this health care bill is.

Dr. Coburn and I went exactly the opposite way. This is not a reform effort that needs to be dominated by government. We chose the carrot versus the stick. In the bill on the Senate floor we are talking about, if an individual does not buy insurance, they are fined. They are fined if they do not buy insurance. We thought the Constitution said that if you tax the American people, you have to do it equally. You have to apply the same tax to this group that you do to that group.

Through equalizing the application of taxes in this country, we were able to come up with a plan that provided every American family $5,700 per year in refundable tax credits. So every American family would get that $5,700 every year.

If, yes, we had that individual who was not married, and he or she got a $2,800 refundable tax credit, and they did not use it, we gave the States the option that they could opt them in. They could actually enroll them with that $2,800 into a high-risk catastrophic plan. We did not penalize the individual. We took what the government had provided and made sure they had insurance so that the next weekend, if they were riding their Harley-Davidson and they had a wreck and they ended up in the emergency room with no insurance, at least for the $200,000 bill to get them well, the hospital was not going to cost-shift that to somebody else because they were going to have catastrophic insurance. Maybe the hospital had to eat the first $5,000. But after that, they had an insurance policy.

But this is the difference in approaches. We are not penalizing the American people. We want them to be part of a health care system that is reformed.

We looked at Medicaid. We saw this problem with a 28-percent cost- shift. We said we have to reform Medicaid. How do you do it? We gave States the option: If you want to enroll your Medicaid beneficiaries into this new plan that we created in this new competitive insurance market, then we will double the investment in your Medicaid beneficiaries so they can have $10,000 worth of coverage through the private sector.

Again, we did not force them. We did what Dell did, what companies did: we gave them cash because we think we can increase the quality and decrease the overall cost.

Tort reform: Dr. Coburn has talked about tort reform. Every doctor has talked about tort reform and defensive medicine, how it has run up the cost of diagnostic procedures because you have to cover yourself for the one lawsuit you get.

We came up with quite a unique approach to it. We gave States three options. We gave them the ability to have arbitration, we gave them the stability to create a health court, and we said to States: If you adopt any one of these three options, we will give you a 1-percent bonus on your Medicaid. You do not have to adopt the tort reform. But if you want the 1-percent bonus on Medicaid, then you have to adopt one of the three options we have put into it.

So, in essence, what are the three things we have done in our bill, which Dr. Coburn, once again, said was the first bill introduced in the Congress of the United States? I have sat on this floor, as Dr. Coburn has, as many people have, and, yes; we have had a sharp exchange about what is in this bill and whether it is beneficial or whether it hurts. I happen to think it hurts. But I have also listened to folks on that side of the aisle say: When are Republicans going to offer something constructive? When are they going to offer a pathway?

We have. We were the first. We were ignored. We will get an opportunity to debate it as we go through this. We will get an opportunity to vote on it, I can assure you. I do not expect it to pass. But there are a lot of good things in here.

I am happy to yield.

All the Republicans voted for it and all the Democrats voted against it.

Let me conclude and give the floor back to the Senator.

There are three objectives Dr. Coburn and I set out to accomplish for all Americans in the bill. The first was to cover all Americans, make sure everybody had the capability to access affordable coverage.

Two, remember what the companies that were self-insured told us: Invest in prevention, wellness, and chronic disease management. The only direct cost savings in health care today is prevention, wellness, and chronic disease management. There are a lot of indirect savings-- tort reform, insurance reform, purchasing insurance across State lines--but the only direct savings comes from prevention, wellness, and chronic disease management.

Third, and probably most important, make sure it is financially sustainable.

Well, I do not know why, right now, we would create a health care plan in America that could not financially be sustainable for decades. Why would we create a health care plan that for the current generation entering adulthood would not live with that health care plan in a financially sustainable fashion for their lives? This one will not. It costs $2.5 trillion. It does not make it through the first 10 years.

Yet we have an option. It is an option that Republicans have already introduced. We have let the American people see it. It is not 2,074 pages. I think it is barely 240-some pages, and it incorporates much more. Oh, by the way, it fulfills--it checks all the boxes the President said we needed to do when we started on health care reform. It covers all the American people, is financially sustainable, maintains the level of quality, and it bends the cost curve down.

What is the most disappointing thing out of this debate so far? It is that we do not have to get down here to tell the American people this is going to cost them more. They know it. They know their insurance premium is going up if they have coverage today. They know the doctors are going to have to charge more because Medicare is going to cut its reimbursements. They know more doctors are going to drop seeing Medicaid beneficiaries because the reimbursements are going to continue to go down. The American people get it. That is why, in an overwhelming fashion, they are opposed to what we are here debating.

My hope is that at some point in this debate we will talk about some rational things, like what we have in the Patients' Choice Act. I do not expect it to become law, but I expect reasonable people to accept things that really do reform health care, and a lot of them are in this bill.

Madam President, I yield to my good friend.

Would the Senator yield for a question?

My question is this: It sounds as though the Patients' Choice Act allows an individual to design the coverage to meet their age, their income, and their health condition.

That is customizing your health care choice.

So one could then conclude that the current legislation we are debating in the Senate not only limits but it takes away choices that currently exist to seniors, to people who work, and to the younger generation.

But typically children are a lot less expensive to insure because they are younger and they are healthier.

What happens?

From the way the Senator has described it, the current bill that is being debated in the Senate really doesn't benefit anybody. Everybody loses.

So at best, we can claim that the bill being debated in the Senate is a $2.5 trillion bill designed to try to stop waste, fraud, and abuse in the health care system.

Think about that. We are spending $2.5 trillion to try to get waste, fraud, and abuse out of just the government side of health care. Yet the bill itself is making the government a bigger factor in health care, which means the likelihood is, because of the design not changing, you have more waste, fraud, and abuse. So there is no real value to the $2.5 trillion, except to the government workers who are hired to either collect the fines and the new taxes or sit on the panels to determine who gets coverage and who doesn't.

And save $2.5 trillion of the American people's money.

My good friend probably remembers the day we marked this up in the Health, Education, Labor, and Pensions Committee. As a matter of fact, it wasn't a day, it was 3\1/2\ weeks and 56\1/2\ hours, if I remember exactly. One of the amendments they accepted was an amendment that is titled this: The 2220 rule. My good friend being a doctor would recognize this was a program the Federal Government had to allow medical students to delay the repayment of their student loans until they actually got their practice up and running. That was eliminated about 2 years ago. I am sure the good doctor remembers that was accepted under a UC in the committee. But if you read the 2,074 pages, it was noticeably absent in the 2220 rule. Yet, as you know, we have less than a million doctors in the United States of America trying to provide medical coverage to 300 million people and growing. And some suggest that if this bill passed, we would lose 25 percent of our doctors in the first year who decided: This is it. I am going to retire. I am out of here.

The 2220 provision is the only thing we had in our bill that actually created an incentive for more individuals to seek medicine as a career.

Reimbursements.

Indian Health.

How could a group such as AARP, whose primary role, by design, is to represent our Nation's seniors, be in favor of a reform package that doesn't provide any additional benefits to our Nation's seniors?

As the Senator knows, we drastically cut Medicare Advantage, the only private sector option that a senior has for coverage. We basically eliminate that. That is 11 million seniors in this country.

If somebody didn't have Medicare Advantage as a choice, what insurance product would they have to go into the marketplace to buy?

AARP, yes. So to eliminate Medicare Advantage is a tremendous financial windfall to AARP.

That association supposedly looking out over the seniors in this country.

I ask my colleague to put that next chart up.

I ask unanimous consent for 5 additional minutes.

Madam President, this is self-explanatory, I think. Today we are borrowing 43 cents out of every dollar we spend; 43 cents of every dollar we spend in the Federal Government we are borrowing from somebody. You know, we talk about these unbelievable numbers in Washington--billions and trillions. The most popular bumper sticker out there is this: Don't tell Congress what comes after a trillion. Personally, I don't want to know, because I know if we get there, we are at the point of no return. Senator Coburn and I are close to the same age. We have kids just getting started raising families. We know what they are going to be faced with to raise their families, to make sure their children and grandchildren get educations, to make sure they go to college and have that opportunity, and make sure they have an opportunity after that for a place to work and an income. Do you know what is going to be the thing that dictates most of what they are faced with? It is right there on that chart. For every penny we borrow, it means we have an obligation to pay interest on that penny. Today interest is practically zero. We provide, as a Federal Government, money to banks they can lend out, and we charge them practically zero. That will not last forever. At some point, interest rates will go up.

Depending upon how much money we have borrowed, that will dictate how much we are obligated to pay in interest.

The Senator is absolutely correct. What we can only hope to pass on to the next generation is an opportunity equal to what we have had. To strap them with this debt, to continue to go down this road and pile on the obligations, we will limit the next generation's opportunity. As you choke that opportunity for them, you will choke the fabric of this country in a way that the problems we are faced with today are minor in comparison to what they will deal with in the future.

As we sit here and debate the pluses and minuses of this health care legislation, I remind my colleagues, when you talk about $2.5 trillion--and you probably never will save that money out of Medicare; you probably never will cut that doctors' reimbursement quite as much as in there--every time you don't do that, we are borrowing 43 cents of every dollar we spend. That is the obligation our children will inherit from us.

I am not willing to do that anymore. I want to make sure we are focused on the opportunity that is there for them. We can only do that if we do it in a responsible way, do the right thing as it relates to health care here.

Will the Senator yield for a question?

I would ask the distinguished Senator from Connecticut if we empower the independent Medicare advisory board to come up with $23.4 billion in cuts under Medicare? Can the Senator from Connecticut assure me that the independent Medicare advisory board would not find a benefit that they would suggest cutting?

If the Senator will yield for an additional question: Is this board empowered to find $23.4 billion worth of cuts?

Will the Senator show me that language?

I thank my colleague from Tennessee. I think it is important, throughout this education of the American people of what is in 2,074 pages, to remind them that for every word in here, it costs the American taxpayer $6.8 million; for every page, $1.2 billion.

I think one has to look a little further at this reform aspect. Does this bill truly reform health care? I think as you read through the bill what you find are the words ``require,'' ``must,'' or ``shall'' 4,677 times. You find the words ``tax,'' ``fee,'' or ``revenue'' 899 times. You find the word ``agency,'' ``department,'' ``bureau,'' ``commission,'' or ``panel'' 470 times. But we are told this bill does reform health care. We are told it increases competition, it provides more choice, it stimulates innovation. Yet we find the word ``choice'' 40 times. We find the word ``innovation'' 25 times. We find the word ``competition'' 13 times.

I suspect their intent is to fix what they haven't reformed by allowing the Secretary of Health and Human Services, in 1,677 spots, to define or determine what congressional intent was. Think about that. This bill basically turns over a lot of the decisionmaking to the current or future Secretaries of Health and Human Services to decide what we meant in the Congress.

Well, my good friend from Tennessee raised a lot of things on Medicaid, and I wish to talk about Medicaid, but I also wish to mention that, once again, we are paying for this by cutting $464 billion from our Nation's seniors. That is a trust fund. They have paid in premiums. Similar to the CLASS Act--it shouldn't be a surprise to us that they are going to steal money out of the CLASS Act that hasn't even been created yet because in the bill it is taking $464 billion from seniors who have paid into it for a lifetime, and within that group of seniors, 11 million seniors are going to have their benefits cut because they chose Medicare Advantage as their preferred insurance product. It is not a question of whether they can keep what they have; they can't keep it because their benefits are going to be cut, and that affects America's low-income seniors the most.

As a matter of fact, in this bill, we fix doctor payments for 1 year. So, in 2011, doctors' reimbursements are going to be cut 23 percent. I see Dr. Barrasso on the floor. So we know more doctors are going to stop covering Medicare beneficiaries. The pool is going to get smaller. We are going to affect every senior's health.

The Senator from Tennessee is 100 percent correct. Today, 40 percent of our Nation's physicians under Medicaid will not see patients because the reimbursements are so low.

Reform in health care means you have to eliminate cost shifting. As Dr. Barrasso knows, cost shifting means when somebody goes in for a service, gets health care delivered, and doesn't pay or somebody goes in who is underinsured, gets delivered a service, and their reimbursement doesn't sufficiently meet the needs of the cost of that service delivered. But it doesn't stop there. Medicaid reimburses at 72 cents of every dollar of service provided. Today, for every Medicaid beneficiary in America, every time they receive a service from a doctor, a hospital, or wherever, 28 cents is shifted over to the private side to those who pay out of pocket, to those who have private insurance.

If you are reforming health care, you can't reform health care without eliminating cost shifting. Yet in this plan, we increase the rolls of Medicaid by 15 million individuals. In essence, what that means is we are going to have cost shifting on steroids now. We are going to have more cost shifting than we had before, which means a higher inflation rate on private health care, that which we pay out of pocket or that which employers, in fact, provide for their employees.

As a matter of fact, incorporated in this bill is a disincentive for small business success. I am not sure everybody has read to that point in the bill yet, but for a company that today can't afford, because of their competition to offer health care--the day they hire their 51st employee, the Federal Government will send them a tax bill of $38,250. At a time when we have 10.2 percent unemployment, 11 percent in North Carolina, small business is going to be the engine of job creation in this country, and we are saying as soon as you are successful enough that you hire the 51st person, if you don't offer the health care we tell you you have to offer, we are going to send you a tax bill of $38,250.

Unfortunately, it doesn't stop there. For the Medicaid beneficiaries, for the Medicare beneficiaries, for everybody in America where we have said drugs are too high, devices are expensive, innovation costs money, what are we going to do? We are going to tax drug companies. We are going to tax medical device companies. We are going to actually raise the cost of our ability to detect something earlier, where our options are greater and, hopefully, through having those options earlier, in fact, we are going to be able to treat a disease or cure it much cheaper.

I might add it is somewhat ironic that we are going to tax vaccines at a time when the industry is trying to meet the needs for vaccines for H1N1 across this country. This bill puts a new tax on the vaccine industry we have tried to revitalize in America.

Let me suggest to my colleagues, this is not a health care bill. This is a layaway plan. In fact, what we have been presented is a plan where they are asking Americans to pay for it for a number of years--4, to be exact--before they get their product. We are going to pay in, in taxes; we are going to pay in, in Medicare shift; we are going to begin to increase the rolls in Medicaid, to wait 4 years down the road before we get the product, before we get any benefit out of it. What we are going to find

4 years down the road is that costs change. You see, it sold as a $849 billion plan today, an $849 billion health care reform package. Well, that is not what it is. If you look at it truly over 10 years, it is a $1.2 trillion plan. If you wait to start until the benefits are paid and look at it for a real 10 years of revenue and benefits, it is a $2.5 trillion plan.

We can't even be honest enough with the American people that we tell them exactly what it is going to cost. But you would expect that out of a layaway plan, and, in fact, that is what we have in front of us.

Let me suggest to my colleagues that if you reform health care, you can have coverage expansion without additional taxpayer investment. You can't take the things that are broken in our system and actually increase their use, such as Medicaid, and expect at the end of the day you are going to be able to save money, provide a better level of care; more importantly, that you are going to have a population that gets the benefits everybody else does: a medical home, preventive care, chronic disease management. It doesn't happen in Medicaid today. It will not happen when you increase the rolls of Medicaid. It will only happen when you reform health care, and this bill does not do it.

I thank my colleague from Tennessee.

I thank my colleagues from New Hampshire and Wyoming. Let me say on the same note, an $800 billion-plus bill, when you ask anybody in America, do you think this will increase the deficit, everybody's hand goes up. But the claim is that this is deficit neutral, that there is no no continuation of increasing the debt. Let me pick three areas, one you were just talking about, Medicare. This bill proposes that we shift $464 billion over 10 years to pay for this new program.

But in that 10-year period, if you took Medicare, the proposal to shift over, if you face the reality that we will not cut doctor reimbursements 23 percent, which is another $246 billion worth of revenue, and the creation of a new program called the CLASS Act actually has people paying in for 20 years before the first person might take out a benefit, those three items alone come to $700 billion of the $800 billion we are paying for it with. Most Members would agree there are cuts that probably will never happen. On the face, it says it is going to contribute to the deficit. It will continue to add to the deficit at greater numbers, as the ranking member of the Budget Committee has stated.

But let me try to point out something I know my colleagues understand. This is a bill about coverage expansion. This is not a bill about health care reform. There are very few reforms, if any, in this bill. The Senator from Wyoming was talking earlier about Medicaid. One of the fundamental reforms that has to be made in health care is that we have to eliminate cost shifting where an individual who is uninsured goes in, receives a service, does not pay, and the cost is shifted to the private side, with people who pay out of pocket, people who have insurance. For the underinsured, the person goes in and receives a service, but the reimbursement is less than the cost of the service, and what is left over is shifted. Usually that is where the debate stops.

But under Medicaid, the current system, we reimburse 72 cents of every $1 provided, meaning 28 cents is shifted to the private pay side, out-of-pocket and insured side. In this reform package, we are increasing the rolls of Medicaid by 15 million Americans. We are taking a program today where, if the attempt is to eliminate cost shift--which it should be in health care reform--we would be eliminating Medicaid and we would be putting the Medicaid beneficiaries in a program that actually provided them a medical home, provided them an opportunity at prevention, wellness, and chronic disease management.

But, no, we are keeping Medicaid intact. And in the bill it says to the States: You cannot change your program. You have a maintenance of effort. You may find a more efficient way to do it, but if that efficiency means you are cutting any benefit, you are asking them to select where they choose health care differently, you cannot do that, States. We are locking you in for 10 years. And we are going to increase the rolls in Medicaid by 15 million Americans. We are actually exacerbating the problem we are trying to solve, which is, either shifting from people who do not pay or where there are reimbursements that underreimburse for a service. We are increasing the rolls by 15 million Americans.

Forget the fact, as the good doctor from Wyoming knows, that when you lock them into Medicaid, you have locked them out of having a medical home. You have locked them into a system that is there to treat them when they get sick and not to spend a dime on trying to keep them well. The truth is, health care reform, in large measure, is about our ability to change the lifestyles of the American people so we make healthier choices.

In part, you do that by creating a medical home. It is the reason most of us, if not all of us, have argued that everybody should be covered in some fashion. Health care should be accessible and affordable. The debate is over: where and what type. And, more importantly, should the American people have the ability to have choice? Should the American people have the ability to construct a health care plan that meets their age, their income, and their health conditions?

What we are doing is, we are taking on a one-size-fits-all government approach to say: If you do not like what is out there, we are not going to let what is out there change. We will give you an option, and it is to be insured and to be managed and to be run by the Federal Government.

I am not sure how others in other States have found it. In North Carolina, it has been overwhelmingly rejected by the population. I daresay, I think we have the greatest health care delivery system in North Carolina, both public and private, some based in academia. I think what North Carolina says is: Do not hurt my quality of care. If we are going to talk about reforms, let's talk about how we increase the quality of care, not decrease it.

Unfortunately, this misses the boat on reform. It is the most expensive approach to coverage expansion that anybody could ever imagine. The question is, if we took some time, if we worked in a bipartisan way, could we find a way to do this more efficiently and more effectively for quality of care, where the outcome was different?

This is a town obsessed with process, as my colleagues know. This is a product where we should be focused on outcome, not process. Because at the end of the day, there is an American family who is going to be the recipient of the rules, the regulations, and also the outcome of what this produces.

I think the Senator makes a good point. I think many in the Congress who have worked on health care for a period of time have seen private businesses across this country reach new efficiencies in health care. Why? Because they have self-insured their employees. Where have they focused? They have focused on exactly what the Senator has talked about: prevention, wellness, chronic disease management, paying employees to enroll in chronic disease management courses, working with dietitians to make sure they lose weight, having cessation programs that are offered for free.

The things we have seen in private companies across the country that have brought down health care costs are absent in this piece of legislation. It is as though they have come to Washington and shared their tremendous experience, and we have ignored it when we sat down to write the bill.

That is exactly right.

Well, the Senator makes a tremendous point about the rational, reasonable reforms that the American people are looking for, and saying: Why can't we purchase insurance across State lines if that creates competition? Why can't we have insurance reform that allows us to construct the products? Why does the Federal Government have to mandate: Here is what the structure is?

Many Americans have chosen over the past several years to have flexible spending accounts, to have the ability to put their money in to take care of their health care needs. What does this bill do? It basically reduces the ability to fund flexible spending accounts at the amounts that are sufficient to let them continue to access their health care, in many cases with their own money. In fact, that is going backwards from what we have learned.

The Senator from New Hampshire mentioned earlier this shift of money from Medicare to this new program. Think about our Nation's seniors, those who are relying on Medicare for their health care, and the next generation that is getting ready to go in--some of us in this room. Well, when you shift $464 billion, you are shifting $1,063 per senior per year. Over the 10-year life of this score, we are going to shift $10,363 per senior, per beneficiary on Medicare today.

Is that fair to our country's seniors who have paid a lifetime of premiums into Medicare to receive a benefit, that because of fiscal irresponsibility that benefit may be cut in the future or the premium may go up for the next generation? And, thank goodness, the current beneficiaries in Medicare are screaming as loud as anybody because they understand the ramifications of what we are getting ready to do.

As the Senator from New Hampshire said, this is all going to happen tomorrow. This is going to happen at 8 o'clock Saturday night. People are going to come to the floor and they are going to vote on a bill, 2,074 pages--one that, at best, takes a team of people reading and a computer searching words in hopes you can identify everything of importance that is in the bill.

I think the Senator from Wyoming, being a medical professional, would probably agree with this: that every disease that can be detected at an early stage provides, one, more treatment options, greater survivability and, in the long run, less expensive cost to treat that disease.

It troubles me we have these determinations being made on cost that are not true costs because they are not putting into the calculation the treatment cost. But, more importantly, incorporated in this bill we are putting fees on medical device companies, we are putting fees on pharmaceutical companies, we are putting fees on health care equipment companies. Why? Because they have to pay for them.

We are replicating the same thing. We are disregarding the fact that when an innovative drug comes off the research bench, there is a likelihood we could cure disease versus maintaining, that we might have a new treatment option that cuts down on the cost.

As the Senator knows, even though he is an orthopedic surgeon, we have cholesterol-busting drugs that now people take who would have been in line for bypass surgery. And after that, we got stents that we put in, in place of bypass surgery, and that bypasses the last resort.

Sure, the creation of those blockbuster drugs was expensive. As they go off patent, generic competition comes in, and they become very inexpensive. But when compared to the $70,000-plus of bypass surgery, those drugs all of a sudden look inexpensive. But, more importantly, when you look at the quality of the care, where a patient did not have their chest cracked, they did not have rehab time, they did not have a hospital cost, we save a tremendous amount of money in the health care system.

I might add, that level of innovation is what makes the U.S. health care system unique to the rest of the world. We may not do primary care very well, and I think we have all admitted that, but if you get sick, where do you want to be treated? Right here in the United States of America because of the innovation that takes place.

Mr. President, I thank and congratulate the chairman of the VA Committee. This is important legislation in front of this body. It is my belief that this will move very quickly, as we can see from the short time agreement: one amendment--one amendment that I think is extremely important for all Members of the Senate to consider.

I rise in support of S. 1963, the Caregivers and Veterans Omnibus Health Services Act of 2009. This is actually the combination of two bills reported out of the Veterans' Affairs Committee this year, and it did enjoy bipartisan support.

The centerpiece of the legislation is the support it would provide to caregivers of severely injured veterans of current wars. The bill would provide counseling, support, living stipends, and health care for those caregivers.

As my colleagues know, family caregivers play an extremely important and, I might say, unique role in helping to meet the severely injured veterans' personal care needs. For some veterans, family members serve as their primary caregiver, some of whom have lost their jobs but, more importantly, have lost their health care as a result of that commitment to that family member.

As the chairman spoke about a servicemember he had remembered in this--Ted Wade is a North Carolinian--he made the same impression with me. I also think about caregivers Edgar and Beth Edmundson from North Carolina as well, the parents of Eric Edmundson, a severely injured veteran from Operation Iraqi Freedom. They have been caring for Eric since the day they took him out of the VA hospital--out of a VA hospital because the VA basically had come to the point where they said they could not improve Eric's life.

After Eric was injured on patrol along the Iraqi/Syrian border, he went into cardiac arrest while he was awaiting transport to Germany. It was in fact that cardiac arrest, that traumatic brain injury, that put Eric in a situation where he couldn't walk and he couldn't talk. As he lay in that long-term care provided by the Veterans' Administration, he got no better. He couldn't walk and he couldn't talk.

Eric's father stepped to the plate and immediately began researching all the options for Eric's treatment. Despite being told his son would not emerge from his vegetative state, Ed Edmundson pushed on. He sold his business, he cashed in his savings and retirement pay, all in an effort to provide Eric 24-hour care as a father.

Under his father's constant attention and relentless pursuit of new options, Eric received the treatment he needed. Without his dad's commitment, without the commitment of the rest of Eric's family--who basically dropped everything else important in life to focus on his needs--Eric would not be doing as well as he is today. I might say he walks and he talks and he continues to make progress every day because his most important caregivers, his parents, believed in him and they believed in what they could accomplish.

Let me tell you the rest of the story. Beth, Eric's mom, recently suffered a compound fracture of her ankle while caring for Eric's daughter Gracie. Because Beth and Ed have no health insurance, they are on the hook for $36,000 worth of medical bills. Had Eric chosen Beth, his mother, as his caregiver, and this legislation was in effect, we would have provided coverage for Beth to have health care coverage. I believe that is what this legislation is about--recognizing the individuals who make life-altering commitments to members of their family or servicemembers who, without that commitment, might not have the quality of life they have.

As I mentioned, assistance to caregivers is just one part of this bill. Other provisions would remove barriers to emergency care provided to veterans at non-VA facilities. It would expand health care services for women veterans, provide additional outreach to veterans in rural communities, provide additional improvements in mental health care services provided to veterans, enhance services to homeless veterans, improve the ability of VA to recruit and retain the needed health care professionals, authorize major medical facility construction projects, test a concept I introduced of providing veterans and their survivors with dental coverage, and much more.

This is a good bill. It is not perfect. It can be better. I urge my Senate colleagues to strongly consider supporting the amendment of Senator Coburn, and let me explain why.

When the committee passed this bill, we did not limit it to current veterans of current wars; we extended it to all veterans. Since it came out of committee in a bipartisan way, we have narrowed it down not to include all veterans. The amendment of Senator Coburn expands it to all veterans.

When the committee considered the caregiver bill, we considered it because we wanted to keep veterans out of nursing homes. That was the goal, to give them an alternative because the traditional role of the nursing long-term care facilities had not worked at improving the quality of care and the quality of life for these veterans. That was our goal.

Senator Coburn brings some definition to who is eligible for this based upon the fact that they would be headed toward a nursing home. We may tinker a little bit with the definition as to whether it is exclusive or totally as inclusive as we would like, but make no mistake, it is not different from the intent of the committee as to why the committee passed the caregivers act.

Let me mention one probably even more important piece of the amendment of Senator Coburn. It actually pays for what we are doing. We say the Secretary ``shall''--that means he has to implement everything in the caregiver bill. The amendment of Senator Coburn is going to say: You know what. We are going to take some money out of the funds that we pay to the U.N., and we are going to fund our veterans. I, for one, am tired of coming to the floor and spending money we don't have.

Why don't we take some of the money we have already appropriated and let's shift it? This is something novel for the Senate, but it is called prioritizing. Let's prioritize where the Federal investment should go. Let's make sure we pass the Caregivers and

Health Care Act. Let's make sure we pay for it with the Coburn amendment, and let's pull that money out of already-appropriated funds so we can not only look at our veterans, but we can look at our children and tell them this is a good bill.

I yield the floor.

Mr. President, I wish to be recognized under the 6 minutes I currently have available to me, and if the clerk will notify me at the end of that time, then I will go into Senator Coburn's allotted time.

Mr. President, I wish to reiterate, as the ranking member of the Veterans' Affairs Committee, this bill was reported out unanimously. I think it will receive unanimous support in its passage later this afternoon in the Senate.

Let me restate for Members, when the committee passed this bill out, we passed it out with all caregivers being included. It was after the committee reported it out that we narrowed it to OEF and OIF veterans and their caregivers. It was the intent of the committee to include all the people Senator Durbin, the majority whip, said we might consider later on but not now. The committee's intent was let's do it in the bill now.

It was also the committee's intent that these were individuals who were targeted for us to provide this caregiver benefit to so we can keep them out of nursing homes because of the Ted Wades, because of the Eric Edmundsons.

Senator Coburn's amendment is consistent with the bill that was passed out of committee unanimously. The bill says the Secretary ``shall;'' therefore, it means he has to. The Secretary will then have to prioritize spending within the Veterans Administration to fund these programs. The third piece of what Dr. Coburn's amendment does is rather than force the Secretary to prioritize within just VA programs, meaning there are going to be veterans who win and veterans who lose, why not say as a Congress: Why shouldn't we do what we are supposed to do? Why should we not prioritize the spending here?

What my good friend from Illinois suggested was why should we prioritize for the United Nations? Let me say the answer is quite simple: It is our money. The suggestion that the Congress doesn't have a fiduciary responsibility to fund programs we implement at a time we are borrowing 50 cents of every dollar we spend is ridiculous on its face.

To suggest that the Senate, the Congress can operate any differently than a family in America suggests that we ignore the input of everybody who asked us to represent them. We do represent the American people, 100 individuals who represent the entire country. How can we do it differently than any family who is out there struggling to meet their end-of-the-month obligations and when their revenue does not meet their expenses? What do they do? They either cut back their expenses or they find a place to raise more revenue.

Let me suggest this is as simple as, Is it time for us to prioritize where we are placing money? Members will have to decide: Is pulling money from the United Nations an appropriate place for us to pull money from to then spend on our country's veterans?

I believe we have an obligation, I believe we have a promise, even for programs that did not exist prior to this time, that when we see it is in the best benefit of the quality of life of our troops, that we provide that benefit for them. But I believe we also have an obligation to this generation and the next one and the next one to pay for it.

This is not a choice that is tough for Members. If you support the Coburn amendment, you support practically everything the committee supported when we passed the bill out by unanimous consent. If you support the Coburn amendment, you believe we have an obligation to pay for it. The only reason you would vote against the Coburn amendment is because you don't think it is appropriate for us to deprive the United Nations of this money to use as they see fit.

I suggest this is where the disconnect is with the majority of America. They would prefer the Senate to decide where that money went and to use it on these caregivers and these veterans programs.

I encourage my colleagues to support the Coburn amendment, support passage of this bill this afternoon when we take it up.

I wish to shift gears slightly because I think it is somewhat ironic that we are talking about expansion of services to our Nation's veterans at a time when some herald the introduction of a bill that, in all likelihood, will deprive other Americans of the ability to have affordable health care.

We have gone through several months of debate now about health care being accessible and affordable for all Americans. We have talked about reforms; let's change the system; let's reform the system; let's make it accessible and affordable; let's bend the cost curve down. In the last 24 hours, some have come and said we have accomplished that, it is amazing.

Let me remind my colleagues, we have all said health care is

unsustainable in its current level of investment, 17 percent of our gross domestic product. I find it somewhat odd that we would start the debate given that it is unsustainable in its current financial investment with how much more money does it cost to reform health care. The obvious answer to me is it should cost zero. If you are already spending too much, we should look at the reforms before we look at the coverage expansion.

I agree every American ought to be covered. As a matter of fact, Dr. Coburn and I have offered comprehensive bills to do that. But it is matched with real reform.

What was heralded in the last 24 hours is, in fact, a $2.5 trillion health care bill--$2.5 trillion--over a 10-year period of collecting the revenues and paying out the expenses. This is where gimmicks, smoke and mirrors--whatever you want to call it--are used in Washington. If you collect revenue for 10 years but you only pay benefits for 6 years, you don't get a true picture of what it is going to cost over 10 years. You get a true impact of the revenue stream which is over $800 billion.

From where will that $800 billion in new revenue appear? Taxes. They go up $493.6 billion--$493.6 billion. We will cut $464.6 billion out of Medicare. A $\1/2\ trillion we are going to take from a program with a designated population of beneficiaries of our Nation's seniors and those who are classified as disabled and we are going to take $\1/2\ trillion from Medicare and shift it over to meet the new burden of a health care plan yet to be constructed.

Why is this problematic? It is $1,063 per Medicare beneficiary every year. Over the 10-year cycle of this health care plan, we are going to steal from every senior in this country $10,363 worth of health care money. We are going to take it from their program, and we are going to put it over in this new program because it is paid for. Legitimately, when you raise taxes, when you raise fees, when you raise revenue, you are making tough choices. I think when you go in and tax health plans and that raises $149.1 billion; when you increase a penalty for a nonqualified health savings account and you get $1.3 billion--these are revenues. They are legitimate.

It is no smoke and mirrors. I don't think the American people believe for a minute this is deficit neutral. I don't believe for a minute they believe we are going to take $464 billion out of Medicare. If they do believe it, they know we are going to pay it back with future taxes on the American people.

That is fine, if that is the way we want to prioritize. But health care reform affects every American. This is a very personal issue for every American and every family. It touches them unlike anything else we do. The truth is, they know if you take it and you put it in one pocket and you take it out of the other pocket, the effect on them either has not changed or it is negative.

Let me suggest to my colleagues this bill is 2,074 pages. I will admit--I may be the only one--I have not read it since it was introduced at 6 o'clock last night. I am not sure there are many Members who have or could have. But let me suggest there will be a question about whether, for the first time, we use taxpayer money to perform abortions. Personally, I believe that is wrong. I will not support a piece of legislation that does that. This bill does that.

An employer mandate, at a time when American companies are trying to be competitive in a global marketplace? We raised $28 billion in employer mandates. I am not sure that is making U.S. companies more competitive in a global marketplace. I think the economy is the No. 1 challenge we have in America. I think 10.2 percent unemployment and going up--if it were a disease, we would be on the floor of the Senate calling it an epidemic and we would be doing whatever and spending whatever to help turn it around. But we are doing nothing. As a matter of fact, we are doing everything we can to try to drive up unemployment, to dry up the economy, and to make companies less competitive in a global market.

The President said one of the objectives of health care reform was we need to bend the cost curve down, we need to make sure there are cost savings in health care for every American. Let me tell you what the Congressional Budget Office says:

Under the legislation, federal outlays for health care will

increase during the 2010-2019 period, as would the federal

budgetary commitment to health care.

That is Washington language for: You know what. Our expenditures on health care are going to go up. What happens when Federal expenditures go up? Everybody's go up. That is a known fact by the American people. The coverage expansion would drive a new increase in government spending on health to the tune of $160 billion over 10 years. Make no mistake, this does not bend the curve down, it bends the curve up. We spend more money.

CBO scored the bill as reducing the deficit by $130 billion over 10 years, 2010-2019. What does it take into account, to come to that calculation? It assumes doctors are going to get cut 23 percent in their reimbursements in 2011. We have less than 1 million doctors to serve 300 million people. Does anybody believe for a minute we are going to allow a 23-percent cut to go in at a time when we are starved--trying to attract people to go into medicine as a profession? If it does go in, we are going to take $247 billion out of the pockets of doctors we rely on to perform the surgeries, to make the diagnosis for us and everybody else in this country.

The new creation of the CLASS Act, long-term care policy, shows in the CBO score a $72 billion savings. Let me explain it like this: Nobody qualifies today because it doesn't exist. People are going to pay premiums to be eligible for this long-term benefit. It takes about 20 years of paying in before somebody is going to be eligible to pull out. It is not similar to Medicare, when we created it, where, even if you never paid in, you started on day one. We are collecting revenues for 20 years before we ever pay out the first dime. It is not hard to understand why you would have a $72 billion surplus out of this.

Let me ask, what happens after that? What happens after you get past that 20-year number? The truth is, it starts to get into the trillions and trillions of dollars for which the Federal Government is obligated, based upon the premiums and the benefits people have assigned to it, that they pay out.

If you eliminated these two gimmicks, just on its face this bill would be $189 billion out of balance, in the red. It would not be paid for.

I suggest that is just two smoke-and-mirror tools. The start date was moved from 2013 to 2014. No longer is our focus on how do we get care delivered as quickly and as efficiently. We just pushed it off a year because we said the Congressional Budget Office says we are short on raising money, and we have raised all we can in fees and taxes. Maybe not all. I think they probably have some things targeted that are still yet to come out. The key thing is, even if you did implement it, there are 24 million Americans who are still without insurance. The objective to cover everybody was not met. There are $25 billion worth of unfunded mandates to our States. I don't know of a State that is in financial health today. There may be one or two.

My State of North Carolina was $4 billion out of balance. Last year, the Federal stimulus was $2 billion of closing the gap. That $2 billion, by the way, we didn't have. We borrowed to give to North Carolina and other States to create jobs. It was used to close budget gaps so they didn't have to make tough decisions. As a matter of fact, we found out this week, on one of the news channels, there is $98 billion that didn't have anything to do with stimulus.

We are the laughingstock of the world on the way we applied the stimulus package. But the sad part is not the fact that it has been uncovered, it is that it didn't do anything to put Americans to work. Now we are saying to the States we are going to put another $25 billion on you.

In Medicare, we are going to cut from the fee-for-service payments $192 billion. So we already have $247 billion over here that we are getting from doctors if we go through with the payment cuts. Now we are targeting another $192 billion out of Medicare reimbursements, right out of the pockets of doctors and hospitals. Is there a community hospital in America that will be able to survive, given the cuts that are getting ready to hit them? We cut Medicare Advantage $118 billion. Some

cheer that. I tell you who doesn't cheer it: the 20 percent of America's seniors who chose Medicare Advantage as their preferred choice to traditional Medicare because it required of them less out-of- pocket obligation, it didn't hit them for $750 deductible the day they walked into a hospital. What about those 20 percent of our Nation's seniors when they lose Medicare Advantage?

What about the $43 billion in DSH, disproportionate share payments, we pay the hospitals to make up for the uncompensated care they deliver? I guess the authors of the bill would say we are covering everybody so there is no uncompensated care. Wrong; 24 million are still without insurance. There is going to be uncompensated care, and we are taking away the money we are providing the hospitals to make up for the uncompensated care they delivered, meaning it is coming right out of their hide, that local hospital in the community we live in; $23 billion in unspecified cuts by the Medicare Advisory Board. Is America comfortable with us turning to another advisory board to cut $23 billion? We just had an advisory board say: If you are 40 to 50 and you are female, you don't need to worry about your breasts, don't need to go get a mammogram, don't need to do self-examinations--trust us.

One of the reasons the health care system in America is the best in the world is because we spend money to innovate. We hope companies find breakthroughs. We look at diagnostic abilities in an effort to try to detect early, so the options are greater and so the cost is less. But now, all of a sudden we are saying that is not important.

There are 162 million Americans who currently have employer-based health care. In this bill, regardless of what that employer does, they will not be eligible for subsidy. If they currently have coverage but they may be below income and for some reason their employer has to drop their health care or cut back on the plan because--maybe they are not competitive after this in the global marketplace--even though they would qualify from an income standpoint, they will not qualify because they were provided health care before. Our favorite, the IRS says it will take another $5 to $10 billion so they can actually go out and collect these fees and taxes.

The cost of the subsidies alone in the exchange is estimated by CBO to grow at 8 percent a year. I ask you, if the reason we have gotten into this discussion, had this debate, was we are trying to turn the cost curve down on health care, and we have quoted a 6-percent increase a year and a 5.5-percent increase a year and a 7-percent increase a year, why in the world would we be considering a plan that CBO tells us is going to have a cost increase for the subsidy of 8 percent a year? I would hope, if we had real reforms that worked, the cost of the subsidy would decline 8 percent a year.

I know there are others seeking time. I will not belabor this point. I ask Members: Support the Coburn amendment on the veterans bill. Support passage of the veterans bill. Read the health care bill. Be prepared to debate the health care bill for a very long time and be prepared to stand for the American people on what is right.

I yield the floor.

Mr. President, I wish to speak to amendment No. 2743 which would reallocate $750,000 from the general operating expense account to fund programs to end veterans' homelessness, including the Department of Veterans Affairs' Homeless Provider Grant and Per Diem Program, and VA's Supportive Services Grants Program.

This money will help more than 131,000 veterans who are homeless on any given night including the estimated 1,659 homeless veterans in my home state. Many veterans are considered homeless or at risk due to their poverty, lack of support systems, and poor living conditions.

Homeless veterans are comprised of middle-age and elderly veterans, as well as younger veterans returning from Iraq and Afghanistan. The VA has identified 1,500 homeless veterans who fought during the current wars and of those, only 400 have participated in programs specifically targeting homelessness.

Sadly, homelessness among the ranks of recently separated combat veterans is not a new phenomenon, and their plight for the Nation's compassionate assistance is just as strong today as it was centuries ago. According to Todd DePastino, a historian at Penn State, homeless veterans of the post-Civil War era sang old Army songs to dramatize their need for work.

After World War I, thousands of veterans marched and camped in the Nation's Capital to express their frustration over bonus money. Many of these veterans were either homeless or at risk of becoming homeless.

After the Vietnam war, returning veterans were faced with serious physical, mental, and socio-economic problems that put them at serious risk of becoming homeless. According to VA the number of homeless male and female Vietnam era veterans is greater than the number of servicemembers who died during the Vietnam war.

It is important that Congress and VA remember the lessons learned from previous wars. We must work together to prevent homelessness before it begins with the goal of eliminating homelessness. Much progress has been made, but we can do better.

My amendment targets two specific areas within VA's medical care budget for more funding. The Homeless Provider Grant and Per Diem Program offers funding to community agencies that provide services to homeless veterans. The purpose of the program is to promote the development and provision of supportive housing and/or supportive services with the goal of helping veterans achieve and maintain residential stability.

The supportive services programs allow veterans who are at risk or who are reentering the workforce to receive services that will reduce their likelihood of becoming homeless. Supportive services include health care services; daily living services, personal financial planning; transportation services; income support services; fiduciary and representative payee services; legal services; child care; housing counseling; and other services necessary for maintaining independent living.

In short, these programs are comprehensive and they work.

My original intention was to offer an amendment that would reallocate $43,387,240, on top of the money in this amendment, for homeless programs. Ten years ago that money was originally appropriated for the Multifamily Transitional Housing Loan Guarantee Program. Since that program has been suspended, I believe this money could be put to a better use. However, the Congressional Budget Office tells me that rescinding the $43 million and spending it on this bill would run afoul of our budget rules. I will therefore look for another opportunity to put this unused money to a better use in the near future. In the meantime, CBO has informed me that the amendment is compliant. I thank my colleagues for their support of my amendment.

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

Mr. President, are we in morning business?

I ask unanimous consent to speak in morning business for 20 minutes.

Mr. President, I come to the floor today to talk about an issue I have been working on for 2 years--namely, ending the arbitrary process through which our own government takes away the second amendment rights of veterans. Let me briefly describe what I mean about this issue.

As most of my colleagues know, the Federal Gun Control Act prohibits the sale of firearms to certain individuals, including convicted felons, fugitives, drug users, illegal aliens, and individuals who have been ``adjudicated as a mental defective.'' Furthermore, the Gun Control Act prohibits possession of firearms by any of these classified individuals. Needless to say, it is a serious matter. Criminal prosecution is

an option against those who violate the law.

The Brady Handgun Violence Prevention Act requires the government to maintain a database of these individuals. We call this the National Instant Criminal Background Check System, NICS. The Brady law and the NICS database aim to prevent those who may pose a danger to society or to themselves from purchasing a firearm. Gun owners reference to the NICS screen customers--again, it goes without saying it is a serious matter to have one's name on NICS.

Every American should expect a rigorous and fair process before their right to buy arms and bear arms is taken away, especially when criminal prosecution is involved. Unfortunately, when it comes to certain veterans, their spouses, their dependent children, their dependent parents, the process is neither rigorous nor fair. Since 1999--now 10 years--the Veterans' Administration has sent the names of 116,000 of its beneficiaries to the FBI for inclusion under the NICS list. Again, the NICS list means those 116,000 individuals can never purchase a firearm. None of these names were sent to the FBI because they were determined to be criminals or a danger to themselves or, for that fact, a danger to others; they were listed in NICS because they couldn't manage their own financial affairs. We should not take away a constitutional right because someone can't balance their checkbook on time.

VA's review process for assigning a fiduciary is meant to determine one's financial responsibility in managing VA-provided cash assistance, such as VA disability payments, pension benefits, and other benefits. For example, a veteran may be assigned a fiduciary if they have a credit problem. The VA focuses on whether benefits paid by the VA will be spent in a manner for which they were intended to be spent. If you held that threshold to every veteran, you would probably assign a fiduciary to all of them because we don't know in fact where the payments go or what they were intended for.

Nothing involved in the appointment of a fiduciary even gets to the question of whether an individual is a danger to themselves or others or whether the person should or should not own a firearm. Yet that is exactly what happens when the VA appoints a fiduciary to one of our Nation's veterans.

Let me put a human face on the issue, if I can. I want to read excerpts from a letter I received from Jennifer Briest. I have her approval to read it. Jennifer is the wife of Corey Briest. Corey served in Iraq. He was a paramedic. He was severely injured in an IED explosion in 2004, which caused severe burns, damage to his lungs, and severe traumatic brain injury after shrapnel entered his skull. Corey has spent the last 5 years recovering from his injuries. Jennifer reports that he is walking, talking, and enjoying life at home with his two children.

Now it gets really sad. Because of his head injury, Corey still requires help with certain things. The VA said he needed help managing his disability compensation payments, and they named Jennifer, his spouse, as his fiduciary. That is where I would like to read from her letter. Again, I quote from her letter:

On May 19, 2009, we had our annual fiduciary meeting with

the VA field examiner. At the end of the meeting our field

examiner said he needed to read a statement to us. He read

the Brady bill statement and then stated that Corey can't

own, possess, use, be around, et cetera, any firearms. He

then went on to say that anyone in our household can't own a

gun while living in this household.

I asked him about Corey going on adaptive hunting trips and

he said that he couldn't. Corey stated that he had a gun that

was handed down from his grandfather and that Corey was going

to hand it down to his son and the field examiner told him

that he couldn't have it. He stated to Corey that if he did

own a gun or be around a gun that he would be threatened with

imprisonment.

The way that field examiner talked to Corey about this

issue was not appropriate. The field examiner said that I

could challenge it and handed me a blank sheet of paper with

a VA heading. I asked the field examiner for the statement he

read to me, but he said that he had to ask his boss [if he

could actually provide a copy of that statement]. After two

weeks of me e-mailing him, I finally got the attached papers

in the mail. I think the VA is taking this way out of concept

and I would greatly appreciate your support.

Well, in case any of my colleagues think the government would never prosecute someone like Corey Briest for possession of a firearm, being around a firearm, I wish to read to my colleagues excerpts from a VA directive that went out to all VA regional offices on September 29, this year, on this very issue.

The directive is meant to inform fiduciary field examiners of their obligation if they were to witness a violation of the Brady Act. I am going to quote from this VA memorandum to their field examiners.

Field Examiners or other VA employees who encounter

beneficiaries believed to be in violation of the Brady Act

are required to notify the Fiduciary Activity Manager as soon

as safely possible. At no time should the employee place him/

herself in danger. The Fiduciary Activity Manager at the VA

regional office of jurisdiction must immediately report the

alleged violation to the Bureau of Alcohol Tobacco and

Firearms at 1-800-ATF-GUNS.

That is straight out of the Department of Veterans Affairs memorandum to their field examiners. For 2 years I have gone through this in the VA Committee. I have tried to plead with my colleagues that this is a breach of the second amendment of our country's veterans, that no veteran who has had their name reported of the 116,000, have ever been judged by a court to have a mental deficiency. In most cases, this is because there is a fiduciary needed to make sure they stay up to date. But there is not an incapacity on their part that has been judged to be a flaw in their judgment. Quite frankly, I find it offensive. I find the language of this directive offensive because the premise seems to be that our veterans are dangerous.

But as I mentioned, there is nothing about the current process that even gets to the question of an individual as dangerous. The current process is also a double standard. Only VA beneficiaries fall under these guidelines. The Social Security Administration assigns fiduciaries to help beneficiaries every single day. Yet it does not send their name to the NICS list.

We have a policy on the books that discriminates against individuals because they wore our Nation's uniform, because they fought on behalf of this country. I find it unacceptable and it must end.

I have a bill, S. 669, that would prohibit the VA from continuing this arbitrary and unfair practice. It would require a judge, a magistrate, or another judicial authority to determine that a VA beneficiary is a danger to themselves or to others before their name could be sent to the NICS list.

Twice the Veterans Affairs Committee approved this bipartisan legislation to afford veterans with due process before their second amendment right was snatched away from them. But twice the bill languished on the Senate floor. S. 669 was approved unanimously by the committee back in May. But it has gone nowhere. And the question is: Can veterans wait any longer or should veterans wait any longer?

I am not here to ask that we put guns in the hands of dangerous people. I am here to ask you, to plead with you, that we treat veterans fairly and that their rights are protected like every other citizen.

Many of our veteran organizations and other groups agree with me. The Veterans Second Amendment Protection Act has the support of the American Legion, the Veterans of Foreign Wars, AMVETS, the Military Order of the Purple Heart, the National Alliance on Mental Illness, the National Rifle Association, and Gun Owners of America.

I plead with my colleagues: Ask for S. 669 to be brought to the floor. Do not sit back and say this is an obscure thing that the VA sometimes engages in and sometimes does not. Again, September 29, 2009, 1 month ago, this directive goes out: Subject: Reporting violations of Brady Handgun Violence Prevention Act.

This letter provides guidance to our field personnel who

may encounter violations--

Violations by a veteran who served his country, is not a danger to himself or to anybody else, but has been deemed to need fiduciary help even if it is a spouse and a second amendment right was yanked from his hands, and now the VA says to their field examiners: Report it because we will prosecute these individuals.

I am not exactly sure how to respond to Jennifer Briest. That letter she sent

me about: Corey continues to make progress after an IED explosion December 4, 2005.

How do you say to a kid who served his country, who is raising a family: One, we had to turn you in so you can never own a gun. And, two, that gun your father handed down to you, Corey, you have to get rid of it. You cannot hand it down to your child, because even if you handed it down today to your son living in your home, they cannot have that gun, because the Veterans Administration says you cannot.

But if a fiduciary was assigned to Corey's father or to his mother, the Social Security Administration does not send that in to the NICS list to deprive them of their second amendment right. This is the most unfair thing I have seen this country do. It is time we end this practice. It is time we respect our veterans. It is time we treat them fairly. It is time we uphold the Constitution of this United States.

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

The PRESIDING OFFICER (Ms. Klobuchar.) The clerk will call the roll.

The assistant bill clerk proceeded to call the roll.